What system components are involved in producing clinical excellence, response time reliability, economic efficiency and customer satisfaction?  How do you know you have it right?  According to the readings, which of the aforementioned performance measures failed in the case of David Rosenbaum and how could the system be corrected to avoid another similar outcome?

Did the disintegration of the continuum of care play a role in this outcome or was it solely an EMS issue?  In the Boston EMS system that you are studying, is a similar situation possible?  How does the system prevent against such outcomes?