Management challenges confronting new EMS systems.

Acute, critical patients require a rapidly applied, highly refined diagnostic approach if their chances for survival are to be maximized. EMS systems have made great strides in addressing the management challenges confronting them, especially via the development and refinement of severity assessment instruments. EMS systems, however, must also evaluate and develop reliable prehospital communications procedures; must develop and maintain a list of needed changes and then prioritize the changes; and must enhance prehospital problem-oriented diagnostic data-gathering protocols. The methodology for the development of the latter has not yet even been explored in the EMS literature. It is hoped that this sharing of Port Worth's recent experiences will help other EMS professionals who find themselves either in the early stages of major system redesign or the initiation of a new EMS system.