Emergency medical services systems.

Overall, our view of Emergency Medical Services (EMS) is too constrained and limits services that could be provided. Some time ago, a friend remarked that EMS was unrelated to Disaster Medicine and, in fact, advised that the World Association for Disaster and Emergency Medicine (WADEM) and this journal (PDM) needed to concentrate either on Disaster Medicine OR EMS. More recently, this same friend came to understand that Disaster Medicine could not work effectively and efficiently without the services provided by an EMS System. The key word was "system". A system is defined as: a regularly interacting or interdependent group of items forming a unified whole. The question is: What constitutes the "whole?" The late Dr. Peter Safar, in his pioneering work with the development of the Pittsburgh EMS System, envisioned the system as a continuum beginning with entry into the system until discharge. But, today, the "whole" is even broader than initially conceived by Dr. Safar. The system now encompasses public health, raising awareness, needs assessments, emergent clinic visits, communicators and communications centers, education and training, hospital receiving facilities, and primary health care. Unfortunately, as my friend initially believed, almost all of the established healthcare systems have come to view EMS as the prehospital emergency response to, assessment of, treatment of, and transport of someone who calls for medical assistance. This is a very narrow perspective: the broad sweep that should encompass EMS has been lost, and EMS systems worldwide have become fragmented and isolated. The systems have been deconstructed into their various components. This isolated, prehospital perception of Emergency Medical Services undoubtedly biased my friend's perception of the role of EMS in the world of Emergency and Disaster Medicine. Furthermore, in many countries and in particular in the US, the same deconstruction of EMS systems has been happening to the other components of the EMS system, e.g., emergency medicine, emergency nursing, and critical medicine and nursing, and especially public health and primary health care. Consequently, it is difficult to comprehend the broad scope of EMS Systems. Given this narrow view, it has been difficult to obtain the resources necessary to fund EMS systems. Generally, funding has been made available only for those services in the system that have high visibility. Other less visible components have been under-appreciated and continue to be under-funded. A lack of adequate support further spurs the parochialism that has resulted from fragmentation. Components and their respective processes now fight for their own individual existence. We have lost the system concept. This dissection of the "system" into a few of its components has spread into the scope of the education and training provided. These educational and training programs now limit the scope of what is being taught. The educational goals are confined with little added appreciation of the whole system. The committed personnel that comprise the system constitute a huge, under-utilized resource. Furthermore, such practices interfere with the professionalization of the broader discipline. There are many benefits that can be accrued by broadening the scope of what is taught and how it is practiced. The scope of what is taught and provided should encompass those services that meet more of the specific and potential needs of the communities they serve. The result would be the provision of services that currently are not being provided or for which access is limited. Such practices should better meet the public health needs of the society, including an enhanced level of preparedness to cope with all of the hazards for which the society is at risk. Emergency Medical Services systems should provide the front line of defense through the provision of surveillance, immunizations, enhancing awareness, as well as response once the event occurs. As such, they should be an important component of public health.