the Department of Health, Education, and Welfare (later Health and Human Services). This office was created by the EMS Systems Act of 1973.

Boyd started by saying, “Regionalization is a verb. It’s what you do, [and] how you do it.” He described his effort to organize a coordinated system first at the state level in Illinois. The effort brought public health, hospitals, surgical personnel and all the components of the emergency and trauma care system together under an organized plan. The state established a lead agency within the Department of Health which aided in breaking the state down into regional groups and organizing the available hospital capacity. However, he said there were many emergency care-related functions in public health, transportation, and other parts of the government that were not under lead agency control, but should have been. He stressed that a lead agency is essential for coordinating an effort as complex as this.

Describing the activities of the federal lead agency at DHEW-HHS in the 1970s, Boyd noted that regional systems are not all the same across the country. His department determined at that time there are at least three basic socio-geographic regional models. The first is an urban-suburban model, including cities such as New York and Chicago. These regions, he said, are medically affluent—they have organized, all advanced life support (ALS) emergency medical services systems and, often, too many hospitals competing for special designations.

Second, there is a rural-metropolitan model. Boyd said this model applies virtually anywhere there are trees—from the west coast to east coast. It includes towns such as Peoria, Illinois; Spokane, Washington; and Memphis, Tennessee—towns that have adequate medical capability in their centers (if they are able to consolidate and organize it), and rural areas nearby.

The third model, wilderness-metropolitan, “is found in large, open areas where there are no trees,” Boyd said. This includes parts of New Mexico, Texas, and Alaska where, he said, “you are really talking about a very bleak rural system.” These are areas with long transport distances and essentially no specialty care.

Boyd said that these regional divisions were used in tailoring the different types of technical assistance offered by the federal government to regional areas. The categories also became part of the federal funding mechanism and the grant process. Boyd said that regional context and sociogeographic mix were important in differentiating the kinds of solutions that might work in a given area.

THE STATES’ PERSPECTIVE

The panel’s second speaker was Bob Bailey, former director of the North Carolina State Emergency Medical Services (EMS) program and past presi-



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