operating procedures are written, and a tabletop exercise might be conducted before moving the concept into a field environment to see if it works. However, when so much time has already been invested, most of the energy is spent on making sure the concept works, and training to ensure it is successful. There is no room for experimentation. Grove suggested that there is an opportunity to leverage the United States Joint Forces Command’s Joint Concept Technology Demonstrations (JCTD). This approach could potentially be used to address development and metrics for rural EMS response.

One JCTD evaluated the Joint Combat Casualty Care System, and Grove pointed out several parallels between some of the desired capabilities of the combat care system and rural EMS: efficient management of low-density, high-demand field medical personnel and evacuation assets; application of medical care to the most critical casualties while monitoring and remotely caring for others; and facilitated critical medical care to forces in denied or remote areas unreachable by evacuation assets in the short term. There are metrics that will be developed for the war fighter paramedic. The JCTD approach to development and metrics is worth looking at, Grove suggested. Some of the technologies that have come out of the JCTD may be useful for EMS in a rural environment, such as a handheld Motorola device that responds to voice commands.

A participant suggested that not just a military model, but those from the Data-Driven Approaches to Crime and Traffic Safety that is funded through the National Highway Traffic Safety Administration (NHTSA) and the Department of Justice, might similarly prove an adept comparison. The program studies crime and traffic crash data to determine the most effective deployment of law enforcement resources.

A primary challenge for assessment of preparedness capabilities and risk is a lack of an identifiable evidence base upon which to develop measures and establish metrics. Also where it does exist, available data are based on urban and suburban conditions which do not necessarily translate to rural and frontier settings. Participants discussed a variety of existing tools and research projects that that could be leveraged for assessment of transportation-related road risks, for example, roadway risk maps; models for predicting the impact of infrastructure changes; a method of expressing and comparing risk based on resources; and approaches to rapidly assess new concepts and technologies. Examples of data sources that might be useful in developing metrics were suggested. A variety of questions will need to be addressed, such as whether there are physical resources that could be measured as proxies for response capacity of an emergency care system, and how exercises, planning, integration, collaboration with nontraditional partners, and other activities should factor into assessments.