1. Government Structure and EMS1
CHAPTER
Government Structure and EMS

2. 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

3. 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

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

5. 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

6. 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 ( ), the "Father of Modern EMS." (Tom Page / Tom Page Photography) 6

7. 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

8. Summary of the Recommendations of the White Paper.8

9. 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

10. 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

11. Components of an EMS System
(1973). 11

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

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

22. 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

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

24. 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

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

26. 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

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

28. 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

29. 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

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

31. 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

32. 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

33. 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

34. 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

35. 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

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

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

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

39. 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

40. 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

41. 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

42. 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

43. 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

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

45. 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

46. 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

47. Volunteers National Volunteer Fire Council
49 state firefighter organizations 47

48. 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