Integrating Children Into Our Emergency Care System: Achieving the Vision

Abstract

On June 14, 2006, the Institute of Medicine (IOM) released a series of reports on the future of emergency care in the United States. One of these reports, Emergency Care for Children: Growing Pains, identifies issues in the emergency care of children in the United States and proposes recommendations to address coordination, regionalization, and accountability of health care in emergency settings. IOM committees recognized that to attend to the needs of children within emergency and trauma care systems, deficiencies in the broader emergency care system, such as crowding, lack of provider coordination, performance data, and clinical evidence, must be addressed. Often, these issues have an even greater impact on the outcomes of children within those systems. A fully integrated system of emergency care is the committee’s vision for the future of emergency care; to that end, the committee made a series of recommendations common to all reports, which bind the reports together and serve as the framework for building the 21 century emergency care system. Figure 1 lists those recommendations. Other recommendations identify areas that are particularly challenging for emergency and trauma care systems in treating children, including maintaining a state of readiness to care for children, maintaining provider competency in pediatric emergency knowledge and skills, calculating and delivering the appropriate dose of medication for children, planning for children as victims of manmade or natural disasters, and conducting meaningful research (Figure 2). The process to develop these reports took 3 years and included 40 committee members who are experts in emergency medicine, pediatrics, out-of-hospital care, trauma care, nursing, pharmacology, research, injury prevention, informatics and information systems, public health, health care administration, health care delivery, and health care policy. In total, the IOM Committee on the Future of Emergency Care and its 3 subcommittees met 19 times, heard public testimony from 60 speakers, reviewed hundreds of articles, and commissioned 11 research articles. The IOM staff was also involved also in meeting with hundreds of