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Student Corner: The SAFR Model of Health Information Exchange

Student Corner is a bimonthly column discussing research projects and interest areas among current EMT and paramedic students. To be featured in this column, contact 

Two key events happened before I joined the emergency medical services family. One was newsworthy, and the other was personal. 

In 2009 Title XIII of the American Recovery and Reinvestment Act of 2009, also known as the Health Information Technology for Economic and Clinical Health (HITECH) Act, was passed. With the passage of this law, a federal mandate helped prompt healthcare providers to move from paper to electronic patient health records.

In December 2014 I started my first job out of college as a marketing representative for a cloud computing services provider and learned about the importance of deploying software through the cloud.

Access to patient information in the prehospital setting is essential in delivering quality, timely care. Improvements in mobile computing, secure communications, wireless technology, and virtual networking solutions like cloud computing are opening up new opportunities to improve decisions by EMS providers. Before digitization, EMTs and paramedics relied on a combination of information provided by the patient, caregivers, and family members to fill in gaps about the patient’s medical history, allergies, medications, and end-of-life treatment decisions on scene. Today providers can look up a patient’s medical records in real time using the SAFR (search, alert, file, and reconcile) health information exchange (HIE) model. The SAFR model is a step toward making accurate, informed care decisions as well as improved coordination of care with hospital providers.

What Is the SAFR Model?

The SAFR model was developed by the California Emergency Medical Services Agency (EMSA) in collaboration with the federal government’s Office of the National Coordinator for Health Information Technology (ONC). SAFR summarizes the workflow of navigating the software platform known as Patient Unified Lookup System for Emergencies (PULSE). A provider’s tablet accesses PULSE and connects to the hospital system’s database and networks. The PULSE platform enables the EMS provider to:

  • Search for the patient’s electronic health records for medical history, allergies, medications, and end-of-life decisions to inform care decisions in the field;
  • Alert the receiving hospital of the patient’s chief complaint, status, vital signs, and treatments rendered by the EMS provider;
  • File the EMS patient care report into the patient’s EHR to ensure the hospital has access to the information;
  • Reconcile treatment decisions to allow both the EMS provider and receiving hospital to improve care for the future.

SAFR in Action

Several pilots across the United States are putting SAFR to the test. A 2017 survey by the ONC found:1 

  • California piloted all four elements of SAFR in San Diego, Imperial, and Orange counties;
  • Colorado piloted the Search and Reconcile elements through 11 EMS agencies;
  • Oklahoma piloted the Search and File elements through three EMS agencies;
  • Two cities, Indianapolis, Ind., and Rochester, N.Y., piloted elements of the SAFR model in their own EMS systems.

Two years after ONC’s survey, California’s statewide HIE, Manifest MedEx, announced a $4.9 million grant to work with 13 EMS providers and 16 hospitals across nine counties to follow SAFR.2 

Measurement of the success of this model is ongoing by both the ONC and National Institutes of Health (NIH). Thus far, the NIH notes, a lack of consistent outcome measures and variation in study designs has prevented standardized data abstraction or synthesis.3 As each community implements the SAFR model, it is imperative for states and the federal government to study the common trends that led to success within those EMS systems and provide guidance around replicating them.


Giving EMS providers access to patient information on scene via mobile technology is critical not only in patient care but in coordination with receiving hospitals. While results from counties and cities conducting pilots of SAFR are limited, these experiments are a step in improving the collection, transmission, and maintenance of patient records. 


1. Office of the National Coordinator for Health Information Technology. Emergency Medical Services (EMS) Data Integration to Optimize Patient Care: An Overview of the Search, Alert, File, Reconcile (SAFR) Model of Health Information Exchange., 2017 Jan; 

2. Monica K. California HIE Receives $4.9M Grant to Connect to EMS Services. EHRIntelligence, 2019 May 9; 

3. Martin TJ, Ranney ML, Dorroh J, Asselin N, Sarkar IN. Health Information Exchange in Emergency Medical Services. Applied Clinical Informatics, 2018; 9(4). 

James Finn, NREMT, graduated from the University of California Los Angeles Center for Prehospital Care EMT course in fall 2019. He is a nationally registered EMT, writer, and marketing consultant based in Los Angeles. Learn more about his work at

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