Abstract
The major difference between the 1983 and 1984 conferences was the increased participation of EMS-system administrators in the latter program. Although there was refinement by the conferees of the previous positions, the focus of the 1984 conference moved away from purely medical issues and towards concerns about cost/benefit analysis, organization, and governance. The triad of government officials responsible for public safety, systems administrators responsible for efficiency, and physicians responsible for medical control is balanced in different ways in different jurisdictions. Nevertheless, there is continuing convergence towards international urban EMS systems that are more similar than different.
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