PATTERNS OF HOSPITAL INVOLVEMENT IN THE PLANNING AND IMPLEMENTATION OF SELECTED COMMUNITY EMERGENCY MEDICAL SERVICE SYSTEMS.

摘要

This study focused on various patterns of hospital involvement in the planning and implementation of selected community emergency medical services systems. Within that context, the emergence of emergency medical services as a recognized and accepted health problem versus a traditionally recognized transportation problem was discussed as well as the newly conceived regional approach for emergency medical services planning within the context of federal legislation.; An historical overview of the federal legislative developmental activities for emergency medical services was presented by a summation of the highlights of Public Law 93-154, and subsequent amendments.; The author acquired the essential data for this research endeavor through his direct participation in a research project funded by the National Center for Health Services Research entitled, "Community Planning for Emergency Medical Services" (Grant No. 1-RO1-HS-02512).; The author utilized the case study approach to present four sequential models which describe the hospital relationship during the emergency medical services planning process in those selected communities: Cape Cod, San Diego County, Vermont State, and the Buffalo, New York area.; The emergency medical services planning process is shown as initially eminating as a dual sub-system approach consisting of both the pre-hospital phase and ultimately the hospital-integration phase. This study identifies the recognition on the part of the participants for the need to integrate the initial sub-system into the single hospital-integrated phase which has the potential for expediting rather than inhibiting the planning and implementation process.; The dissertation also identifies three specific strategies which can be utilized by emergency medical services systems' leaders in implementing the recommended hospital-integration phase. Those strategies, the coercive, competitive, and cooperative, are defined, discussed, and analyzed.; The document concludes by identifying seven specific recommendations for emergency medical services system management in guiding them in deciding which of the above noted strategies they would choose to implement or exercise in terms of bring hospitals into a high level of involvement aimed at creating a strong hospital-integration phase and ultimate high systems maturity.