administrators. Therefore, it is very important that the preparedness and EMS communities actively engage health care providers and insurers.

THE ROLE OF GOVERNMENT

James DeTienne, supervisor of EMS and Trauma Systems in the Montana Department of Public Health and Human Services, said that the role of government in response to rural MCIs encompasses leadership, workforce, training, and technology. A balance needs to be struck between providing structured support and maintaining command sovereignty with local leaders.

Leadership

While all responses are ultimately local, leadership from federal and state governments is urgently needed in rural response and EMS, DeTienne said. From the federal perspective, this means adjudicating across interstate, regional, and national jurisdictions to provide broad guidance to communities. Similarly, states must assume responsibility for ensuring the needs of local emergency responders and health care providers are measured and adequately met. A leadership role for government at all levels is to facilitate a realistic public perception of what emergency services are available and what they are capable of doing with their current resources.

Drew Dawson, director of the Office of Emergency Medical Services at the NHTSA, further detailed potential roles the federal government could play productively. The responsibility of the federal government, first and foremost, Dawson said, is communication and collaboration with all stakeholders in the system. There needs to be a coordinated federal vision of where rural emergency medical services should be. That vision must be developed in concert with state and local areas, and with federal leadership. One participant suggested that this vision might best come to fruition by strengthening EMS within the federal government, recognizing that EMS is a critical component of the everyday health system and disaster response. This strengthened role could in part be tasked with elevating the priority of EMS preparedness, guiding better allocation of grants and alignment of grants with federal policy, and removing barriers to communicating best practices solutions across state and regional jurisdictions.

In fact, Dawson commented that the federal government is in a key position to develop and share best practices, by sponsoring forums such as this IOM workshop and others that bring rural communities together with state and local partners. He suggested that there is also a need for federal support of additional research into rural emergency medical services, not just with respect to patient care, but with respect to systems. Development



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