reimbursement with system performance and system design. He also noted that comparison against system benchmarks is important, whether those are generated at the federal, state, local, or regional level.

Dawson concluded, “It seems to me that perhaps one of the most important things is relationship building … continuing to build relationships among emergency services providers [and] among the components of the system, so that you have day-to-day honest dialogue and the people just get along with each other. That may be one of the most critical things we do.”

Jon Krohmer, principal deputy assistant secretary and deputy chief medical officer in the Office of Health Affairs at the Department of Homeland Security, said he would support all of Dawson’s comments. He pointed out that “something that came up in the preparedness discussion [Chapter 8] is the fact that the system is stressed on a daily basis right now… . We have to figure out ways to address that.”

Another key point of the discussion, Krohmer said, was the issue of leadership and how that comes about. At the federal level there has been a lot of controversy about who the federal lead agency is and how the federal partners should work together. Krohmer said that, through a combination of the Federal Interagency Committee on Emergency Medical Services (FICEMS) and the Emergency Care Coordination Center (ECCC), the federal agencies have over the last couple of years been able to increasingly work together on these issues.

But, he said, he is not sure about the leadership or authority responsibilities held at the state and sub-state levels. Obviously, it varies state to state, but he said to his knowledge, within most states there is nothing that authorizes or empowers an entity to become the regional leader. He challenged the group to focus on who will provide leadership at the state and sub-state levels and what authorities and responsibilities these groups must have.

Andrew Roszak, senior health policy fellow at the Emergency Care Coordination Center (ECCC), within the Office of the Assistant Secretary for Preparedness and Response (ASPR), in the Department of Health and Human Services, endorsed Dawson and Krohmer’s comments, especially those regarding federal leadership. He said that with the advent of FICEMS and the Council on Emergency Medical Care and the establishment of the ECCC, “we are at a unique place in time where emergency care is finally getting a voice within the federal government—and very importantly, a centralized voice.”

Roszak said that the ECCC is very interested in regionalization. He said, “We are tasked with looking at the delivery of daily in-hospital emergency care. Regionalization, obviously, plays right into that.” He said the ECCC’s goal is also to coordinate emergency care issues throughout the federal government. Currently, these issues are scattered among many different agencies

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