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The subcommittee considered the evolving role of EMS as an integral component of the overall health care system in the areas of dispatch and medical direction.They also focused on integration with trauma systems, pediatric EMS, public health, prevention, emergency department overcrowding, EMS system planning and coordination at the federal, state, and local levels; EMS funding and infrastructure investment, EMS workforce trends, professional education; EMS research priorities and funding.The primary foundation-based supporters of emergency care research training are the Emergency Medicine Foundation (EMF), affiliated with the American College of Emergency Physicians (ACEP), and the Society for Academic Emergency Medicine (SAEM).
The prehospital EMS subcommittee contributed to the Emergency Medical Services at a Crossroads report by highlighting and suggesting changes to the administration of services, organizational infrastructure, and financing mechanisms that characterized the 2004-2006 prehospital emergency care system.
This subcommittee assessed the current organization, delivery, financing of EMS services and systems, andprogress toward the EMS Agenda for the Future.
Also, they evaluated the progress the country's pediatric EMS system has accomplished since the publication of the IOM's 1993 report, Emergency Medical Services for Children.
The subcommittee considered the role of pediatric emergency services as an integrated component of the overall health system; system-wide EMSC planning, coordination, and funding; embedded pediatric training in professional education; health services; clinical research.
Most of the evidence base that exists to support EMS has been generated by researchers at a small number of medical schools, generally in midsized cities, who have ongoing relationships with municipal EMS systems (NHTSA, 1996).
The preponderance of published EMS research is component-based, focusing on a single intervention or health problem rather than broader system-level issues.Trauma care deals principally with the acute management of patients with traumatic injuries.Like emergency medicine research, trauma care research is concerned with the treatment of these patients in the prehospital and hospital settings, but it reaches further into the inpatient setting, particularly the intensive care unit (ICU) and surgical departments.In three consensus reports released in 2006, the Committee on the Future of Emergency Care in the United States Health System documented the state of affairs and discussed ways to improve the 9-1-1 and medical dispatch systems, prehospital emergency medical services (EMS), and hospital-based emergency and trauma care networks that serve adults and children.To develop these reports, the staff and committee chair organized the committee into three subcommittees (that included external participation from individuals not affiliated with the primary consensus committee) to address focal areas of emergency care: prehospital services, pediatric emergency care, and hospital-based emergency care.In addition, there has been a growing contribution to the EMS literature by nonphysicians.Trauma care research is a parallel field of study that is also defined by time and place.Despite the size, scope, sophistication, and critical role of EMS in the United States, the evidence base to support EMS-related clinical and system design decisions is much less well developed than that in other areas of medicine (NHTSA, 1996).Consequently, EMS has for years operated without a sufficient scientific basis to support many of its actions (NHTSA, 2001a; Mc Lean et al., 2002; Sayre et al., 2003).In 2001, NHTSA and the Maternal and Child Health Bureau within HRSA released the eight recommendations: (1) career EMS investigators should be developed and supported; (2) centers of excellence should be created to facilitate EMS research; (3) federal agencies should commit to supporting EMS research; (4) other public and private institutions should be encouraged to support EMS research; (5) results of this research should be applied by EMS professionals and others; (6) EMS providers should require that evidence be available before implementing new procedures, devices, or drugs; (7) standardized data collection methods should be established; and (8) exceptions from informed consent rules should be adopted (NHTSA, 2001a).The above efforts have helped draw attention to the lack of a research base for EMS and spurred some development in the area.