An important first step in studying the impact of EMS system design on quality and outcomes is a more systematic characterization of local EMS systems. While some data exist to characterize EMS services in 200 of the nation’s largest cities, this information is incomplete and does not address how services are organized outside large urban areas. The present study was designed to address this gap in our information. In a previous study, the Center for Injury Research and Policy collected data with State and local EMS directors to characterize: • Overall size of EMS systems; • Access to systems through 911; • Provider and dispatch agency types; • Response configurations, operating procedures, and use of volunteers; • Mutual-aid agreements and response to calls outside the primary service area; • Medical control; and • Source of system funding. For the current study, using the information gleaned from these surveys, we investigated the variation in systems by geographic region of the country, the rurality of the area serviced by the system and the overall size of the system as defined by the number of EMS calls responded to annually. The survey also contained a series of subjective assessments focusing on adequacy of resource levels and system support, extent to which bystanders were involved in EMS, and adaptation of the system to change. In the broadest terms, the most obvious difference noted was how each State related our operational definition of a local EMS system to itself. States choose to organize local emergency medical services coordination in a variety of ways from hospital-centered models to county-based systems to larger regional entities. Fifteen States identified systems that were at either a county or equivalent level, although many States identified regional or multi-jurisdictional areas to survey. States were consistent in how their areas were divided (e.g., county versus regional), although a few States did provide contact information for both types of areas as well as independent cities, or miscellaneous systems such as hospitals or tribal authorities. It is important to note that there were areas identified in ten States where no systems existed according to our operational definitions. Conversations with the State EMS offices revealed that while there were EMS agencies operating in these areas, they did not operate under a coordinated, local administration. In addition to documenting overall variation in the organization and delivery of EMS across systems, this study underscored the challenges faced by systems providing services in rural and wilderness areas of the country. Most apparent (and of potential concern) are low percentages in rural and wilderness areas of full-time versus part-time and career versus volunteer EMS providers, ALS versus BLS providers involved in transport, and dispatch agencies providing pre-arrival instructions. In addition, a higher percentage of systems in more rural/wilderness versus urban/suburban areas had no medical direction in place and or had some organized medical direction but with no one person with primary responsibility. System financing was clearly a challenge for all systems, but a slightly higher percentage of systems in rural and wilderness areas rely on fee for service as their primary source of funding. Variation across States is a ubiquitous theme in EMS and is well supported by the results of this study. States have evolved quite differently in how they handle the oversight of EMS. With such contrasting approaches in State regulation and policy, along with differences in overall size, demographics and geography, it is not surprising that we saw variability in our data across these States. (Author/publisher)
Samenvatting