With the certainty of gravity, the use of broadband wireless communication, high-speed data transmission and video imaging are currently available technologies that should be strongly considered by the Emergency Medical Service agencies of today for the applications of tomorrow. Rather than waiting for impending issues to overwhelm available resources, EMS entities must come to grips with how the pre-hospital industry will manage these newer technologies, putting them to use to improve service delivery in more cost-effective and efficient ways.

To illustrate this point, rather than discuss a broad range of technology-related topics, this article will restrict its focus to one important issue -- reducing the number of "unnecessary" or non-essential EMS transports. We will review the reasons why this is such an important issue, the obstacles and risks associated with remedying it, and a depiction of how technology may be used as part of the solution. Because we are exploring a new approach to an old problem, we will keep the focus more on the conceptual, rather than the details of actual implementation. We ask the reader to keep an open mind.

The State of EMS

The Institute of Medicine recently outlined the current state of hospital and pre-hospital services in the 2007 publications "Emergency Medical Services at the Crossroads" and "Hospital-Based Emergency Care - At the Breaking Point". This new "bible" for emergency care accurately reflects the growing crisis in the U.S. and provides a starting point for discussion of potential solutions. The "continuum of care" that exists to notify and disburse EMS workers, treat patients anywhere in a community, and provide safe travel to definitive care facilities, often involves unique partnerships between public and private entities. The assumption within this system is that each entity assumes responsibility to support the success of the next. As an essential component of the continuum therefore, it is incumbent upon pre-hospital providers to incorporate new methodologies whenever possible to reduce non-essential transports and other antiquated policies that adversely affect the emergency service system as a whole.

As is widely discussed, EMS agencies face a number of critical challenges in the contemporary world of emergency services. These include:

• High percentage of non- and under-insured patients
• ED overcrowding
• Reliance on 911 dispatch systems beyond the intended use
• High cost of service
• Inefficient use of existing resources
• Reduced morale resulting from increased call volumes and high stress
• Medical liability