2000 200-city survey. Operational & clinical EMS trends in large, urban areas.

: The year's survey illustrated ongoing stability with respect to providers and operational approaches, and explored relationships that could provide opportunities for improvement. The continued use of hot response to every request for service is a high-risk response strategy. Today's EMD protocol systems can enable systems to safely prioritize requests for service. Response time performance reported by measure interval and averaged response time, while appearing to follow a rational model for transportation providers, fell short with respect to first responder response times which appeared to have no correlation with response clock start times. A possible explanation for this difference is the lower percentage of first responder agencies that are subject to external response-time performance review. The medical direction results suggest an investment in a full-time medical director could reduce online medical control requirements. The use of handheld computing technology could serve as a vehicle for building accurate clinical databases, as well as a means to deliver DS technology to the patient's bedside. Use of this technology could also improve reimburesment through more accurate reporting. The future of EMS has enormous challenges that must be overcome, especially in light of reduced health-care insurance reimbursements. However, these challenges also present an opportunity for EMS to reinvent itself. The capture and analysis of operational and clinical data by EMS systems will prove essential to understanding what changes can be made to enable them to meet future demands.