data definitions, and reporting requirements. There is also

difficulty linking prehospital data to hospital or outcomes

data.

..... Review and Evaluation

The care rendered by prehospital providers is overseen by a

physician medical director. Day-to-day operations generally

function using either "standing orders" (offline medical

control-protocols developed to guide patient care) or

online medical control (real-time telephone/radio communication with hospital personnel to answer clinical questions

or to receive orders). Protocols undergo periodic review for

updates based on changing system needs and current science. Proactive systems have robust continuous quality

Table 9-3. The "Simple Triage and Rapid Treatment"

(START) system.

Green (minor)

Yellow (delayed)

Red (immediate)

Black (deceased)

Care may be delayed (eg, non-l imbthreatening extremity trauma)

Will require urgent care (eg, hemorrhage

with signs of adequate perfusion)

Requires immediate care for life-threatening

injury (eg, severe hemorrhage or airway

compromise)

Either dead or mortally wounded, such that

dedication of any additional resources is

unl ikely to alter outcome

improvement processes, by which EMS data are used to

identify areas of the system in need of improvement .

..... Disaster Plan/Preparedness

Emergency response plans exist at local, state, and national

levels. Key features include provisions for interagency

communication and agreements regarding the optimal

allocation of limited resources when a system's capacity is

exceeded-a situation referred to as a mass casualty incident. In these situations, the "Simple Triage and Rapid

Treatment" (START) algorithm is a commonly employed

triage protocol used to assess severity of injury and to

assign transport priority. Providers assign 1 of 4 colors to

victims during an initial assessment focused on the ABCs

(Table 9-3).

..... Mutual Aid

Agreements among neighboring municipalities or EMS

services are common to bolster the capacity of a given

agency's emergency response system. Interagency communication and equipment interoperability are potential

challenges that need to be addressed in establishing such

relationships.

SUGGESTED READING

Emergency Medical Services: Clinical Practice and Systems

Overstght. National Association of EMS Physicians. Dubuque,

IA: Kendal/Hunt, 2009.

Mechem CC. Emergency medical services. ln: Tintinalli JE,