The Regionalization of Emergency Medical Services: a Strategy for Planning

The Regionalization of Emergency Medical Services: A Strategy for Planning and Intervention Shelley F. Bernstein E. Michael Paul Thomas Submitted to the Department of Urban Studies and Planning on May 23, 1975, in partial fulfillment of the requirements for the degreesof Bachelor of Science in the Department of Urban Studies and Planning and Master of City Planning. In response to increasing interest and concern about the quality of emergency medical services (EMS) among members of the medical community and the public at large, the Emergency Medical Services Systems Act of 1973 was passed overwhelmingly in Congress and enacted into law. The Act seeks to establish "EMS systems" on the substate regional level throughout the country. Although a body of literature exists that examines the regionalization of governmental functions from a normative perspective, little is known about the regional provision of such private sector functions as hospital emergency services. Moreover, the dynamic processes of implementing the regionalization of locally provided services has received only perfunctory attention, despite the likelihood of political and institutional reluctance to cooperate on a regional level. Finally, the creation of EMS systems requires the incorporation of service components from public sector, private sector, health and municipal institutions into an integrated regional service system. This study constitutes an exploratory effort at assessing the appropriateness of regional provision of EMS, identifying the critical aspects of implementing the regional scale of service, and understanding the process of creating a service system with components based in established institutional settings. In the context of the largely uncharted policy of the EMSS Act, this study examines the translation of the concept of regional systems into an attempt to actualize this form of EMS provision in an eight town area on the North Shore of Massachusetts. In the course of performing this case study, information was gathered from the files of the regional health planning agency on the North Shore, from an extensive set of interviews with involved parties in all aspects of EMS planning, provision, and decisionmaking, and from involvement in a critical series of meetings at which the institutional concerns of EMS providers were revealed in confrontation with the prospect of implementing a regional ambulance system. Throughout the research, the effects of present EMS provision within broader based institutions were encountered and analyzed. Particular emphasis was placed on investigation of the cost structure of service provision, the role which EMS played in furthering the goals of the institutions in which it was provided, and the values and incentive structures inherent to the diverse components of service. In these investigations, the critical issue at