country are overcrowded. Ambulances are turned away, and patients, once they are admitted, may wait in hallways for hours or even days before inpatient beds open up for them. Often the specialists that patients need to see are not available. And the system that transports patients to the hospitals is fragmented and inconsistent in the level of quality it provides.

The IOM Committee on the Future of Emergency Care was formed in September 2003 to examine the full scope of emergency care; explore its strengths, limitations, and challenges; create a vision for the future of the system; and make recommendations to help the nation achieve that vision. Over 40 national experts from fields including emergency care, trauma, pediatrics, health care administration, public health, and health services research participated on the committee or one of its subcommittees. In June 2006, the committee released three reports: Emergency Medical Services at the Crossroads; Hospital-Based Emergency Care: At the Breaking Point; and Emergency Care for Children: Growing Pains. These reports provided complementary perspectives on the emergency care system, while the series as a whole presented a common vision for the future of emergency care in the United States.

This study was requested by Congress and funded through a congressional appropriation, along with additional sponsorship from the Josiah Macy Jr. Foundation, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and the National Highway Traffic Safety Administration.



The emergency care system in the United States is in many ways a victim of its own success. Not only has the hospital ED become the place that people turn to first when they have an illness or injury that demands immediate attention, but it has also been given an increasing number of other responsibilities as well. EDs today provide much of the medical care for patients without medical insurance. Insured patients increasingly turn to the ED during times when their physician is unavailable, such as evenings and weekends, and they are often sent to the ED for tests and procedures that their physician can’t easily perform in the office. In some rural communities, the hospital ED may be the main source of health care for a large percentage of residents. EDs also play a key role in public health surveillance and in disaster preparation and response.

The number of patients visiting EDs has been growing rapidly. There were 113.9 million ED visits in 2003, for example, up from 90.3 million a

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