A recent exchange on the 9-1-1 list serv was interesting. Some were complaining that the public and press were blaming 9-1-1 organizations for failures in other parts of the emergency response chain. They argued that people should understand that 9-1-1 simply answers the public's calls and connects with the right response agency (police, fire or EMS) -- the actions of which are beyond the control of the 9-1-1 center.
Others noted repeated instances (also my personal experience) when members of the public thought that 9-1-1 was the whole response system. In fact, the public thinks "9-1-1" is the full emergency response system -- functioning as an integrated whole to respond to their emergencies.
I think the public is right (to want it to be that way) -- and far ahead of most in the emergency response organizations in thinking about emergency services in a modern way. When they call 9-1-1, the public is expecting an end to end service, not a set of stovepipes that talk to each other.
We in emergency response don't tend to think of ourselves as a unified whole -- but instead as a set of distinct stovepipes: 9-1-1, EMS, fire, police, emergency rooms, public health, emergency managers, traffic managers, hospitals, trauma centers, doctors offices, urgent care, mental health, poison control. As a result, we have systems that can't communicate, we incur significant expenses in duplicative systems and processes, we can't measure end to end outcomes. We optimize within each stove pipe, which is exactly the wrong way to optimize end to end.
It doesn't help a heart attack victim to have 9-1-1 and EMS do their jobs perfectly, and then sit in an ED repeating all the same information and waiting for a doctor to process them on (instead of skipping the ED entirely and going directly to the cath lab, saving 30 minutes, as they are doing in Seattle now because of integrated information systems).
Our balkanized organization is a result of history, and it has worked pretty well, but that doesn't mean we should not listen to the public and change how we think about, plan and deliver emergency service for the future.