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Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
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Index

A

Accidental Death and Disability: The Neglected Disease of Modern Society, 18, 32, 75, 81

Accountability

fragmentation of EMS system and, 6, 83

importance of, 83

model systems, 91, 93, 94, 95

recommendations for performance indicator development, 1112, 85

shortcomings of current system, 73, 83

Accreditation

of EMS system components, 85

national standardization of EMS personnel training, 125, 144

of paramedic education, 9

Acute Injury Care Research Agenda, 217

Advanced cardiac life support, 32

Advanced emergency medical technicians, 123

Advanced life support (ALS)

ambulance equipment, 158159

effectiveness, 164

field application, 21, 80, 209210

fleet characteristics, 55

research efforts, 218

research needs, 164, 209210

training curriculum, 33, 124

transport reimbursement, 47

Agency for Healthcare Research and Quality, 100, 105

research program, 208, 214215

Air medical services

accreditation, 85

capacity and access, 161

coordination of emergency response, 10, 162

current system, 11, 61

dispatch decisions, 157158

effectiveness, 6162

government oversight, 11, 161162, 170

Hurricane Katrina response, 188

interfacility transport, 162163

Iraq War experiences, 191192

lack of coordination, 74

origins and development, 160161

recommendations, 11, 162, 170

regional disparities, 24

roles and responsibilities, 161

safety concerns, 61, 161

Ambulance services

accreditation, 85

ambulance crashes, 20, 159160

ambulance design, 159

design and capabilities, 27, 33

disaster preparedness funding for, 176

diversion, 2223, 4041, 86

driver training, 159160

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

dynamic load-responsive deployment, 65

emerging technologies for, 163164

equipment, 158159

fleet characteristics, 5556

hospital-based EMS, 58

information technologies for, 163, 164, 170

interfacility transport, 162163

legal requirements, 4849

licensing, 158, 159

light and siren use, 160, 220

Medicare reimbursement, 47

national capacity, 158

origins and development, 3233

performance measurement, 86

private EMS systems, 5859

problems of hospital emergency department crowding, 40

regional disparities, 2324

in rural areas, 65

utilization, 83

See also Prehospital care;

Transportation of patient

American Board of Emergency Medicine, 9, 144

American College of Emergency Physicians (ACEP), 35, 7879, 208

American College of Surgeons, 35, 7879, 85

Anthrax, 181

Automated external defibrillators (AEDs), 16, 140141, 218219

Automatic crash notification, 16, 27, 63, 149, 155157

Avian influenza, 178

B

Basic life support (BLS) transport

features, 158

fleet characteristics, 55

Medicare reimbursement, 47

training curriculum, 124

Battlefield Medical Information System Tactical (BMIST), 169

Biochemical weapons, 181182, 193194, 199200

Bioterrorism Hospital Preparedness Program, 12, 100, 197

Blood substitute, 163

Bystander care, 6566, 140141

C

California

EMS system management, 35

model EMS and trauma system, 9495

San Francisco EMS system, 39

Capacity, EMS

air medical services, 161

ambulance services, 158

goals for system, 5

local disaster preparedness, 194196

national, 15

9-1-1 systems, 53, 63, 151

Cardiac arrest

incidence, 16

Public Access Defibrillation trial, 218219

Cardiac Arrest Registry to Enhance Survival (CARES), 87, 217

Cardiopulmonary resuscitation (CPR)

citizen first responders, 6566, 140

origins of EMS system, 1, 32

prehospital care research, 219, 220

Categorization

of emergency providers, 8, 7980, 114115

of trauma care capabilities, 78, 114115

Causes of ED visits, 1617

Centers for Disease Control and Prevention (CDC)

EMS-related programs, 44

National Center for Injury Prevention and Control, 36, 44, 46, 99100, 217

research efforts, 208, 217

Centers for Medicare and Medicaid Services

EMS reimbursement, 41

performance measurement activities, 88

recommendations for, 78, 114, 116

See also Medicaid;

Medicare

Centers for Public Health Preparedness, 181

Civil War, U.S., 32

Commission on Accreditation of Ambulance Services, 85

Commission on Accreditation of Medical Transport Systems, 85

Committee on the Future of Emergency Care in the United States Health System, 5, 2425

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

Communications technologies and systems

automatic crash notification, 16, 27, 63, 149, 155157

for coordination of care, 7677

current model systems, 90

current shortcomings, 3, 10, 38, 164

disaster response, 182, 198199

interoperability among EMS systems, 23, 27, 164167, 171, 199

obstacles to improvement, 166

recommendations for, 1011, 164165, 171

September 11, 2001, terrorist attack responses, 183

telephone location tracing, 23

transmission of clinical information, 10

Voice over Internet Protocol, 154

Wireless Public Safety Interoperable Communications Program, 167

See also 9-1-1 systems

Confidentiality issues

Health Insurance Portability and Accountability Act requirements, 4950, 113, 213

research and, 210, 213, 222, 223

Congress, recommendations for, 67, 1314, 96, 115, 198, 202, 223, 224, 226

Coordination of care

air medical services, 10, 162

communication requirements, 7677

conceptual development, 34

current model systems, 9091, 92, 93, 94

current shortcomings, 3, 10, 3940, 73, 7475

demonstration projects to promote, 97

disaster response, 201202

efficiency of care and, 23

establishment of national agency for regulation and support, 67, 105111

goals, 5, 910, 7576

obstacles to, 6, 49

in pediatric intensive care system, 76

regional disaster response planning, 176, 196198

role of Federal Interagency Committee on EMS, 44

in trauma system, 76

See also Regionalization of EMS system

Costs

benefits of regionalization, 8

Emergency Medical Services Cost Analysis Project, 215

enhanced 9-1-1 technology, 153, 154

Health Insurance Portability and Accountability Act compliance, 50

scope of EMS costs, 7

See also Economics

Crash Injury Research and Engineering Network (CIREN), 215, 216

Crossing the Quality Chasm: A New Health System for the 21st Century, 19

Crowding, hospital emergency department

disaster effects, 183184

payment incentives to reduce, 89

quality of care and, 40

D

Data Elements for Emergency Department Systems (DEEDS), 84

Defibrillators, automated external, 16, 140141, 218219

Delayed treatment

ambulance diversion and, 4041

field stabilization and, 21, 80

response times in rural areas, 63

use of ambulance lights and sirens, 220

Demonstration projects

funding levels, 98

granting agency, 9899

purpose of grants for, 9697

rationale, 9596

recipients of grants for, 96

recommendations for, 1314, 96, 115

Department of Health, Education and Welfare (DHEW)

evolution of emergency medical care system, 33, 34

See also Department of Health and Human Services

Department of Health and Human Services (DHHS), 105

disaster planning and operations, 12, 196197, 202

disaster preparedness funding, 105, 176

establishment of new lead agency in, 67, 107, 108, 115

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

recommendations for, 7, 8, 1112, 13, 7980, 85, 107, 113115, 169, 171, 196197, 202, 224, 226

research role, 13, 224, 226

structure of EMS system support, 44, 99100

See also Department of Health, Education and Welfare

Department of Homeland Security (DHS)

disaster preparedness funding, 12, 176, 192193, 197198

EMS funding and support, 43, 44, 46, 100, 176

establishment, 184

recommendations for, 12, 196197, 202

Department of Transportation (DOT)

evolution of EMS system, 33, 34, 43, 99

recommendations for, 12, 196197, 202

See also National Highway Traffic Safety Administration

Disaster Medical Assistance Teams (DMATs), 100, 186187

Disaster response

accidental man-made disasters, 179

biochemical threats, 181182, 193194, 199200

certification and licensure for EMS personnel, 13, 201

challenges, 182, 192, 202

communications and information systems for, 182, 198199

coordination of, 201202

current readiness, 4, 43, 192194

definition of “disaster,” 175

emergency support functions, 185

EMS involvement in regional planning, 176, 196198

establishment of new lead agency for oversight and support, 108109, 115

funding distribution, 1213, 176, 192193, 197198, 202

goals for EMS systems, 27

homeland security funding, 43, 176

local capacity, 194196

National Incident Management System, 184

natural disasters, 178179, 193194

recent events, 177, 183192

recommendations for, 1213, 196197, 198, 200, 202

research funding, 221

risks for EMS workers, 182

shortcomings of current EMS and trauma systems, 175176, 202

strategies for improving, 194202

training, 13, 43, 176, 195196, 200, 202

types of threats, 177, 192, 193194

volunteer screening and coordination, 188

Dispatch of emergency services

compensation for dispatchers, 141

dynamic load-responsive deployment, 65

model of EMS delivery, 5362

need for coordination, 910

prearrival instruction for bystanders, 140

recognizing nonemergency calls, 141142, 157

roles and responsibilities, 141

selection of equipment and personnel for response, 157158

training for, 141

See also 9-1-1 systems

Dumping of uninsured patients, 48

E

Earthquakes, 178

Economics

challenges for EMS system, 41

cost-effectiveness of EMS interventions, 23

demonstration project grant funding, 98, 115

disaster preparedness funding, 1213, 176, 192193, 197198, 202

dispatcher compensation, 141

EMS workforce salaries, 4, 42, 136

evolution of EMS funding, 2, 18, 31, 33, 34, 35, 41

fire-based EMS funding, 57

funding of new lead agency for EMS system, 110111

homeland security funds, 43

9-1-1 systems funding, 151

patient transport costs, 48

possible negative consequences of regionalization, 78

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

recommendations for research, 78, 114, 116

research funding, 13, 208, 210, 214217, 218, 220221

state funding for EMS services, 52

structure of federal support for EMS, 4348

See also Costs

Education. See Training of EMS personnel

Effectiveness of current EMS system, 2021

Efficiency of care, 23

Elderly

emergency transport, 7, 16

EMS utilization, 46

future demand for EMS, 134

Electrocardiography, 16, 163

Emergency care, defined, 25

Emergency Management Assistance Compact (EMAC), 187188

Emergency medical services (EMS)

definition, 25

scope of, 25

See also Emergency medical services system

Emergency Medical Services Agenda for the Future, 6, 24, 3637, 7576, 100, 120, 167170, 208

Emergency Medical Services Agenda for the Future: Implementation Guide, 120, 122, 208

Emergency Medical Services at Midpassage, 19, 34

Emergency Medical Services Cost Analysis Project (EMSCAP), 215

Emergency Medical Services Education Agenda for the Future: A Systems Approach, 120, 122, 124, 125, 126127

Emergency Medical Services for Children, 3536, 98, 106, 216217

Emergency Medical Services Outcomes Project (EMSOP), 215, 216

Emergency medical services system

characteristics, 5556

definition, 25, 55

development, 12, 6, 18, 3137, 7374

effectiveness, 2021

essential elements, 34

goals, 5, 2627, 3637, 73

patient characteristics, 1617

recommendations for establishment of national agency for, 67, 105111

shortcomings of current system, 35, 14, 31, 3743, 73

strengths of current system, 3, 16

Emergency medical technicians (EMTs), 2

compensation, 42

credentialing and certification, 124

disaster preparedness, 176, 200

education curriculum, 123124

national certification, 126

registration status, 133, 134

roles and responsibilities, 127

scope of practice model, 123

training, 211

Emergency Medical Treatment and Active Labor Act (EMTALA), 23, 4849, 112113

recommendations for, 113114, 115

Emergency Medicine Foundation, 208

Emergency support functions, 185

Emergency Systems for Advance Registration of Volunteer Health Professionals, 188

EMS. See Emergency medical services

EMS Performance Measures Project, 84

EMS Systems Act (1973), 31, 34

Endotracheal intubation, 209210, 219

England, 2005 terrorist attacks in London, 189190

ENHANCE 9-1-1 Act, 151

Equipment and supplies, EMS

biochemical event response, 199200

current supply and access, 149150

emergency support functions, 185

local disaster preparedness, 194196

needs, 149

technological advances, 149

See also Air medical services;

Ambulance services;

Communications technologies and systems;

Information technologies and systems

Equitable care, 2324

F

Federal Aviation Administration (FAA), 161, 162

Federal Communications Commission (FCC), 152153, 154, 167

Federal Emergency Management Agency (FEMA), 100, 185186, 187

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

Federal government

air ambulance oversight, 161162

demonstration project granting agency, 9899

disaster preparedness funding, 176, 192193, 197198

disaster response, 184185, 201202

EMS research funding, 208

establishment of new agency for emergency care system integration, 67, 98, 105111, 115

evolution of emergency medical care system, 18, 31, 3237, 41, 99

fragmentation of EMS support and regulation, 99, 102

interagency collaboration in EMS, 100101

leadership in emergency care, 3

legislative framework of EMS system, 4853, 112114

to promote communications interoperability among EMS systems, 166, 167

research support, 208, 214217

structure of EMS oversight and funding, 4348, 99100

See also specific governmental entity

Federal Interagency Committee on EMS (FICEMS)

future of EMS system leadership and, 6, 104105

membership, 101

new lead agency for EMS system and, 109110

purpose, 6, 44, 100102

Federalwide Assurance program, 213214, 223, 226

Fire-based EMS, 2, 132

advantages, 57

current system, 55, 56

disadvantages, 5758

funding, 57

structure and operations, 5657

Fire department first responders, 127, 158

Floods, 178

Florida EMS and trauma system, 9394

Fragmentation of EMS system

current state, 3, 6, 18, 31, 3839, 41, 73

disaster response, 176

federal support and regulation, 6, 99, 102

origins, 6, 34, 35

structure of federal oversight, 43

G

Grant payments to emergency care system

Centers for Disease Control and Prevention block grants, 4446

demonstration programs for enhancing emergency care, 14, 9699

disaster preparedness funding, 12, 46, 193194, 198

federal block grants to states, 18

origins and early development, 34, 35, 36

private funding, 34

research grants, 221222

H

Health Insurance Portability and Accountability Act (HIPAA)

impediments to EMS in, 4950, 113

implications for research, 20, 113, 210, 213, 222, 223

purpose, 49, 113

recommendations for, 113114, 115

Health Level Seven, 84

Health, Medical Care and Transportation of the Injured, 32

Health Plan Employer Data and Information Set (HEDIS), 88

Health Resources and Services Administration

as demonstration project granting agency, 9899

EMS system programs and offices, 3536, 4344, 44

performance measurement activities, 85

recommendations for, 1314, 96, 115

research support, 208209, 215, 216217

Trauma-EMS Systems Program, 181

Healthy People 2010 initiative, 4446

Highway Safety Act (1966), 31, 33, 43

Hospital-based EMS

bioterrorism preparedness, 44

disadvantages, 58

emergency department crowding, 40

employment, 132

establishment of new lead agency for oversight and support, 108109, 115

numbers of, 55

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

problems in coordination with prehospital care, 3940

structure and operations, 58

Hurricane Katrina, 175, 176, 178, 182, 185189, 193, 194, 199, 201

I

Infectious disease

pandemics and outbreaks, 178179

public health surveillance, 75

risks for EMS personnel, 20, 4142, 137, 159

Influenza pandemics, 178179

Information technologies and systems

for ambulance services, 163, 164, 170

for disaster response, 198199

EMS system data, 168169, 170

goals, 167170, 170

Health Insurance Portability and Accountability Act and, 49, 50, 113, 210, 213, 222, 223

interoperability among EMS systems, 164165

National Health Information Infrastructure, 11, 169, 171

9-1-1 caller identification and location, 151154

patient data, 169, 170

for performance measurement, 86

Wireless Public Safety Interoperable Communications Program, 167

See also Communications technologies and systems

Informed consent, EMS research and, 212213, 222223

Injury, accidental

data sets, 169

preventive interventions, 75, 217

as public health problem, 36

research needs, 19

Injury in America: A Continuing Health Problem, 36

Interagency Committee on EMSC Research (ICER), 100

Iraq War, 191192

Israel, 2001 building collapse in Jerusalem, 190191

J

Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 85

Jurisdictions of responders, 10, 23, 3839

K

Korean War, 33

L

Language barriers, 2122

Leadership

current federal, 43, 52, 99102

disaster response, 201202

establishment of new agency for emergency care system, 67, 105111, 115

Federal Interagency Committee on EMS for, 104105

Hurricane Katrina response, 185, 187

to promote communications interoperability among EMS systems, 166

strategies for improving EMS system, 102104

See also Medical directors, EMS

Licensure and credentialing

air medical services, 161

ambulance services, 158, 159

Disaster Medical Assistance Teams, 187

disaster response training, 13, 200201, 202

emergency medical technician training requirements, 124

EMS personnel registration status, 130

EMS subspecialty certification, 9, 143144

national EMS certification, 126127

national scope of practice model, 122123

reciprocity among jurisdictions, 123, 137

recommendations for, 9, 144, 202

shortcomings of current EMS training system, 41

state government oversight, 51, 123

volunteers in disaster response, 188

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

Longitudinal Emergency Medical Technician Attribute and Demographic Study (LEADS), 215

M

Maryland EMS and trauma system, 35, 9092

Medicaid

EMS reimbursement, 41, 4648

EMS utilization, 52

payment incentives for performance improvement, 89

state agencies, 52

See also Centers for Medicare and Medicaid Services

Medical directors, EMS

payment incentives, 89

potential problems, 143

qualifications, 64, 143

roles and responsibilities, 142143

system performance research, 220

Medicare

emergency transport reimbursement, 7, 114

influence on EMS services, 48

payment incentives for performance improvement, 89

See also Centers for Medicare and Medicaid Services

Metropolitan Medical Response System, 100, 188189

Military medicine, 3132, 33, 160161, 169, 191

Missouri, 60

Models of emergency care

dispatch centers, 5362

fire-based EMS systems, 5658

historical and conceptual development, 34

hospital-based EMS systems, 58

local level, 53

municipal service, 5960

private systems, 5859

recommendations for demonstration program, 1314, 9596

research needs, 42

rural EMS systems, 6266

staffing models, 60

systems currently in operation, 9095

trauma system, 7879

Mortality

air ambulance crashes, 61

ambulance crashes, 20, 159160

ambulance diversion and, 4041

automobile accident, 24

EMS workforce occupational fatalities, 137

Mouth-to-mouth ventilation, 1, 32

Municipal EMS services, 5960

Mustard gas, 181

N

National Association of Emergency Medical Technicians, 35

National Association of EMS Physicians, 35

National Association of State EMS Officials (NASEMO), 35, 5051, 52, 126127

National Center for Injury Prevention and Control, 36, 44, 46, 99100, 217

National Disaster Medical System, 186187

National EMSC Data Analysis Resource Center (NEDARC), 217

National EMS Education and Practice Blueprint, 120, 122

National EMS Information System (NEMSIS), 168169, 215

National EMS Research Agenda, 208209, 215, 223, 224

National EMS Scope of Practice Model, 9, 201, 215

National Governors Association, 201202

National Health Information Infrastructure, 11, 169, 171

National Highway Traffic Safety Administration

development of EMS systems, 36, 43, 99

EMS funding and technical assistance, 6, 52

EMS research, 208209

9-1-1 systems management, 151, 155

origins, 6, 33

performance measurement activities, 85

recommendations for, 8, 7981, 114115

research activities, 215

system integration goals, 7576

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

National Incident Management System (NIMS), 37, 184

National Institutes of Health (NIH), 44, 208, 214, 221, 224

National Quality Forum, 85

National Registry of Emergency Medical Technicians, 124, 126, 130

National Response Plan, 37

National Standard Curricula, 123124, 125

National Trauma Data Bank, 169

9-1-1 systems

automatic crash notification, 155157

caller identification and location, 23, 151154

capacity and utilization, 2, 53, 63, 151

cell phone calls, 151154

enhanced, 151, 152154

establishment of new lead agency for oversight and support, 108109, 115

funding, 151

next generation, 154155

nonemergency calls, 141142, 157

origins and development, 2, 150151

performance measurement, 86

prearrival instructions, 5455, 140, 219

regional disparities, 23, 150

strengths of current system, 16

structure and operations, 27, 5354, 151

Voice over Internet Protocol, 154

O

Obese patients, 22

Omnibus Budget Reconciliation Act (OBRA) (1981), 35

Ontario Prehospital Advanced Life Support study, 218

Outcomes research

air ambulance effectiveness, 6162

Emergency Medical Services Outcomes Project, 215, 216

Health Insurance Portability and Accountability Act and, 50

performance measurement, 86

prehospital interventions, 21, 163164, 209

regionalization rationale, 77

P

Paramedics

compensation, 42, 136

disaster preparedness, 176, 200

recommendations for training standardization, 125126, 144

roles and responsibilities, 127, 129130

scope of practice model, 123

supply problems, 134135

training for research, 211

Patient-centered care, 2122

Patient characteristics

challenges of special populations, 2223

demographics, 1617

Medicaid utilization, 52

See also Elderly;

Pediatric care

Pediatric care, 2425

challenges in EMS care, 22

coordination in intensive care system, 76

emergency transport patients, 16

EMS-C, 3536, 98, 106, 216217

prehospital endotracheal intubation, 209210, 219

research, 216217

Pediatric Emergency Care Applied Research Network (PECARN), 216217

Performance measurement

access to data, 12, 88

Cardiac Arrest Registry to Enhance Survival, 87

current efforts, 8485

current EMS effectiveness, 2021

demonstration project, 97

information technologies for, 86

key indicators, 86

National Highway Traffic Safety Administration assessments, 52

need for EMS system review, 1819

patient-level data for, 86

private EMS system evaluation, 59

public perception of EMS system performance and, 84

quality aims for health care system, 19

recommendations for, 1112, 8586, 115

research needs for, 42

statewide EMS system evaluations, 36

See also Public reporting

Personal protective equipment, 199200

Police first responders, 127

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

Prehospital care

bystander care, 6566, 140141

categorization of services, 79, 114115

historical and technical development, 3237

jurisdictional issues, 10, 23, 3839

need for coordination, 910, 74

participation in National Health Information Infrastructure, 11

patient stabilization out of hospital, 21, 80

recommendations for protocol development, 8, 8083, 115

recommendations for research, 13, 221, 224

research efforts, 218220

research needs, 42, 163164, 209210

research rationale, 207

in rural areas, 6364

safety risks, 19

scope of, 15

strengths of current system, 16

transmission of clinical information, 10

See also Air medical services;

Ambulance services;

Dispatch of emergency services;

Emergency medical services system;

9-1-1 systems

Preventive Health and Health Services, 44

Preventive interventions

accidental injury, 36

coordination of EMS with public health agencies, 75

Private EMS systems, 5859

Public Access Defibrillation (PAD) trial, 218219

Public health agencies, coordination between EMS and, 75

Public involvement

citizen first responders, 6566, 140141

goals for EMS system, 56

self-triage, 83

Public perception of EMS system performance, 18, 8384

Public reporting

of aggregate performance data, 12, 88

current state, 88

forms of, 87

goals, 8788

importance of, 87

Public safety answering points, 53, 141, 151, 154.

See also 9–1–1 systems

Q

Quality of care

ambulance diversion and, 4041

current system, 4

financial incentives for performance improvement, 8889

measurement, 4

out-of-hospital stabilization, 21, 80

regionalization of services and, 77

R

Radioactive materials exposure, 181

Red Cross, 32

Regional flow of patients, 2

Regional variation in EMS systems

causes of, 95

medical oversight and review, 9

9-1-1 systems, 23, 150, 153154

origins of, 2, 35, 41

response time, 22

role of demonstration projects, 9596

scope of practice, 122123

shortcomings of current system, 2, 53

strategies for enhancing emergency care and, 13

as strength, 53

structure of state government EMS oversight, 5051

training of EMS personnel, 9, 125

workforce qualifications, 119

See also Rural areas

Regionalization of EMS system

benefits of, 7778

categorization of emergency departments for, 8

characteristics, 99

current model systems, 91, 9395

definition of “region,” 26

implications of Emergency Medical Treatment and Active Labor Act, 112113

possible negative consequences of, 78

rationale, 23, 8, 7778

recommendations for, 8

in rural areas, 65

Reimbursement

efficiency of care and, 23

federal system, 4648

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

incentives for unnecessary transport, 8889

Medicare and Medicaid, 44, 4648

payment incentives for performance improvement, 89

recommendations for research, 78, 114, 116

state role, 52

Research

barriers to, 18, 210217, 220, 222

current EMS knowledge base, 207, 208210

data sources for, 210211, 212214, 223

demonstration program for enhancing emergency care, 1314, 9596

development of EMS system, 34

disaster preparedness, 221

establishment of new lead agency for EMS system and, 109

federal entities for, 208, 214217

funding, 13, 208, 210, 214217, 218, 220221, 224

goals, 207, 210

grant review process, 221222

informed consent issues, 212213, 222223

infrastructure for, 210

needs. See Research needs

practice applications, 211

prehospital care knowledge base, 218220

priority topics, 223224

protections for human subjects, 213214, 222

recommendations for, 13, 220221, 223, 224, 226

regulatory environment, 210, 212214, 222223

strategies for improving, 27, 220224

training for, 210, 211212

trauma care, 207208

Research needs

cost-effectiveness of EMS interventions, 23

effectiveness of EMS, 2021

EMS system finances, 78

EMS system review, 1819

outcomes data, 21

prehospital interventions, 163164, 209210

shortcomings of EMS knowledge base, 45, 18, 27, 42, 208210

Response times

ambulance diversion and, 2223

causes of delay, 22

current system, 4, 16

determinants of, 4

performance measurement, 86

in rural areas, 63

variation among EMS systems, 22

Rhode Island, 2003 nightclub fire in West Warwick, 190

Ricin, 181

Robert Wood Johnson Foundation, 34

Roles and Resources of Federal Agencies in Support of Comprehensive Emergency Medical Services, 19, 33

Rural areas

air medical services, 161

challenges for EMS systems, 42, 6264

crash fatalities, 24

development of EMS system, 36

disaster response readiness, 200

disparities in care, 2324, 62

EMS workforce characteristics, 132, 138

need for new workforce staffing models, 138139

9-1-1 systems, 63

population trends, 138

regionalization of services, 65

response times, 63

role of EMS in, 66

strategies to enhance EMS, 6566

transport costs, 48

volunteer-based EMS systems, 60, 62

S

Safar, Peter, 32

Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU), 6, 101

Safety

air medical services, 61, 161

ambulance crashes, 20, 159160

of EMS personnel, 1920, 4142, 136137

risks in disaster response, 182

risks in prehospital emergency care, 19

Sarin, 181

Scope of emergency medical services, 1, 15

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

Scope of practice, EMT and paramedic

definition, 9

national model, 122123

recommendations, 9, 123, 144

September 11, 2001, terrorist attacks, 37, 38, 176, 183185, 192, 198199

Severe acute respiratory syndrome (SARS), 178

Smallpox, 181

Society for Academic Emergency Medicine, 208

Spain

ambulancias, 31

2004 terrorist attacks in Madrid, 190

State governments

air ambulance regulation, 161162, 170

ambulance regulation, 159

Centers for Disease Control and Prevention block grants, 4446

demonstration programs for enhancing emergency care, 14, 96

disaster planning and operations, 12, 201202

Emergency Management Assistance Compact, 187188

EMS oversight, 5053

EMS personnel credentialing and

certification, 122123, 124, 126127, 201

evolution of EMS system, 35

licensing reciprocity between, 123, 137, 201

model EMS systems, 9095

recommendations for, 9, 11, 12, 123, 126, 144, 162, 170

Structure of EMS systems

barriers to research, 210211

categorization of emergency providers, 7980

communications and, 10, 164

establishment of new lead agency, 106, 107, 108, 115

federal oversight and funding, 6, 4350, 99101

fire department–based, 5657

goals, 7879

hospital-based, 58

local decision making, 53

9-1-1 systems, 5354

prehospital care research, 219220

regional variation in EMS systems, 2, 164

research role, 207

state government oversight, 5053

See also Fragmentation of EMS system

Surveillance, public health, 75

T

Terrorist attacks

disaster preparedness, 12, 192193

hospital bioterrorism preparedness, 44

Jerusalem (2001), 190191

London (2005), 189190

Madrid (2004), 190

National Response Plan, 184185

research funding, 221

threat types and characteristics, 179182

training for EMS personnel, 43

See also September 11, 2001, terrorist attacks

Texas EMS and trauma system, 9293

Tornadoes, 178

Training of EMS personnel, 27

accreditation, 9

ambulance drivers, 159160

disaster response readiness, 4, 13, 43, 176, 195196, 200, 202

dispatchers, 141

efforts to standardize, 120121

EMS subspecialty certification, 9, 143144

first responders, 127

graduation trends, 135

historical development, 33

medical directors, 64, 143

model components, 120121

national certification, 126127, 144

national core content, 120, 121122

national standard curricula, 123124

origins and development, 32

recommendations for, 9, 125126, 143144, 144, 200, 202

regional variation, 119, 125

for research, 210, 211212

scope of practice model, 120, 121, 122123

settings for, 125

shortcomings of current system, 41

Transportation of patient

cost per transport, 48

disaster response, 182

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
×

Emergency Medical Treatment and Active Labor Act requirements, 112113

incentives for unnecessary transport, 8889

interfacility, 162163

Medicaid reimbursement, 41, 52

Medicare reimbursement, 7, 47, 48

patient characteristics, 1617

recommendations for protocol development, 8, 8083, 115

shortcomings of current system, 3, 10

strengths of current system, 16

See also Air medical services;

Ambulance services;

Prehospital care

Trauma care

definition, 25

research, 207208

Trauma center definition, 25

Trauma system, coordination of care in, 76, 7879

Trauma Systems Consultation, 79

Triage, 77, 81, 141, 190192

U

Uniform Prehospital EMS Dataset, 168

Uninsured patients, 48

Urban Area Security Initiatives, 193, 194

URGENCY Decision Assist software, 156157

V

Ventricular fibrillation, 21

Voice over Internet Protocol, 154

Volunteer-based EMS systems, 60, 62, 188

W

Washington state, Seattle EMS system, 38

Wireless Public Safety Interoperable Communications Program (SAFECOM), 167

Workforce, 27

ambulance working conditions, 159

calls per week, 132

career development, 136

challenges for EMS system, 4142

compensation, 4, 42, 136

demographics, 130132

dispatchers, 141142

efforts to standardize qualifications and requirements, 120121

employment, 132, 134

future challenges, 119, 135

job satisfaction, 135

licensing reciprocity between jurisdictions, 123, 137

occupational fatalities, 137

professional identity, 4, 42

projected growth, 134, 135

registration status, 130, 133, 134, 137138

roles and responsibilities, 127130

rural EMS systems, 42, 6364, 138139

safety concerns, 1920, 4142, 136137

size, 15, 132135

staffing models, 60

supply problems, 134135

variations in education and training, 119

volunteer-based EMS systems, 60, 137139

See also Emergency medical technicians;

Medical directors, EMS;

Scope of practice, EMT and paramedic;

Training of EMS personnel

World Wars I and II, 32

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Medical Services: At the Crossroads. Washington, DC: The National Academies Press. doi: 10.17226/11629.
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Emergency Medical Services: At the Crossroads Get This Book
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Emergency Medical Services (EMS) is a critical component of our nation's emergency and trauma care system, providing response and medical transport to millions of sick and injured Americans each year. At its best, EMS is a crucial link to survival in the chain of care, but within the last several years, complex problems facing the emergency care system have emerged. Press coverage has highlighted instances of slow EMS response times, ambulance diversions, trauma center closures, and ground and air medical crashes. This heightened public awareness of problems that have been building over time has underscored the need for a review of the U.S. emergency care system. Emergency Medical Services provides the first comprehensive study on this topic. This new book examines the operational structure of EMS by presenting an in-depth analysis of the current organization, delivery, and financing of these types of services and systems. By addressing its strengths, limitations, and future challenges this book draws upon a range of concerns:

• The evolving role of EMS as an integral component of the overall health care system.

• EMS system planning, preparedness, and coordination at the federal, state, and local levels.

• EMS funding and infrastructure investments.

• EMS workforce trends and professional education.

• EMS research priorities and funding.

Emergency Medical Services is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.

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