its operation through prevention, bystander training, and monitoring of system performance.

While these objectives involve substantial, systemwide change, they are achievable. Early progress toward the goal of more integrated, coordinated, regionalized emergency care systems has become derailed over the last 25 years. Efforts have stalled because of deeply entrenched political interests and cultural attitudes, as well as funding cutbacks and practical impediments to change. These obstacles remain today, and they represent the primary challenges to achieving the committee’s vision. However, the problems are becoming more apparent, and this provides a catalyst for change. The committee calls for concerted, cooperative efforts at multiple levels of government and the private sector to finally break through and achieve the goals outlined above. Presented below are the committee’s findings and recommendations for achieving its vision of a 21st-century emergency care system.

Federal Lead Agency

Responsibility for all aspects of emergency care is currently dispersed among many federal agencies within the Department of Health and Human Services, Department of Transportation, and Department of Homeland Security. This situation reflects the unique history and the inherent nature of emergency care. As described above, unlike other sectors of the medical provider community, EMS has one foot planted firmly in the public safety community, along with police, fire, and emergency management. In addition, the early development of the modern EMS system grew out of concerns regarding the epidemic of highway deaths in the 1960s. Thus while EMS is a medical discipline, the National Highway Traffic Safety Administration became its first federal home, and it has remained the informal lead agency for EMS ever since. The need for a formal lead agency for emergency care has been promoted for years, and was highlighted in the 1996 report of the National Highway Traffic Safety Administration Emergency Medical Services Agenda for the Future. In 2005, the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU) gave statutory authority to what had been an informal planning group, the Federal Interagency Committee on EMS (FICEMS). While this group holds promise for improving coordination across federal emergency care agencies, the committee sees it as a valuable complement to but not a substitute for a lead agency, as some have suggested it should be.

The committee believes a true federal lead agency is required if its vision of a coordinated, regionalized, and accountable emergency care system is to be fully realized. It therefore recommends that Congress establish a lead agency for emergency and trauma care within 2 years of the release of this



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