Finally, the lack of unified accountability disperses responsibility for system failures and perpetuates divisions between public safety and medical-based emergency and trauma care professionals. The degree to which the scattered responsibility for emergency and trauma care at the federal level has contributed to this disappointing performance is unclear. Regardless, the committee believes a new approach is warranted.

Alternative Approaches

Strong federal leadership for emergency and trauma care is at the heart of the committee’s vision for the future, and continued fragmentation of responsibility at the federal level is unacceptable. The committee considered two options for remedying the situation: (1) maintain the status quo, giving the FICEMS approach time to strengthen and mature, or (2) designate or create a new lead agency within the federal government for emergency and trauma care. Some of the key differences between these two approaches are summarized in Table 3-1.

Option 1: Maintain the status quo and allow FICEMS to strengthen The committee considered the ramifications of maintaining the status quo. The problems associated with fragmented federal leadership of emergency care, documented above, include variable funding, periodic program cuts, programmatic duplication, and critical program gaps. With the recent enactment of a statutory framework for FICEMS, however, the committee considered the possibility that the need for a lead federal agency has diminished. The committee carefully examined the rationale for delaying the move toward a lead federal agency and allowing FICEMS time to gain strength. The central argument in support of this strategy is that there have been a number of recent improvements in collaboration at the federal level, and these efforts should be given a chance to work before an unproven and politically risky approach is pursued. Several recent developments support this view: the enactment of a statutory framework for FICEMS; the increasing level of collaboration among some federal agencies; the substantial new NHTSA funding for a next-generation 9-1-1 initiative; and the elevation of the NHTSA EMS program to the Office of EMS, which has the potential to improve visibility and funding for EMS, and perhaps other aspects of emergency and trauma care, within the federal government.

While the committee applauds these positive developments, setbacks have occurred as well. As noted above, DHHS’s Division of Emergency Medical Services, its Division of Trauma and EMS, and most recently its Trauma-EMS Systems Program were recently zeroed out of the federal budget. Federal funding for AHRQ, nonbioterrorism programs at CDC, and other federal programs related to emergency and trauma care at the

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