EMS System Regionalization

In the United States, the emergency medical services (EMS) system is a network of healthcare resources that delivers acute unscheduled care to patients outside of a hospital. The system closely interfaces with the rest of the healthcare infrastructure, including in-hospital components, outpatient clinics, and public health. These services vary in capabilities, with some healthcare providers able to offer basic life support and others able to offer advanced life support or air medical services. A key characteristic of EMS is regionalization, ensuring that patients are transported to hospitals that are best capable of treating their medical needs, even if it is not the local hospital in the ambulance's jurisdiction. Regionalization of care refers to organizing healthcare delivery so that high-acuity or specialized patients are directed to facilities with the appropriate resources, often within a geographical network. The most common reasons for bypassing local hospitals include transport to specialized hospitals hosting designated stroke centers, trauma centers, ST-elevation myocardial infarction (STEMI) centers, and burn centers, among others. Regionalization of emergency medical care has become the standard of care in recent years, supported by evidence showing improved patient outcomes, reduced overall resource utilization, and reduced costs. However, the success of a regionalized system requires constant quality assurance from all stakeholders, including the EMS medical director. EMS physicians play a crucial role in ensuring that the system meets the needs of patients in their region while educating other healthcare providers on the importance of regionalization. For example, hospital administrators may prioritize retaining patients within their facilities to support operational sustainability, and EMS operations may favor shorter transports to improve unit availability and response times. Therefore, the EMS medical director must help different stakeholders interface effectively and ensure that the medical needs of the ambulance-arrived patient are the primary focus. An effective regionalized prehospital system separates hospitals into different levels based on their ability to treat specific emergencies. This process involves 2 key steps—categorization and designation of hospitals. Categorization is the process of classifying hospitals based on their capabilities, whereas designation is the process of formally selecting hospitals to receive patients who need specific, specialized care. Professional bodies often set categorization, whereas governmental agencies typically set designation. The need for categorization and designation emerged from the understanding that not every hospital can be equipped to manage the full spectrum of medical emergencies, particularly those requiring highly specialized resources and personnel. For example, a patient with a time-sensitive condition, such as severe trauma, requires specialty services for hemorrhage control and blood transfusions without delay. Categorization and designation help to ensure that patients are transported to the most appropriate hospital with verified capabilities to treat their medical condition.