There are some core elements that run through every emergency medical services system, Dawson said, regardless of specialty. For example, each EMS system has core needs relating to infrastructure. Dawson presented a slide that shows “what an emergency medical services system is all about” (see Figure 7-1). He said it starts with notification through 9-1-1, and continues on through response, specialization, responding to specialty care patients, rehab, and public education. Dawson noted that this panel’s charge was to focus on a couple of the infrastructure elements listed on the slide, in particular communications. Communications are central to achieving the IOM recommendation of a coordinated system. In addition, the panel will focus on data and data collection, which are essential to measuring and improving the system.


Kevin McGinnis, former emergency medical services director for the state of Maine and consultant to the National Association of State EMS Officials, said that he has been involved with building EMS systems since 1974. A lot has changed about EMS in the last 35 years, he said, but one constant has been its communication system, with its almost total reliance on voice communications with some telemetry and other data thrown in. The result is an aging and challenged infrastructure.

McGinnis said there is an immediate call for action in this area. A Federal Communications Commission (FCC) mandate for narrowbanding—which means making the small pipes smaller—has a drop-dead date of January 1, 2013, at which point many of the systems in use today will become illegal. McGinnis said this is one of the biggest EMS communications challenges in 35 years. In some places, it will mean wholesale replacement of radios—a costly proposition in a cash-strapped field. In other places, radios will need to be reprogrammed. Exquisite choreography among hospitals and ambulance services will be required to make this transition simultaneously.

The second area of challenge (and opportunity), he said, is technology. Done properly, this can substantially contribute to the regionalization effort. As a number of associations have begun planning around the communications capabilities that will be needed in the next 10 years, it has become clear that EMS will need to transition from about 90 percent voice to some mix of voice and data, perhaps 60/40 or 50/50. Otherwise, voice communications will become a bottleneck in communications between the field and the hospital, not a facilitator.

McGinnis predicted that as the physicians in emergency departments who provide online medical direction get busier, and as medics adopt diagnostic and other technology that provides much more information about the patient, changes will be needed. We’ll need to be able to take a lot of

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