Emergency care regionalization

The practice of EMS medicine will bring the EMS physician into contact with systems of care of varying sizes. EMS systems witness and must manage the breadth of unscheduled, often emergency, out-of-hospital care for patients. The provision of optimal care for these patients often requires the use of specialty referral centers. The transport of a patient with a "time-critical diagnosis" (such as major trauma, acute stroke, or ST-elevation myocardial infarction) to the appropriate receiving facility requires regionalization of care in geographic areas, providing for a designation process that ensures the quality of care. This chapter examines the history of the development of regionalization of EMS systems, giving attention to the processes of categorization and facility designation. The evolution of the law giving way to authorization and requirements for these processes is addressed, with specific discussion regarding the bypass of hospital facilities by EMS agencies, with attention to the perplexing issue of hospital diversion that is so pervasive in many systems today. Finally, a proposal for the "optimal emergency medical care system" will provide essential elements and steps necessary to create a successful, functioning system that optimizes patient care, financial resources, and fairness to all members of the emergency medical care system.