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Emergency Care for Children: Growing Pains
ing emergency services, the kinds of illnesses and injuries with which they presented, and the readiness of providers to care for them. These studies were generally single-site research projects initiated at children’s hospitals, medical schools, and/or local departments of health. For example, published research described the epidemiology of cardiac arrest and resuscitation in children in suburban King County, Washington (Eisenberg et al., 1983); pediatric emergencies in Minneapolis, Minnesota; and pediatric versus adult death rates in the field in Los Angeles County (Seidel et al., 1984).
Emerging information on pediatric injuries and illnesses and early indications of inadequacies in the capacity of the emergency care system to address pediatric needs played a large part in the U.S. government’s decision to create the Emergency Medical Services for Children (EMS-C) program in 1984. EMS-C was among the first government programs to support the collection of data on pediatric emergency care. Its early activities included collecting data on pediatric emergencies to assess the need for specialized pediatric programs. Some of the major pediatric emergency care research published in the late 1980s continued to show shortcomings in the emergency care system for children (Seidel, 1986a,b; Seidel et al., 1991), including differences in deaths rates for children in rural versus urban settings (Gausche et al., 1989a,b). There were also studies that focused on ways to improve the system for children, such as creation of a specialized pediatric emergency care system in Los Angeles (Henderson, 1988); creation of a new tool, the Broselow tape, for estimating pediatric weight and drug dosages (Lubitz et al., 1988); and development of an accurate pediatric trauma score (Ramenofsky et al., 1988).
The 1993 Institute of Medicine (IOM) Report Emergency MedicalServices for Children called attention to the need for pediatric emergency care research by highlighting knowledge gaps in the field. These gaps encompassed the most basic questions about emergency care services for children:
What is the structure of the system?
Who uses the system?
For what is the system used?
What services or procedures are provided to patients?
When are services provided?
What are the outcomes of using the system?
What are the global costs of the system?
How well does the system perform?
The report noted that “research is needed to validate the clinical merit of care that is given, to identify better kinds of care, to devise better ways to