In addition, the state has developed a County Hospital Alert Tracking System (CHATS) that monitors the status of hospitals so that ambulances can be directed to less crowded facilities. The system can also be used for individual services—for example, patients with acute coronary syndrome can be directed to facilities according to the current availability of reperfusion suites. The Facility Resource Emergency Database (FRED) system was designed to gather electronically detailed information from hospitals on bed availability, staffing, medications, and other critical capacity issues during disasters, but is also used to communicate information to and from hospitals on a day-to-day basis.

The state ensures coordination and compliance with protocols through a system of EMS operational programs that are required to undertake credentialing, medical oversight, and quality improvement activities.

While EMS and 9-1-1 are operated locally, EMS providers use statewide treatment and triage protocols that promote regionalization of care at state-designated facilities. In addition to trauma centers, these facilities currently include neurotrauma, hyperbaric, burn, eye, perinatal, and hand centers. Regulations have recently been promulgated to designate stroke centers, and the relatively new prehospital stroke protocol will triage acute stroke patients to these designated stroke centers. The state is divided into five regions, each with an advisory council that includes representatives from EMS, hospitals, and trauma and specialty centers. Each region has a representative on the 29-member State EMS Advisory Council.

The Maryland system monitors the performance of providers, as well as that of the system itself. Providers are monitored through their affiliated EMS operational programs, and when necessary, quality assurance issues are referred to the state-level Provider Review Panel. EMS operational programs are required to submit performance data, and as a state agency, MIEMSS reports on system performance. The CHATS system enables EMS programs, participating hospitals, and the public to view the status of hospitals, including availability of ICU beds, ED beds, and trauma beds, at all times through its website. CHATS also collects and reports historical information on trends in hospital diversion, which are reviewed on a regular basis. A statewide web-based EMS patient care report is replacing paper ambulance run sheets so that data can be collected and analyzed more quickly and accurately, thereby facilitating real-time performance improvement.