Federal Involvement in EMS Begins
Accidental Death and Disability called for improving prehospital trauma care.29 As a result, Congress passed the Highway Safety Act in 1966, which established the National Highway Traffic Safety Administration (NHTSA) within the Department of Transportation. Because motor vehicle crash injuries constituted a substantial proportion of the EMS patient load, NHTSA was charged with improving EMS systems by administering grants for ambulance purchases, communications systems, and training programs, and with supporting other traffic related system improvements. NHTSA furthered its role in the advancement of prehospital care by developing national standard curricula for the education of EMS personnel and by lending its foresight, leadership, and commitment to the development of EMS systems.
In 1973, Congress enacted the EMS Systems Act (Public Law 93-154). This Act provided funding for the development of regional EMS systems and authorized a program of research in emergency techniques, methods, devices and delivery. The National Center for Health Services Research (NCHSR), predecessor to the Agency for Healthcare Research and Quality (AHRQ), was responsible for administering this applied research effort. Between 1974 and 1981, the NCHSR supported approximately 50 EMS demonstration projects.
In 1984, Congress established the federal EMS for Children (EMSC) program as a demonstration grant co-sponsored by NHTSA and housed in the Maternal and Child Health Bureau. The Institute of Medicine issued a 1993 report on EMS for children that identified several priority areas, including a call for additional data collection, evaluation and research.4 Since the report was issued, the EMSC program has played a valuable part in advancing the cause of EMS research and in establishing directions for the future of EMS for children. In addition to providing funding and leading EMS initiatives, the program has developed a consensus document of research priorities, including identifying appropriate outcomes.33
In January 2001, seven federal agencies participated on an interagency program announcement, PA-01-044, titled Emergency Medical Services for Children Research. The topics to be studied include asthma, traumatic brain injury, and violence prevention. HRSA's other federal partners in this effort (besides the Agency for Healthcare Research and Quality) were the National Institute for Occupational Safety and Health at the Centers for Disease Control and Prevention, as well as the National Heart, Lung and Blood Institute, National Institute for Child Health and Human Development, National Institute on Drug Abuse, National Institute of Mental Health, and the National Institute of Nursing Research, all from the National Institutes of Health.
Other EMSC initiatives providing funding for EMS research include the support of the development of a National EMS Database jointly with NHTSA, awards to promote pediatric patient safety research in EMS, and the EMSC Network Development Demonstration Project (NDDP) Cooperative Agreement Grant (CDA#93.127L). The $1.8 million NDDP grant is being supported by the EMSC program in collaboration with the Division of the Research, Training and Education of the Maternal and Child Health Bureau. NDDP will support the best proposals to create research networks for performing high quality collaborative research on EMSC topics. Each research node will collect data from participating EDs in its area in order to get answers to pediatric emergency care research questions which were previously difficult to obtain.