State of California - NHTSA Assessment of California EMS System

I am pleased to transmit to each of you the assessment of Emergency Medical Services completed on August 26, 1999 by a Technical Assistance Team assembled by the National Highway Traffic Safety Administration (NHTSA). I am extremely impressed with the product they produced, as well as in the short period of time it was accomplished.

Much of what has been recommended mirrors efforts of the EMSA 1998 Vision effort which culminated with a December 3-4, 1998 conference in San Francisco. There are a total of 90 recommendations, some of which are partially duplicated. Of these, 44 are priority recommendations identified in bold italics.

Recommendations were made in the ten system component areas, plus disaster systems, which we had requested. The recommendations in each area are as follows:

Regulations and Policy, 14 recommendations (of which 8 are priority);
Resource Management, 12 recommendations (5 priority);
Human Resources and Training, 6 recommendations (4 priority);
Transportation, 5 recommendations (2 priority);
Facilities, 6 recommendations (3 priority);
Communications, 14 recommendations (6 priority);
Trauma Systems, 4 recommendations (1 priority);
Public Information and Education, 5 recommendations (2 priority);
Medical Direction, 11 recommendations (7 priority);
Evaluation, 9 recommendations (4 priority); and
Disaster Systems, 4 recommendations (2 Priority).

Each of these components has three sections. The first is "Standard." This delineates the NHTSA goal to strive for, which has not necessarily been reached. The second is "Status." This is the Technical

Assistance Team's judgement on where emergency medical care is at this time in California. Finally, there is the section on "Recommendations." Of the total 90 recommendations, there are some that are partially duplicative. For instance, the recommendation for a State Medical Director appears three times (in Regulation and Policy, Resource Management, and in Medical Direction).

A matrix of the recommendations and proposed disposition is attached. EMSA staff has performed a preliminary evaluation of these recommendations with the goal of determining at least the following:

Which recommendations can be implemented at this time, under current authority, with the cooperation of EMSA, the local EMS Agencies, and our EMS constituent groups.
Which recommendations need to be referred to the Vision process.
Which Vision Committees should get which recommendations.
Which recommendations require funding (we are now in the process of dealing with our EMSA budget for the next fiscal year).
Which recommendations require regulatory change.
Which recommendations will require legislation.

It appears to me that we can, and should, begin working on many of the recommendations at this time.

By far, most of the recommendations will go to the Vision groups. The Vision process is now beginning, and is, as you all know, fully funded, including expenses paid for up to ten committee members and the Vision Group lead on each of the six Vision Committees. The Vision Committees are: Funding (which will receive a great number of the assessment recommendations since lack of funding was a recurrent theme throughout the assessment report); Governance and Medical Control (an area which had numerous innovative recommendations in the assessment report) ; Education and Personnel; System Review and Data; Access; and Prevention.

This NHTSA assessment further supports our continuing efforts to move EMS forward in California. We will rely upon you to take these recommendations under consideration, and in conjunction with the vision process, help shape a future that improves emergency medical care.

If you have any questions please contact me.