The role of prehospital care providers in the advancement of public health.

The idea of providing out-of-hospital medical care and emergency transport to the public is a relatively new concept, gaining federal recognition in the late 1960s.1 The current structure of EMS systems is based on an amalgamation of several evolutions of this service as new technologies, public demands, and proposed or capricious systems of health care continue to emerge.2 Currently, EMS focuses on providing medical interventions to reduce morbidity and mortality associated with existing illness or injury. However, as EMS continues to evolve, its focus may broaden to include a variety of public health activities, including monitoring individual and community health, providing primary prevention programs, and participating in health systems coordination. Insuffi ciencies in the current healthcare system are also shifting the expectations of EMS from caring exclusively for an individual’s emergent medical needs to becoming more integrated in public health efforts focused on ensuring the organization of health surveillance, emergency preparedness, and community-based medical programs. EMS may be well suited for this evolution because it is the “frontline” of medical care for communities and provides interventions where disease and injury are fi rst encountered. An extension of this concept is the recent application of the “exception to informed consent” methodology to EMS interventional trials. In such trials, the public health perspective in emergency research is used (i.e., benefi cence to the critical patient and community atlarge, coupled with social justice, outweighs patient autonomy in select circumstances). This chapter will introduce the reader to broad areas of community-oriented public health that are (and will likely be increasingly) infl uenced by the day-to-day activities of EMS. Some of the discussion may seem futuristic, yet the structure and attributes of EMS systems place them in a unique position to infl uence public health at the state, community, and individual patient levels. The discussion will be organized from a public health perspective, incorporating essential services of local public health programs. The role of EMS in key public health priorities including education, emergency preparedness, healthcare coordination, and research will also be addressed.