In addition, in many communities there is little interaction between emergency care services and community safety net providers, even though the two share a common base of patients, and their actions may affect one another substantially. The absence of coordination represents missed opportunities for enhanced access, improved diagnosis, patient follow-up and compliance, and enhanced quality of care and patient satisfaction.

Coordination between EMS and public health agencies could also be improved. Through their regular activities, EMS providers have information that could serve as a barometer for both illness and injury trends within the community, potentially assisting state and local public health departments. However, communication links between these agencies are often not well established. Moreover, although prevention activities are generally limited in the emergency care setting, utilization of emergency services represents an important opportunity for imparting information on injury prevention to patients. Emergency care providers could benefit from the resources and experiences of public health agencies and experts in establishing injury prevention activities.

Finally, perhaps now more than ever, with the threat of bioterrorism and outbreaks of diseases such as avian influenza, it is essential that EMS, EDs, trauma centers, and state and local public health agencies partner to conduct surveillance for disease prevalence and outbreaks and other health risks. Emergency responders can recognize the diagnostic clues that may indicate an unusual infectious disease outbreak so that public health authorities can respond quickly (GAO, 2003c). However, a partnership that allows for improved communication of information between emergency care providers and public health officials must first be in place.

Movement Toward Greater Coordination

The value of integrating and coordinating emergency and trauma care has long been recognized. For example, the 1966 National Academy of Sciences/National Research Council (NAS/NRC) report Accidental Death and Disability: The Neglected Disease of Modern Society called for better coordination of emergency and trauma care through community councils on emergency medical services, which would bring together physicians, medical facilities, EMS, public health agencies, and others to procure equipment, construct facilities, and ensure optimal emergency care on a day-to-day basis, as well as in a disaster or national emergency (NAS and NRC, 1966).

Although the drive toward system development waned when federal funding of EMS was folded into state block grants in 1981, the goal of system planning and coordination has remained paramount within the emergency and trauma care community. In 1996, the National Highway Traffic

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