Saade et al., 2002; Kunen et al., 2003; Trokel et al., 2006). Studies also indicate wide variation in practice patterns in the care of children (Glaser et al., 1997; Isaacman et al., 2001; Hampers and Faries, 2002; Davis et al., 2005), as well as an undertreatment of children in comparison with adults (Su et al., 1997; Gausche et al., 1998; Orr et al., 2006).

Providing quality pediatric emergency and trauma care is not just about having the right training and equipment. Indeed, the delivery of care should be built on a strong foundation in which emergency care is well planned and coordinated, care is based on scientific evidence, data are collected so providers can learn from past experience, and system performance is monitored to ensure quality. Moreover, since preventing an injury or illness is almost always better and more cost-effective than even the best emergency care, the emergency care system should promote prevention through surveillance, research, and patient education. Unfortunately, today’s emergency care system generally does not function in this way.


The Current Emergency Care System

While not new, the problems facing the nation’s emergency care system that are reviewed in this report have been growing and have become more visible to the public. Critical stories have increasingly been appearing in the media regarding slow EMS response, ambulance diversions, trauma center closures, the medical malpractice crisis, ground and air ambulance crashes, and the alarming decline in on-call specialist coverage. The events of September 11, 2001, and more recent disasters, such as the train bombings in Madrid, the bus and train bombings in London, and Hurricane Katrina, have heightened the visibility of the issue. Although emergency care is a vital component of the nation’s health system, to date there has been no comprehensive study of emergency care in the United States.

A study of the emergency care system is a logical extension of previous work conducted by the National Academy of Sciences and the IOM. In 1966, the National Academy of Sciences (NAS) and the National Research Council (NRC) produced the landmark report Accidental Death and Disability: The Neglected Disease of Modern Society (NAS and NRC, 1966), which helped focus attention on the lack of adequate trauma care in the United States and is widely recognized as the impetus for the development of the prehospital EMS system in place today. Other reports, such as Emergency Medical Services at Midpassage and The Emergency Department: A Regional Medical Resource (NAS and NRC, 1978), have also had a major impact in shaping the development of the emergency care system. More

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