for emergency and trauma care within the government, and coordinate grants so that federal dollars would be allocated efficiently and effectively.

A lead federal agency could better move the emergency and trauma care system toward improved integration; unify funding and other decisions; and represent all emergency and trauma care patients, providers, and settings, including prehospital EMS (both ground and air), hospital-based emergency and trauma care, pediatric emergency and trauma care, rural emergency and trauma care, and medical disaster preparedness. Specifically, a federal lead agency could:

  • Provide federal leadership on important policy issues that cut cross agency boundaries.

  • Create unified accountability for the performance of the emergency and trauma care system.

  • Rationalize funding across the various aspects of emergency and trauma care to optimize the allocation of resources in achieving system outcomes.

  • Coordinate programs to eliminate overlaps and gaps in current and future funding.

  • Create a large combined federal presence, increasing the visibility of emergency and trauma care within the government and among the public.

  • Provide a recognizable entity that would serve as a single point of contact for stakeholders and the public, resulting in consolidated and efficient data collection and dissemination and coordinated program information.

  • Enhance the professional identity and stature of emergency and trauma care practitioners.

  • Bring together multiple professional groups and cultures, creating cross-cultural and interdisciplinary interaction and collaboration that would model and reinforce the integration of services envisioned by the committee.

Although creating a lead agency could yield many benefits, such a move would also involve significant challenges. Numerous questions must be addressed regarding the location of such an agency in the federal government, its structure and functions, and the possible risk of weakening or losing current programs. HRSA’s rural EMS and EMS-Trauma System programs have already been defunded, and the EMS-C program is under the constant threat of elimination. There is real concern that proposing an expensive and uncertain agency consolidation could jeopardize programs already at risk, such as EMS-C, as well as cripple new programs just getting started, such as NHTSA’s enhanced 9-1-1 program. This is particularly likely if there is resistance to the consolidation from within the current agency homes for these programs.

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