Assignment: Public Health System Interface

Assignment: Public Health System Interface ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Public Health System Interface Can you help me understand this Health & Medical question? Assignment: Public Health System Interface Discuss common themes across the assigned journal articles relative to public health preparedness from the emergency and disaster healthcare perspective. _exs.pdf s1072751506013184.pdf em_and_public_health.pdf iom_future_of_emergency_care.pdf Emergency Medical Services: At the Crossroads (Free Executive Summary) Free Executive Summary Emergency Medical Services: At the Crossroads Committee on the Future of Emergency Care in the United States Health System ISBN: 978-0-309-10174-5, 310 pages, 6 x 9, hardback (2007) This free executive summary is provided by the National Academies as part of our mission to educate the world on issues of science, engineering, and health. If you are interested in reading the full book, please visit us online at . You may browse and search the full, authoritative version for free; you may also purchase a print or electronic version of the book. If you have questions or just want more information about the books published by the National Academies Press, please contact our customer service department toll-free at 888-624-8373. Emergency Medical Services (EMS) is a critical component of our nation’s emergency and trauma care system, providing response and medical transport to millions of sick and injured Americans each year. At its best, EMS is a crucial link to survival in the chain of care, but within the last several years, complex problems facing the emergency care system have emerged. Press coverage has highlighted instances of slow EMS response times, ambulance diversions, trauma center closures, and ground and air medical crashes. This heightened public awareness of problems that have been buildingover time has underscored the need for a review of the U.S. emergency care system. Emergency Medical Services provides the first comprehensive study on this topic. This new book examines the operational structure of EMS by presenting an in-depth analysis of the current organization, delivery, and financing of these types of services and systems. By addressing its strengths, limitations, and future challenges this book draws upon a range of concerns:• The evolving role of EMS as an integral component of the overall health care system.• EMS system planning, preparedness, and coordination at the federal, state, and local levels.• EMS funding and infrastructure investments.• EMS workforce trends and professional education.• EMS research priorities and funding.Emergency Medical Services is one of three books in the Future of EmergencyCare series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems. This executive summary plus thousands more available at Copyright © National Academy of Sciences. All rights reserved. Unless otherwise indicated, all materials in this PDF file are copyrighted by the National Academy of Sciences. Distribution or copying is strictly prohibited without permission of the National Academies Press Permission is granted for this material to be posted on a secure password-protected Web site. Assignment: Public Health System Interface The content may not be posted on a public Web site. Emergency Medical Services: At the Crossroads Summary Emergency medical services (EMS) is a critical component of the nation’s emergency and trauma care system. Hundreds of thousands of EMS personnel provide more than 16 million medical transports each year. These personnel deal with an extraordinary range of conditions and severity on a daily basis—from mild fevers to massive head traumas. The work they do is challenging, stressful, at times dangerous, and often highly rewarding. EMS encompasses the initial stages of the emergency care continuum. It includes emergency calls to 9-1-1; dispatch of emergency personnel to the scene of an illness or trauma; and triage, treatment, and transport of patients by ambulance and air medical service. The speed and quality of emergency medical services are critical factors in a patient’s ultimate outcome. For patients who cannot breathe, are in hemorrhagic shock, or are in cardiac arrest, the decisions made and actions taken by EMS personnel may determine the outcome as much as the subsequent hospital-based care—and may mean the difference between life and death. DEVELOPMENT OF THE EMS SYSTEM The modern EMS system in the United States developed only within the past 50 years, yet its progress has been dramatic. In the 1950s, EMS provided little more than first aid, and it was not uncommon for the local ambulance service to comprise a mortician and a hearse. In the late 1950s, researchers demonstrated the effectiveness of mouth-to-mouth ventilation, and in 1960 cardiopulmonary resuscitation (CPR) was shown to be effective in restoring breathing and circulation. These clinical advances led to the Copyright © National Academy of Sciences. All rights reserved. This executive summary plus thousands more available at Emergency Medical Services: At the Crossroads EMERGENCY MEDICAL SERVICES AT THE CROSSROADS realization that rapid response of trained community members to emergency situations could significantly improve patient outcomes. Over time, local communities began to develop more sophisticated EMS capacity, although there was significant variation nationwide. Increased recognition of the importance of EMS in the 1970s led to strong federal leadership and funding that resulted in considerable advances, including the nationwide adoption of the 9-1-1 system, the development of a professional corps of emergency medical technicians (EMTs), and the establishment of more organized local EMS systems. Federal funding for EMS, however, declined abruptly in the early 1980s. Since then, the push to develop more organized systems of EMS delivery has diminished, and EMS systems have been left to develop haphazardly across the United States. There is now enormous variability in the design of EMS systems among states and local areas. Nearly half of these systems are fire-based, meaning that EMS care is organized and delivered through the local fire department. Other systems are operated by municipal or county governments or may be delivered by private companies, including for-profit ambulance providers and hospital-based systems. Adding to this diversity, there are more than 6,000 9-1-1 call centers across the country, each run differently by police, fire, county or city government, or other entities. Given the wide variation in EMS system models, there is broad speculation about which systems perform best and why. However, there is little evidence to support alternative models. For the most part, systems are left to their own devices to develop the arrangement that appears to work best for them. Fire-based systems across the United States are in transition. The number of fires is decreasing while the number of EMS calls is increasing, raising questions about system design and resource allocation. An estimated 80 percent of fire service calls are now EMS related. While there is little evidence to guide localities in designing their EMS systems, there is even less information on how well any system performs and how to measure that performance. A key objective of any EMS system is to ensure that each patient is directed to the most appropriate setting based on his or her condition. Coordination of the regional flow of patients is an essential tool in ensuring the quality of prehospital care, and also plays an important role in addressing systemwide issues related to hospital and trauma center crowding. Regional coordination requires that many elements within the regional system—community hospitals, trauma centers, and particularly prehospital EMS—work together effectively to achieve this common goal. Yet only a handful of systems around the country coordinate transport effectively. There is often very little information sharing between hospitals and EMS regarding emergency Copyright © National Academy of Sciences. All rights reserved. Assignment: Public Health System Interface This executive summary plus thousands more available at Emergency Medical Services: At the Crossroads SUMMARY and trauma center patient loads or the availability of emergency department (ED) beds, operating suites, equipment, trauma surgeons, and critical specialists—information that could be used to balance the patient load among EDs and trauma centers in a region. The benefits of better regional coordination of patients have been demonstrated, and the technologies needed to facilitate such approaches currently exist. Strengths of the Current System EMS care has made important advances in recent years. Emergency 9?1?1 services now link virtually all ill and injured Americans to immediate medical response; through organized trauma systems, patients are transported to advanced, lifesaving care within minutes; and advances in resuscitation and lifesaving procedures yield outcomes unheard of a decade ago. Automatic crash notification technology, while still nascent, allows for immediate emergency notification of crashes in which vehicle air bags have deployed. And medical equipment, including air ambulance service, has extended the care available to emergency patients, for example, by bringing rural residents within closer range of emergency and trauma care facilities. Systemic Problems Despite the advances made in EMS, sizable challenges remain. At the federal policy level, government leadership in emergency care is fragmented and inconsistent. As it is currently organized, responsibility for prehospital and hospital-based emergency and trauma care is scattered across multiple agencies and departments. Similar divisions are evident at the state and local levels. In addition, the current delivery system suffers in a number of key areas: • Insufficient coordination—EMS care is highly fragmented, and often there is poor coordination among providers. Multiple EMS agencies—some volunteer, some paid, some fire-based, others hospital or privately operated—frequently serve within a single population center and do not act cohesively. Agencies in adjacent jurisdictions often are unable to communicate with each other. In many cases, EMS and other public safety agencies cannot talk to one another because they operate with incompatible communications equipment or on different frequencies. Coordination of transport within regions is limited, with the result that the management of the regional flow of patients is poor, and patients may not be transported to facilities that are optimal and ready to receive them. Communications and handoffs between EMS and hospital personnel are frequently ineffective and omit important clinical information. Copyright © National Academy of Sciences. All rights reserved. This executive summary plus thousands more available at Emergency Medical Services: At the Crossroads EMERGENCY MEDICAL SERVICES AT THE CROSSROADS • Disparities in response times—The speed with which ambulances respond to emergency calls is highly variable. In some cases this variability has to do with geography. In dense population centers, for example, the distances ambulances must travel are small, but traffic and other problems can cause delays, while rural areas involve longer travel times and sometimes difficult terrain. Determining the most effective geographic deployment of limited resources is an intrinsic problem in EMS. But speed of response is also affected by the organization and management of EMS systems, the communications and coordination between 9-1-1 dispatch and EMS responders, and the priority placed on response time given the resources available. • Uncertain quality of care—Very little is known about the quality of care delivered by EMS. Assignment: Public Health System Interface The reason for this lack of knowledge is that there are no nationally agreed-upon measures of EMS quality and virtually no accountability for the performance of EMS systems. While most Americans assume that their communities are served by competent EMS systems, the public has no idea whether this is true, and no way to know. • Lack of readiness for disasters—Although EMS personnel are among the first to respond in the event of a disaster, they are the least prepared component of community response teams. Most EMS personnel have received little or no disaster response training for terrorist attacks, natural disasters, or other public health emergencies. Despite the massive amounts of federal funding devoted to homeland security, only a tiny proportion of those funds has been directed to medical response. Furthermore, EMS representation in disaster planning at the federal level has been highly limited. • Divided professional identity—EMS is a unique profession, one that straddles both medical care and public safety. Among public safety agencies, however, EMS is often regarded as a secondary service, with police and fire taking more prominent roles; within medicine, EMS personnel often lack the respect accorded other professionals, such as physicians and nurses. Despite significant investments in education and training, salaries for EMS personnel are often well below those for comparable positions, such as police officers, firefighters, and nurses. In addition, there is a cultural divide among EMS, public safety, and medical care workers that contributes to the fragmentation of these services. • Limited evidence base—The evidence base for many practices routinely used in EMS is limited. Strategies for EMS have often been adapted from settings that differ substantially from the prehospital environment; consequently, their value in the field is questionable, and some may even be harmful. For example, field intubation of children, still widely practiced, has been found to do more harm than good in many situations. While some recent research has added to the EMS evidence base, a host of critical clinical questions remain unanswered because of limited federal research support, as well as inherent difficulties associated with prehospital research due to Copyright © National Academy of Sciences. All rights reserved. This executive summary plus thousands more available at Emergency Medical Services: At the Crossroads SUMMARY its sporadic nature and the difficulty of obtaining informed consent for the research. The committee addresses these problems through a series of recommendations that encompass a wide range of strategic and operational issues, from workforce training, to additional investment in research, to the development of national standards for EMS system performance. CHARGE TO THE COMMITTEE The Committee on the Future of Emergency Care in the United States Health System was formed by the Institute of Medicine (IOM) in September 2003 to examine the emergency care system in the United States; explore its strengths, limitations, and future challenges; describe a desired vision of the system; and recommend strategies for achieving that vision. The committee was also tasked with taking a focused look at the state of hospital-based emergency care, prehospital emergency care, and pediatric emergency care. This report, one of a series of three, is focused on the committee’s findings and recommendations with respect to prehospital EMS. ACHIEVING THE VISION OF A 21ST-CENTURY EMERGENCY CARE SYSTEM Assignment: Public Health System Interface While today’s emergency care system offers significantly more medical capability than was available in years past, it continues to suffer from severe fragmentation, an absence of systemwide coordination and planning, and a lack of accountability. To overcome these challenges and chart a new direction for emergency care, the committee envisions a system in which all communities will be served by well-planned and highly coordinated emergency care services that are accountable for their performance. In this new system, dispatchers, EMS personnel, medical providers, public safety officers, and public health officials will be fully interconnected and united in an effort to ensure that each patient receives the most appropriate care, at the optimal location, with the minimum delay. From the patient’s point of view, delivery of services for every type of emergency will be seamless. The delivery of all services will be evidence-based, and innovations will be rapidly adopted and adapted to each community’s needs. Ambulance diversions—instances where crowded hospitals essentially close their doors to new ambulance patients—will never occur, except in the most extreme situations. Standby capacity appropriate to each community based on its disaster risks will be embedded in the system. The performance of the system will be transparent, and the public will be actively engaged in Copyright © National Academy of Sciences. All rights reserved. This executive summary plus thousands more available at Emergency Medical Services: At the Crossroads EMERGENCY MEDICAL SERVICES AT THE CROSSROADS its operation through prevention, bystander training, and monitoring of system performance. While these objectives involve substantial, systemwide change, they are achievable. Early progress toward the goal of more integrated, coordinated, regionalized emergency care systems has become derailed over the last 25 years. Efforts have stalled because of deeply entrenched political interests and cultural attitudes, as well as funding cutbacks and practical impediments to change. These obstacles remain today, and they represent the primary challenges to achieving the committee’s vision. However, the problems are becoming more apparent, and this provides a catalyst for change. The committee calls for concerted, cooperative efforts at multiple levels of government and the private sector to finally break through and achieve the goals outlined above. Presented below are the committee’s findings and recommendations for achieving its vision of a 21st-century emergency care system. Federal Lead Agency Responsibility for all aspects of emergency care is currently dispersed among many federal agencies within the Department of Health and Human Services, Department of Transportation, and Department of Homeland Security. This situation reflects the unique history and the inherent nature of emergency care. Assignment: Public Health System Interface As described above, unlike other sectors of the medical provider community, EMS has one foot planted firmly in the public safety community, along with police, fire, and emergency management. In addition, the early development of the modern EMS system grew out of concerns regarding the epidemic of highway deaths in the 1960s. Thus while EMS is a medical discipline, the National Highway Traffic Safety Administration became its first federal home, and it has remained the informal lead agency for EMS ever since. The need for a formal lead agency for emergency care has been promoted for years, and was highlighted in the 1996 report of the National Highway Traffic Safety Administration Emergency Medical Services Agenda for the Future. In 2005, the Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU) gave statutory authority to what had been an informal planning group, the Federal Interagency Committee on EMS (FICEMS). While this group holds promise for improving coordination across federal emergency care agencies, the committee sees it as a valuable complement to but not a substitute for a lead agency, as some have suggested it should be. The committee believes a true federal lead agency is required if its vision of a coordinated, regionalized, and accountable emergency care system is to be fully realized. It therefore recommends that Congress establish a lead agency for emergency and trauma care within 2 … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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