Mapping Our Future

Before 1966, a soldier who was wounded on the front lines in Vietnam had a better chance of surviving than someone injured in an accident on an American highway. If you looked at the delivery of emergency care in Vietnam, a wounded soldier usually had quick advanced life support (ALS) intervention at or near the scene; rapid evacuation was provided by helicopter only several miles to a waiting trauma team capable of performing most surgeries.

What did we have in America at the same time? Many ambulance services were operated by funeral homes. It was not uncommon to see slow responses, one-person ambulances, no medical intervention at the scene and rapid transport to the closest medical facility. Unfortunately, many Ameri-cans died needlessly waiting for medical care or from being mishandled at the scene. In essence, your chances of survival were better in Vietnam than they were in America.

In 1966, a National Academy of Science white paper, Accidental Death and Disability: The Neglected Disease of Modern Society, concentrated on the fact that many Americans were dying because of a lack of appropriate emergency care. This paper laid the foundation for the EMS systems we generally see today.

But that paper was written more than 30 years ago and many have questioned where the EMS profession is going. Peter Drucker, the management guru, once said, "The best way to predict the future is to create it." And that is exactly what has been going on in the EMS community over the last several years.

In 1996, the National Highway Traffic Safety Administration (NHTSA) and the Health Resources and Service Administration/Maternal and Child Health Bureau initiated a project to have agencies, organizations and individuals involved in EMS evaluate their functions and map a course for the future. What developed from a steering committee was a document, EMS Agenda for the Future. Many have called this document the "second white paper" (also see "21 Steps To The 21st Century" on page 45).

The purpose of EMS Agenda for the Future was to determine the most important directions for future EMS development. The agenda visualizes an EMS system that is integrated with the health care system, proactive in improving community health, funded for service to the community, and accessible through both conventional landline and wireless telephones.

The vision statement of the agenda says, "EMS of the future will be community-based health management that is fully integrated with the overall health system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. EMS will be integrated with other health care providers and public health and public safety agencies. It will improve community health and result in more appropriate use of acute health care resources. EMS will remain the public's emergency medical safety net."

In May 1998, a two-day conference was held in Arlington, VA, as part of the release of the EMS Agenda for the Future implementation guide. The conference was titled, "EMS Agenda for the Future - Making it a Reality."

The implementation plan advocates three strategies: building bridges between EMS and other health care system components; creating an infrastructure to streamline public access to and delivery of emergency care; and developing tools and resources to build a new EMS system. Fourteen areas were identified to help build on the past of EMS and propel it into the future. Those areas included: integration of health services; EMS research; legislation and regulation; system finance; human resources; medical direction; education systems; public education; prevention; public access; communication systems; clinical care; information systems; and evaluation.

Carrye Brown, administrator of the U.S. Fire Administration (USFA), gave a keynote address during the conference's dinner. One of the items Brown clearly illustrated is that the fire service plays a vital role in the delivery of emergency medical service in the United States. Statistically, she pointed out that medical calls account for two-third of all responses by the U.S. fire departments that provide EMS. Such departments represent 80 percent of the country's 33,000 fire departments.

Brown further pointed out that the USFA has already undertaken programs to assist in reaching the agenda's goals. Some of those programs are Internet-based training, providing increased access to education, an emergency medical services recruitment and retention manual, a video and manual on implementation of EMS in the fire service, sponsorship of "EMS Week" activities, and expansion of the National Fire Incident Reporting System (NFIRS) to include the reporting of EMS data.

One thing is for sure: not everybody will agree with the recommendations or the plans for implementing EMS Agenda for the Future, but work with the document has only begun. Much is still to be accomplished. The vital role played by the fire service in the delivery of emergency care in this country clearly shows that the fire service should be one of the agenda's leading developers.

For a free copy of the implementation guide, you may fax a request to the NHTSA at 202-366-7721.

Gary Ludwig is the Chief Paramedic/EMS Bureau Chief for the St. Louis Fire Department. He is currently serving his fourth term as an elected executive board member to the EMS Section for the International Association of Fire Chiefs and is a frequent lecturer at fire and EMS conferences. Ludwig has a master's degree in management and is a licensed paramedic. He can be reached at