200 city survey. JEMS 2001 annual report on EMS operational & clinical trends in large, urban areas.

This year's survey offered examples of evolving partnerships between the public and EMS providers with a growing number of systems implementing PAD programs. The apparent influence of a communication center's managing agency on prioritization strategies is concerning. However, further study is needed. EMS managers must pay careful attention to comm center practices and technology to ensure their ability to support response prioritization and the efficient management of EMS resources. The small reduction in the use of hot response (lights and siren) to every request for service is disappointing in light of medical literature and position statements that condemn this practice. Resource response can be safely prioritized using today's EMD protocol systems. Prioritization and changing response [figure: see text] time requirements to address impending revenue and service demand changes will require additional standardization of methodologies and reporting of response times to relate this measure to other system performance indicators (e.g., patient morbidity/mortality, cost, customer satisfaction, etc.). The future presents a difficult road for system administrators. However, the adoption of a growing number of information-management tools and changes in procedures and dispatch processes offer potential solutions. The increased use of hand-held computers or personal digital assistant (PDAs) to gather and provide information and the almost universal use of CAD will aid providers in performing the research necessary to change response time performance requirements, improving EMS system efficiency. Use of this technology will also likely improve patient care and reimbursement through more timely and accurate reporting and analysis. The medical director's role will be critical to ensuring potential changes don't compromise patient care. Obtaining a better understanding of how much time can safely elapse between the time of the 9-1-1 call and when patient-care activities commence will be an important component of future strategies. More sophisticated EMD, CAD and AVL technologies will also play an indispensable role in reforming system design and daily operations. In light of the events of Sept. 11 and events yet to occur, EMS managers and providers face significant operational challenges. Overcoming these challenges will require leadership, a willingness to question and change tradition and the ability to cope with the discomfort of changing demands and uncertainty. Maintaining the hard-fought successes of EMS will increasingly require more imagination and the willingness of current and future practitioners to study, develop and implement innovative approaches to addressing future requirements.