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Introduction

In June 2006, the Institute of Medicine (IOM) Committee on the Future of Emergency Care in the U.S. Health System released a series of reports on the state of emergency care. The reports, Emergency Medical Services at the Crossroads; Hospital-Based Emergency Care: At the Breaking Point; and Emergency Care for Children: Growing Pains, identified a number of disturbing problems including overcrowded emergency departments, a lack of coordination among emergency providers, variability in the quality of care provided to patients, workforce shortages, lack of disaster preparedness, a limited research base, and shortcomings in the systems’ ability to care for pediatric patients. These problems, while apparent to those who work in the field, are largely hidden from public view, in part because popular fictional television programs frequently depict the emergency care system in fine shape. Despite the lifesaving feats performed every day by emergency departments and ambulance services, the nation’s emergency medical system as a whole is overburdened, underfunded, and highly fragmented.

The exposure of some of the shortcomings in the nation’s emergency care system coincided with the 40th anniversary of the National Academy of Sciences/National Research Council 1966 report, Accidental Death and Disability: The Neglected Disease of Modern Society. The report prompted public outcry by describing an epidemic of automobile-related and other

The planning committee’s role was limited to planning the workshops, and the workshop summaries have been prepared by the workshop rapporteurs as factual summaries of what occurred at the workshops.



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Future of Emergency Care: Dissemination Workshop Summaries 1 Introduction In June 2006, the Institute of Medicine (IOM) Committee on the Future of Emergency Care in the U.S. Health System released a series of reports on the state of emergency care. The reports, Emergency Medical Services at the Crossroads; Hospital-Based Emergency Care: At the Breaking Point; and Emergency Care for Children: Growing Pains, identified a number of disturbing problems including overcrowded emergency departments, a lack of coordination among emergency providers, variability in the quality of care provided to patients, workforce shortages, lack of disaster preparedness, a limited research base, and shortcomings in the systems’ ability to care for pediatric patients. These problems, while apparent to those who work in the field, are largely hidden from public view, in part because popular fictional television programs frequently depict the emergency care system in fine shape. Despite the lifesaving feats performed every day by emergency departments and ambulance services, the nation’s emergency medical system as a whole is overburdened, underfunded, and highly fragmented. The exposure of some of the shortcomings in the nation’s emergency care system coincided with the 40th anniversary of the National Academy of Sciences/National Research Council 1966 report, Accidental Death and Disability: The Neglected Disease of Modern Society. The report prompted public outcry by describing an epidemic of automobile-related and other The planning committee’s role was limited to planning the workshops, and the workshop summaries have been prepared by the workshop rapporteurs as factual summaries of what occurred at the workshops.

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Future of Emergency Care: Dissemination Workshop Summaries injuries and the poor state of trauma care nationwide. Nevertheless, the report made a tremendous impact; it is widely viewed as the impetus for the creation of the trauma and prehospital emergency medical services (EMS) systems, the specialty in emergency medicine, and federal programs to enhance the emergency care infrastructure and research base. A similar opportunity exists today for the advancement of emergency care. The IOM received funding from 14 organizations to conduct a series of dissemination workshops associated with the release of the 2006 reports on the future of emergency care. Sponsors included the Agency for Healthcare Research and Quality, the American Academy of Pediatrics, the American College of Emergency Physicians, the American College of Surgeons, the Association of Academic Chairs of Emergency Medicine, the Centers for Disease Control and Prevention, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents’ Association, the Emergency Nurses Association, the Health Resources and Services Administration, the National Association of EMS Physicians, the National Highway Traffic Safety Administration, the Robert Wood Johnson Foundation, and the Society for Academic Emergency Medicine. The sponsors recognized that advancing emergency care will take a concerted effort by the principal stakeholders—federal, state, and local officials; hospital leadership; physicians, nurses, emergency medical technicians, and other clinicians; and the public. The workshops were intended to engage those stakeholders. The purpose of the dissemination workshops was to (1) provide a forum to engage the public and stakeholder groups in a national discussion of issues identified in the three IOM reports on the future of emergency care; (2) disseminate findings from these reports; (3) explore the implications of the recommendations in the reports at the federal, state, and local levels; (4) identify continuing research and data needs; (5) and consider implementation issues and strategies connected with the recommendations. The purpose was not to change the findings or recommendations in the three IOM reports, but rather to provide an opportunity to discuss the issues publicly. The workshops were organized by a nine-member workshop planning group that selected the locations for the workshops, the broad topics for discussion, the structure of the agenda, and the presenters. Three one-day regional dissemination workshops were conducted in Salt Lake City, Utah (September 7, 2006), Chicago, Ilinois (October 27, 2006), and New Orleans, Louisiana (November 2, 2006). Each of the workshops featured focused discussions in two issue areas. The meeting in Salt Lake City focused on pediatric emergency care and care in rural areas; in Chicago it was workforce issues and hospital efficiency; and in New Orleans it was EMS issues and disaster preparedness. The workshops included panels comprised of experts and key stakeholders drawn from the region and nationally. A fourth capstone workshop, held in Washington, D.C.,

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Future of Emergency Care: Dissemination Workshop Summaries provided an opportunity to engage congressional and other federal policy leaders in a discussion of emergency care issues. All workshops featured invited presentations and structured discussions. In addition, time was reserved at each workshop for attendees to pose questions to IOM committee members and the invited panelists. This report summarizes the proceedings of the workshops. Each regional workshop began with an overview of the findings and recommendations from the three reports on the future of emergency care. Those findings and recommendations are summarized in the next chapter. The remainder of the report devotes one chapter to each of the workshops. The agendas of the workshops are found in Appendix A and a list of attendees appears in Appendix B. Appendix C contains a glossary of the acronyms used in this document.