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Standing at the Crossroads (Again)

This is not the first time we've featured a cover report that focuses on the "crisis" in EMS. In October 2004, Associate Editor John Erich wrote about the state of the industry, highlighting the problem areas that emerged from an EMS Issues Summit conducted by ACEP in May 2004. These included system integration failures, recruitment and retention problems, a shortage of comprehensive data on EMS systems operations, a deficit of funding and EMS-supportive legislation, and a paucity of patient-care related performance measures. Following that report, Erich documented the issue of the disappearing EMS workforce (March 2005), the question of which federal agency is most qualifed to lead EMS (August 2005) and the negative impact of ambulance diversions on EMS systems' performance (May 2006).

With the recent release of the Institute of Medicine's (IOM) report on the state of the EMS industry, Emergency Medical Services at the Crossroads, it feels like deja vu all over again. Will we ever solve the multitude of problems facing the EMS profession?

In EMS & Its Midlife Crisis, starting on page 40, Erich summarizes the main recommendations of the IOM report, which include the creation of a lead federal EMS agency under the Department of Health and Human Services, improved regionalization to match up patients with resources, development of evidence-based indicators for EMS systems, endorsement of a national scope of practice for EMS personnel, development of integrated and interoperable communications and data systems, increased resources to assist EMS systems in responding to both natural and manmade disasters, and an increased focus on prehospital-based research. But what does all of this mean? How many more articles can we print that talk about what needs to be changed before anything is changed? The IOM has an ambitious timeline in place for some of its recommendations, suggesting that they be implemented within 18 months! With change in EMS usually moving at glacial speed, it seems hard to imagine that these problems will be resolved by the end of 2007. At best, what we can hope for is that this report shines a long-awaited spotlight on an industry that, despite its many challenges, has managed to stay afloat primarily through the dedication of the folks who provide EMS care. Hopefully, the movers and shakers in our nation's capital will read the report and take the recommendations seriously-after all, lives depend on it.

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