The Future of Emergency Care of Children: Mind the Gaps

Abstract

In June 2006, the Institute of Medicine (IOM) released the Future of Emergency Care in the United States series consisting of 3 reports: Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads,and Emergency Care for Children: Growing Pains. On the day of release, the findings of the reports made national news with warnings of an emergency medical system (EMS) on the brink of collapse burdened by overcrowding, boarding, and ambulance diversions. It was disappointing that the pediatric report received the least amount of media coverage. The reason, I believe, is that the findings are not easily summarized in the popular sound bite. The harsh reality is that improvement in the emergency care of children must occur at many levels. This includes providing the equipment, training, and pediatric protocols for the smallest community in rural America and extends to funding for pediatric emergency medicine research. In other words, a lot of work must be done. So although we can tolerate the media glossing over the current gaps in the provision and quality of emergency care of children, the advocacy efforts to fully inform and engage policy makers to support improvement deserve our full attention. The 2006 IOM Growing Pains report follows up and expands on the 1993 IOM report Emergency Medical Services for Children. That work represented the first comprehensive look at pediatric emergency care. It documented shortcomings in education, communications, planning, evaluation, and research that expose the limited capacity of the emergency care system to address the needs of children. As a result of the findings and recommendations published in 1993, the Emergency Medical Services for Children (EMS-C) program within the Department of Health and Human Services (DHHS) was expanded and the first EMS-C 5-year plan was developed. The 2006 report notes that the accomplishments of the EMS-C Program are numerous. Perhaps foremost among