continuum of care. The statewide communications center provides support by maintaining communications links, providing medical direction, and maintaining continuity of care. The center has direct links to incident command to facilitate management of EMS resources as an event unfolds.

The state also is developing a new wireless digital capability that will connect EMS with other public safety entities (police, fire, emergency management, public health) throughout the state. In addition, the state has developed a County Hospital Alert Tracking System (CHATS) to monitor the status of hospitals and EMS assets so ambulances can be directed to less crowded facilities. This capability can also be applied to individual services—for example, patients with acute coronary syndrome can be directed to facilities based on the current availability of reperfusion suites. The Facility Resource Emergency Database system was designed to gather detailed information electronically from hospitals on bed availability, staffing, medications, and other critical capacity issues during disasters, but is also used to monitor and report on system capacity issues on a regular basis.

The state ensures coordination and compliance with protocols through its statewide training, provider designation, and licensure functions. In addition to providing EMS training and certification, the system offers statewide disaster preparedness training for members of the National Disaster Medical System.

Regionalization

While EMS and 9-1-1 are operated locally, they utilize statewide protocols that promote regionalization of pediatric services to two designated centers. Regionalization is also used to direct adult patients to trauma, stroke, burn, eye, perinatal, and hand referral centers. The control of air medical services by the state facilitates the regionalization of care through the active operation of dispatch.

Accountability

The state monitors performance at the provider and system levels through a provider review panel that regularly evaluates the operation of the system. As a state agency, the system reports on its performance goals and improvements. Also, CHATS enables participating hospitals and the public to view the status of hospitals at all times through its website, including data on availability of cardiac monitor beds, ED beds, and trauma beds. Paper ambulance run sheets are being replaced with an electronic system so that data can be collected and analyzed quickly to facilitate real-time performance improvement.

While Maryland is relatively advanced in achieving the goals of coor-



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