Navigating NHTSA: An Interview with Drew Dawson

Drew Dawson is chief of the National Highway Traffic Safety Administration's (NHTSA's) EMS Division. While he supervises a surprisingly limited staff, Dawson has seemingly limitless oversight duties and responsibilities as head of the only national governmental office dedicated solely to prehospital emergency medical operations. Previously EMS director for Montana, he has also served as chair of the National Association of State EMS Directors (NASEMSD).

The existence and/or formation of a lead federal EMS agency is being actively debated at multiple levels of the industry these days, with various national EMS and fire associations taking sides and making definitive statements about their views on the past, present and future of EMS. Although NHTSA's EMS Division has promulgated such documents as the EMS Agenda for the Future, there are strong arguments that a national EMS agency might be better situated within the Department of Homeland Security (DHS) or the Department of Health and Human Services (DHHS).

In this month's column I spoke with Dawson regarding these issues, as well as NHTSA's impact on today's EMS systems.

Have the strident debates that began in 2005 regarding the location--or relocation--of a lead federal EMS agency made you re-evaluate your division's role in the industry?
We welcome constructive, factual debates about the federal government's role in emergency medical services. We all learn and improve from the discussion of divergent viewpoints. The debates have further energized NHTSA's long-standing commitment to help support the nation's EMS system, to build consensus among our federal and national partners, and to fund significant national projects that have a positive impact on EMS. EMS is, and always has been, a part of NHTSA's core function. We continue to keep an open mind about opportunities for improvement. We are looking forward to reviewing the independent, objective and science-based Institute of Medicine report, The Future of Emergency Care in the United States Health System, scheduled for release this spring.

Although the debates have predominantly focused on NHTSA, there are several federal programs whose resources and talents have long been essential to improving our nation's EMS system. Among our federal partners, the debates have reinforced what we've always known: We are not in competition with each other, but rather we work together in a coordinated manner--tapping each other's talent, expertise and resources; cooperating with each other rather than building silos around our respective programs.

The debates often illustrate that there is not always widespread awareness of our projects at NHTSA. Therefore, we have resolved to communicate more effectively via websites, publications and continuing our verbal avenues of communications. We will also continue to involve the national EMS community in consensus-based projects and identify additional, and perhaps more formal, opportunities for input to the federal programs.

The "old" Federal Interagency Committee on Emergency Medical Services has always been an opportunity for interested federal agencies to share information with federal and non-federal colleagues. The "new" FICEMS is much different in several ways:

1. It is created by law, clearly signaling the intent of Congress for strong federal collaboration in supporting emergency medical services;
2. It is required to submit an annual report to Congress;
3. Its membership consists of high-level officials of each of the named federal agencies;
4. It has specific responsibilities to state, local, tribal and regional EMS agencies required by law, including:

1. Ensuring coordination among the federal agencies;
2. Identification of needs for both EMS and 9-1-1;
3. Recommendation of new expanded programs--including grant programs--for improving emergency medical services and implementing improved EMS communications technologies, including wireless 9-1-1;
4. Identification of ways to streamline the process through which federal agencies offer support; and
5. Assisting in setting priorities based on identified needs and advising, consulting and making recommendations on matters regarding implementation of coordinated state EMS programs.

NHTSA is required to provide staff support (in cooperation with DHHS and DHS) to FICEMS, including scheduling meetings, setting agendas, keeping minutes and records, and producing reports. We are also working with our federal partners to explore opportunities for more formal non-federal input to FICEMS.

What are some of the projects that NHTSA's EMS Division is currently working on?Are there plans to update the EMS Agenda for the Future, now 10 years old?

The EMS Agenda for the Future, a consensus-based national EMS vision, has spawned a number of significant national projects, many of which are co-funded by the Health Resources and Services Administration's Emergency Medical Services for Children program (EMSC) and the Centers for Disease Control and Prevention's Division of Injury Response. We currently have interagency financial agreements with the CDC, EMSC and the U.S. Fire Administration. Some current projects include:

• National EMS Information System (NEMSIS)--The absence of solid data continues to thwart EMS system development at local, state and federal levels. The hope is that in time, all EMS field providers in the country will be able to provide a limited amount of data from each EMS response so that a vast amount of data can be collected and analyzed to help direct future EMS research and funding--something that has never been possible in the past. The national EMS database will be housed at NHTSA's National Center for Statistics and Analysis (NCSA).
  
• National EMS Scope of Practice Model--A component of the EMS Education Agenda for the Future: A Systems Approach, the National EMS Scope of Practice Model defines the various levels of out-of-hospital EMS personnel and the skills and knowledge each must possess. It will guide the development of national EMS education standards and serve as a model for state EMS personnel licensing.
  
• National EMS education standards--The national EMS education standards will be developed by the National Association of EMS Educators. These standards, which will eventually replace the DOT National Standard Curricula, will provide the learning objectives necessary for successful program completion for each personnel level identified in the Scope of Practice Model.
  
• EMS Work Force for the 21st Century--The goal of this initiative is to promote a sufficient, stable and well-trained work force for the future of EMS in the United States. The project will include assessment, projections and modeling, as well as development of strategies to assure a sufficient work force. Provider safety and wellness will be addressed, as will leadership development.
  
• EMS Medical Director/Public-Health Integration Primer--A key concept presented in the EMS Agenda for the Future is the integration of community EMS systems with local public-health systems. NHTSA and NAEMSP will work cooperatively with the National Association of County and City Health Officials (NACCHO) and a multidisciplinary task force to develop a primer to enhance the understanding, appreciation, coordination and collaboration between local EMS medical directors and public-health officials.
  
• EMS Research Agenda--As recommended in both the EMS Agenda for the Future and the EMS Agenda for the Future Implementation Guide, NHTSA and Emergency Medical Services for Children initiated development of the National EMS Research Agenda. The Research Agenda is completed and is currently available on NHTSA's website and in hard copy. The next step in this process was the development of a National EMS Research Strategic Plan, including a listing of research priorities. This document was published in Prehospital Emergency Care (July/September 2005). Next steps include addressing the ethical/informed consent/community consultation issues related to EMS research.
  
• Feasibility study for EMS work force safety and health surveillance system--There is limited information about the occupational risks associated with working in the prehospital environment. NHTSA's Office of Research and Technology has contracted with Bedford Research Inc. to determine the feasibility of developing a national EMS worker injury surveillance system. NHTSA's EMS Division will coordinate the input of national EMS stakeholder organizations throughout the course of this project.
  
• EMS and technology--Many new technologies hold great potential for application in emergency medicine and the improvement of emergency care. To date, however, most technologies are developed independently, leaving those who deliver emergency care to determine how to incorporate them into their current practice. Through an initiative coordinated by the National Association of EMS Physicians, this project will link individuals, associations and educational institutions having extensive EMS knowledge with developers of multiple kinds of technologies to increase national EMS community involvement in evaluating the clinical utility of technology before it is deployed in EMS.
  
• Preparedness activities--NHTSA EMS is working closely with the Department of Homeland Security on a variety of projects including a National Emergency Responder Credentialing System EMS Working Group, Targeted Capabilities List revision and Emergency Services Sector-Government Coordinating Council. The U.S. Fire Administration and NHTSA have jointly funded national incident management training for fire and for EMS personnel. NHTSA EMS is working with the Department of Health and Human Services regarding Emergency Support Function 8 coordination.

Forty years after the publication of Accidental Death and Disability: The Neglected Disease of Modern Society by the prestigious National Academy of Sciences/National Research Council, the Institute of Medicine is publishing The Future of Emergency Care in the United States Health System, an independent scientific analysis of emergency care, including prehospital emergency medical services. Rather than revise the Agenda for the Future, NHTSA and its federal partners are committed to a thorough review of the IOM report as a basis for future activities.

For more information regarding these and other projects of NHTSA's EMS Division, visit www.nhtsa.gov (look for "Emergency Medical Services" on the Traffic Safety subpage), or call 202/366-5440.