There is a problem with their interpretation of confidentiality. It protects for the wrong reason and prevents any quality improvement in that situation if a problems is not recognized. As well, it treats the ambulance as a separate entity totally in a "system". In a time where improvements are needed to determine contracts and expenditures as well as capital budget planning for trauma, stroke and cardiac systems throughout a region, this region seems to be protecting another interest. Even in HIPAA, it allows for data collection for quality improvement.