Government Structure and EMS 1 CHAPTER Government Structure and EMS

Learning Objectives 1.1 Identify six key historical events and key figures that have impacted the progress of emergency medical services (EMS), then discuss their collective influence. 1.2 Identify four key federal, state, and local legislative events that have formed the emergency medical services, and then discuss their collective influence. 2

Learning Objectives (Cont.) 1.3 Identify federal, state, and local EMS system components and discuss their interrelationship. 1.4 Identify the components of an EMS system. 1.5 Explain the various National Highway Traffic Safety Administration EMS agendas for EMS, related topic. 3

Learning Objectives (Cont.) 1.6 Identify the various trade organizations that support EMS activities. 4

The Beginning of EMS History of prehospital emergency medicine Crusades Napoleonic Wars Union Army, 1862 Doctor “house calls” World War II Korean War Vietnam War 5

The Beginning of EMS (Cont.) James O. Page James O. Page often remarked that it does not matter who the provider is, just as long as he is doing a good job. To ensure that the next generation of providers van do the best job possible, today’s managers and leaders must continue to improve the system based not only on its history but also with a vision of the future. FIGURE 1.1 James O. Page (1936-2004), the "Father of Modern EMS." (Tom Page / Tom Page Photography) 6

The White Paper 1966 Accidental Death and Disability: The Neglected Disease of Modern Society National Academy of Sciences (NAS) Long-range effects of quality emergency medical care on mortality Concluded: Average response time exceeded 40 minutes Crews were inadequately equipped and trained Americans had a greater chance of surviving in the combat zones of Korea or Vietnam than on the nation’s highways 7

Summary of the Recommendations of the White Paper. 8

National Highway Traffic Safety Administration Created in 1966 by Congress First federal standards in EMS Highway Safety Act of 1966 Developed specifications for training, equipment requirements, and design of the emergency vehicle itself Funds communications and education for EMS 9

Federal Initiatives Emergency Medical Services Systems Act of 1973 Designated federal funding Developed the first set of DOT national curriculums for EMTs and paramedics Funded Department of Health, Education, and Welfare Identified 15 components of an EMS system 10

Components of an EMS System (1973). 11

The EMS Agenda for the Future 1996 Department of Transportation and the National Highway Traffic Safety Administration More of a community-based approach to EMS 12

The EMS Agenda for the Future 14 attributes for EMS systems: Integration of health-care services EMS research Legislation and regulation System finance Human resources Medical direction Education systems 13

The EMS Agenda for the Future (Cont.) 14 attributes for EMS systems (cont.) Public education Prevention Public access Communication systems Clinical care Information systems Evaluation 14

The EMS Agenda for the Future (Cont.) The effectiveness of EMS will be measured by the impact it has on the movement of the patient through the health-care system 15

Integration of EMS and the Health-Care System Key partnerships with EMS Hospitals Receiving facilities, medical control, education resource Fire departments, rescue squads, law enforcement First responders, specialized resources 16

Integration of EMS and Health-Care System (Cont.) Key partnerships with EMS Regional, state, and national EMS organizations Funding, advocacy, education, lobbying efforts ASTM, NFPA 17

Functions of an EMS System System organization and management Authority to direct, develop, and allocate resources Medical direction Offline and online or direct Protocols Direct transport, treatment, and triage decisions 18

Functions of an EMS System (Cont.) Communication systems Interagency, mutual aid, disaster communication Public education Prevention, system access, system education, citizen CPR and first aid Quality improvement Ongoing review of performance of all systems 19

Star of Life National EMS symbol Six-barreld cross represents Six system functions: Detection Reporting Response On-scene care Care in transit Transfer to definitive care FIGURE 1.4 Star of Life 20

Star of Life (Cont.) Staff in the center Represents medicine and healing FIGURE 1.4 Star of Life 21

The End of Federal Funding Mid-1980s EMS programs slashed or eliminated Systems became dependent on state and local funding Differences in systems today Lack of comprehensive 911 coverage 22

The Impact of Television on EMS Emergency, Rescue 911 Raised awareness and expectations Public demand for high-quality EMS Integration of EMS services 23

Federal Government and EMS Department of Homeland Security Safe, Accountable, Flexible, Efficient Transportation Equity Act Federal Interagency Committee on EMS Federal oversight committee for EMS Congressional mandate to report to congress yearly National EMS credentialing system Federal Emergency Management Agency (FEMA) National Fire Academy 24

National Fire Academy Located in Emmitsburg, Maryland Focuses on EMS management, EMS special operations, EMS safety and incident command 25

National EMS Credentialing System Credentials EMS workers from across state lines Documents minimum qualifications, certifications, training, and education Designed to allow EMS providers to be plugged into the national incident management system 26

Health and Human Services Department of Health and Human Services Contributes to national EMS activities 27

Health and Human Services (Cont.) Centers for Disease Control (CDC) Injury prevention programs, surveillance, maintains WISQAR, database Education on infectious disease, promotes standards for bloodborne pathogens Maintains Strategic National Stockpile 28

Health and Human Services (Cont.) Center for Medicare/Medicaid Services Sets reimbursement schedules, standards for billing, privacy regulations, works with Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) 29

Health and Human Services (Cont.) Health Resources and Services Administration Level of pediatric care and education of EMS providers EMS for children 30

Health and Human Services (Cont.) Federal Office of Rural Health Care Policy Rural EMS Agenda for the Future Provides funding for rural EMS associations Rural EMS and Trauma Technical Assistance Center Radio equipment, support facilities, information technology 31

Federal Communications Commission FCC has long history of helping EMS Telemetry units, field radios, base-station frequencies, 911, E911 Creating cell phone technologies Wireless Telecommunications Bureau Oversees the development of public safety radio systems Wireless frequencies for paperless systems 32

Department of Commerce Manages national quality award Malcolm Baldrige Award The Baldrige national quality program Public-private partnership to improve the performance of national organizations Award presented by the president of the United States Categories of health care, small business, manufacturing, and education 33

Malcolm Baldrige Award Criteria for performance Leadership Strategic planning Focus on patients, other customers, and markets Measurement, analysis, and knowledge management Staff focus Process management Organization performance results 34

State Organizations Activities U.S. Department of Health and Human Services Robert Wood Johnson Foundation Provided $15 million dollars for 44 EMS projects in 32 states Wedworth-Townsend Act Governor Ronald Reagan “Mobile intensive care paramedics” 35

State EMS Offices Funnel federal funds to EMS agencies Located within the state department of health, or department of public safety 36

State EMS Offices (Cont.) State directors advise state legislatures on: Medical practice Certification requirements Educational standards Funding appropriations 37

State EMS Offices State fire marshall office Provides equipment, training on ICS, and other training 38

County and Local Governments Provide oversight and accountability to the public Oversee health-related activities Local health departments Oversee many large metropolitan EMS services 39

Medical Authority Grants certification recertification, and decertifies prehospital personnel Grants privileges Establishes, implements, revises, and authorizes medical protocols, policies, and procedures Establishes destination criteria Ensures competency of personnel Establishes training levels 40

Structure of Local EMS Providers Single-role organization Multiple-role organization Fire-based Cross-trained/dual role Third service Private enterprise, corporate Has public oversight 41

Professional Organizations International Association of Fire Chiefs (IAFC) International Association of Fire Fighters (IAFF) International City/County Management Association (ICMA) American Federation of State, County, and Municipal Employees (AFSCME) 42

Other Groups American Red Cross American Heart Association American Stroke Association American Ambulance Association American College of Emergency Physicians National Association of EMS Physicians American College of Surgeons 43

Other Groups (Cont.) Association of Air Medical Services Air Medical Physician Association American Society for Testing and Materials National Fire Protection Association 44

Accreditation Agencies Commission on Accreditation of Allied Health Education Programs Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions Commission on Accreditation of Ambulance Services 45

Provider Associations National Association of EMS Educators Emergency Nurses Association International Tactical EMS Association National Association of Emergency Medical Technicians National Registry of EMT’s 46

Volunteers National Volunteer Fire Council 49 state firefighter organizations 47

Summary Responsibility to manage an EMS system requires an understanding of a larger picture involving outside agencies and government sources Research, standards, regulation, and education emanate from many outside sources; EMS personnel should utilize these resources to ensure life long learning 48