With hindsight, a major weakness was the limited amount of face-to-face interaction between local planners and decision makers and the University of Pittsburgh staff. Such "base-line" simulations were required in order to achieve face validity and provide a basis for comparing alternatives. It was particularly needed in order to simulate each region's existing system. RURALSIM's complexity was needed to examine the different alternatives proposed by local planners. The newer simulation languages now available alleviate this problem somewhat. To implement RURALSIM required the participation of the University of Pittsburgh research team. The result was a model capable of handling a rather diverse set of situations, but one that could not be turned over to the general public for use. While every effort was made to assure generalizability, for any given situation, it required extensive modification and tailoring.
Based upon the results of the four field tests, the following observations are relevant: 1. Political factors which posed the most significant barriers included: conservative attitudes concerning the funding and regulation of EMS activities by local governments general opposition to governmental intervention in the private sector strong resistance to mandatory standards for EMS jurisdictional disputes between EMS-related agencies lack of cooperation between the local governments competition between prehospital-care providers and between hospitals overemphasis on local jurisdictional boundaries in the planning and delivery of services and the allocation of EMS resources, such as ambulances, according to political priorities, rather than more objective criteria.
Why were these applications of simulation technology unsuccessful? Parochialism, the volunteer nature of EMS planning, and limited regional commitment to resolve such complex problems at the local level all combined to present significant barriers to implementation.
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