Читать книгу Emergency Medical Services - Группа авторов - Страница 19

By 1973, several major lessons had emerged from the demonstration projects and the various studies undertaken during the preceding 7 years. Although federal activities had been limited to the 1968 DHEW regional demonstration projects mentioned earlier, significant progress had been made. The projects proved that a regional EMS system approach could work. However, because systems research was not a component of the DHEW program, the demonstration projects did not prove that a regional approach, or for that matter any particular approach, was more effective than another.

Many national organizations supported further federal involvement, both in establishing EMS program goals and in providing direct financial support. After several attempts at passing federal EMS legislation, a modified EMS bill was passed with support from numerous public and professional groups. President Nixon vetoed this bill in August 1973, based on the conservative philosophy that EMS was a service that should be provided by local government, and the federal government should neither underwrite operations nor purchase equipment. Additional congressional hearings led to the reintroduction of a bill proposing an extensive federal EMS program, based on the rationale that individual communities would not be able to develop regional systems without federal encouragement, guidelines, and funding. Finally, in November 1973, the Emergency Medical Services Systems Act was passed and signed. It was added as Title XII to the Public Health Service Act, to address EMS systems, research grants, and contracts. It also added a new section to the existing Title VII concerning EMS training grants [31].

The law was reauthorized in 1976, 1978, and 1979, with a continuing goal to encourage development of comprehensive regional EMS systems throughout the country. The available grant funds were divided among the four major portions of the EMS Systems Act: Section 1202 – Feasibility studies and planning; Section 1203 – Initial operations; Section 1204 – Expansion and improvement; and Section 1205 – Research. Applicants were encouraged to build on existing health resources, facilities, and personnel. The EMS regions were ultimately expected to become financially self‐sufficient. Therefore, a phase‐out of all federal funding initially targeted for 1979 was extended to 1982. This EMS program was administered in DHEW through the Division of Emergency Medical Services, with David Boyd, the medical director of the Illinois demonstration project, named as director. The law and subsequent regulations emphasized a regional systems approach, a trauma orientation, and a requirement that each funded system address the 15 “essential components” (Box 1.2). Medical oversight was not one of the 15 components, although subsequent regulations encouraged and then required medical oversight.