the system; and recommend strategies for achieving that vision. The committee was also tasked with taking a focused look at the state of pediatric emergency care, prehospital emergency care, and hospital-based emergency and trauma care. This report is one in a series of three that presents the committee’s findings and recommendations in these areas. Summarized below are the committee’s findings and recommendations for improving pediatric emergency and trauma care. In addition, this report serves as a follow-up to the 1993 IOM report Emergency Medical Services for Children, which represented the first comprehensive look at pediatric emergency care in the United States. That report, which documented shortcomings in a number of areas, received considerable attention from emergency care providers, professional organizations, policy makers, and the public. Over the past 13 years, the federal Emergency Medical Services for Children (EMS-C) program, a grant program that assists states in dealing with pediatric deficiencies within their emergency care systems, has been actively addressing the shortcomings identified in that report. The committee’s findings and recommendation regarding the EMS-C program are summarized below as well.

ACHIEVING THE VISION OF A 21ST-CENTURY EMERGENCY CARE SYSTEM

As noted above, emergency care for children cannot be improved until some of the long-standing problems within the overall emergency care system are addressed. To that end, the committee developed a vision for the future of emergency care that centers around three goals: coordination, regionalization, and accountability. Many elements of this vision have been advocated previously; however, progress toward achieving these elements has been derailed by deeply entrenched political interests and cultural attitudes, as well as funding cutbacks and practical impediments to change. Concerted, cooperative efforts at all levels of government—federal, state, regional, local—and the private sector are necessary to finally break through and achieve optimum emergency care.

Coordination

One of the most long-standing problems with the emergency care system is that services are fragmented. EMS, hospitals, trauma centers, and public health have traditionally worked in silos. For example, public safety and EMS agencies often lack common radio frequencies and protocols for communicating with each other during emergencies. Similarly, emergency care providers lack access to patient medical histories that could be useful in decision making. Only about half of hospitals have pediatric interfacility transfer agreements. Moreover, planning is fragmented; often pediatric



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