Administration and Leadership

Recommendations for a National Trauma Care System from IAEMSC 2016

IAEMSC trauma recommendations
James Robinson Dr. David Marcozzi prepare to deliver their presentation entitled: "Where you Live Should Not Determine IF You Live." Photo Lawrence Tan

Day two of the International Association of EMS Chief’s (IAEMSC) 2016 EMS Leadership Summit included a notable presentation on the National Academies’ recommendation for a national trauma care system. 

The report, titled “Where you Live Should Not Determine IF You Live: Implementing the National Academies’ Recommendations on Translating Military Trauma Lessons Learned to the Civilian Sector,” was presented by James Robinson and Dr. David Marcozzi. Robinson is the IAEMSC Immediate Past President and Assistant Chief of Denver Health EMS. Marcozzi is an associate professor and Director of Population Health for the Department of Emergency Medicine at the University of Maryland.

The National Academies report identified that there is no federal civilian health lead for trauma care (including prehospital, in-hospital and post-acute care), despite past recommendations that such a lead agency be established. The report concluded that the collection and integration of trauma data across the care continuum is incomplete in both the military and civilian sectors. As an analogy, a worldwide network of ATMs exists and can provide users with account balances anywhere in the world, yet EMS cannot send medical data to a receiving facility from across the street.

Despite its significant societal burden, civilian investment in trauma research is not commensurate with the importance of injury. Trauma care and research is grossly underfunded at the National Institutes of Health (NIH). In both the military and civilian sectors, performance transparency at the provider and system levels is lacking. No process exists for benchmarking trauma system performance across the entire continuum of care within and between the military and civilian sectors.

The National Academies report concluded that the greatest opportunity to save lives after injury is in the prehospital setting. However, prehospital care is not currently linked to healthcare delivery reform efforts. The variable standards of care, a paucity of universal protocols and current reimbursement practices for civilian EMS (i.e., pay-for-transport) are major impediments to the seamless integration of prehospital care into the trauma care continuum. The panel made a recommendation that Congress, in consultation with the Department of Health and Human Services (HHS), should identify, evaluate and implement mechanisms that ensure the inclusion of prehospital care (e.g., EMS) as a seamless component of healthcare delivery rather than merely a transport mechanism.

The entire report with the recommendations for a national trauma system is available at