and it recently received funding for a major nationwide initiative to promote the development of next-generation 9-1-1 service.

DHHS has played an important supporting role in the development of EMS and has taken the lead role with respect to hospital-based emergency and trauma care. It housed the Division of Emergency Medical Services and the Division of Trauma and EMS for many years, and most recently the Trauma-EMS Systems Program. All of these programs have been eliminated; the latter was recently zeroed out of the federal budget for fiscal year 2006. DHHS continues to support CDC’s National Center for Injury Prevention and Control, the EMS-C program, and the National Bioterrorism Hospital Preparedness program. These programs have made important contributions to emergency and trauma care despite inconsistent funding and the frequent threat of elimination. The Agency for Healthcare Research and Quality (AHRQ), another DHHS agency, has historically been the principal federal agency funding research in emergency care delivery, including much of the early research on management of out-of-hospital cardiac arrest. Recently, AHRQ has funded important studies of ED crowding, operations management, and patient safety issues. It is active as well in funding research on preparedness, bioterrorism planning, and response.

DHS also plays an important role in emergency and trauma care. The Federal Emergency Management Agency (FEMA), once an independent cabinet-level agency now housed in DHS, provides limited amounts of grant funding to local EMS agencies through the U.S. Fire Administration. DHS also houses the Metropolitan Medical Response System (MMRS), a grant program designed to enhance emergency and trauma preparedness in major population centers. This program was migrated from DHHS to DHS in 2003. In addition, DHS houses the Disaster Medical Assistance Team (DMAT) program, through which health professionals volunteer and train as locally organized units so they can be deployed rapidly, under federal direction, in response to disasters nationwide. However, this program will migrate to DHHS in January 2007.

Efforts have been made to improve interagency collaboration at the federal level, especially in recent years. Over the last decade, federal agencies have worked collaboratively to provide leadership in the emergency and trauma care field, to minimize gaps and overlaps across programs, and to pool resources to jointly fund promising research and demonstration programs. For example, NHTSA and HRSA jointly supported the development of the Emergency Medical Services Agenda for the Future, which was published in 1996. This degree of collaboration has not been universal, however, and has been evident in some agencies more than others. Furthermore, collaborative efforts are limited by the constraints of agency authorization and funding. At some point, agencies must pursue their own programmatic goals at the expense of joint initiatives. Furthermore, to the



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