BOX 4-1Challenges Facing the Prehospital System

  • Absence of dedicated federal funding mechanisms
  • Communications capabilities
  • Weather impact on mobilization and deployment of resources
  • Acquisition and mobilization of supplies and assets
  • EMS human resources
    • Integration into healthcare delivery system
    • Recruitment and retention of personnel
    • Transitioning to paid staff to offset decreasing incentive to volunteer
    • Training and education (time, expense, availability of personnel)
    • Leadership
    • Physician participation (e.g., medical direction at the scene and hospital)
  • Trauma transport
    • Hospital availability and access (reaching care within the “golden hour”)
    • Personnel and equipment out of service for other calls during extended travel time
  • Risk assessment
    • Assessing likelihood and consequences of incidents
    • Defining the metrics or markers of success of preparedness
  • Political and cultural landscapes—Where does disaster preparedness fit?
  • Rural-urban paradox of prehospital care
  • Technologic idolatry (i.e., the belief that a technology-based approach is inherently better than one that is low- or no-tech)

From: 4, Challenges Facing the Prehospital System

Cover of Preparedness and Response to a Rural Mass Casualty Incident
Preparedness and Response to a Rural Mass Casualty Incident: Workshop Summary.
Institute of Medicine (US) Forum on Medical and Public Health Preparedness for Catastrophic Events.
Washington (DC): National Academies Press (US); 2011.
Copyright © 2011, National Academy of Sciences.

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