Emergency Care for Children Growing Pains (2007) / Chapter Skim
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This shortcoming is due in part to inadequacies of the broader system. The emergency and trauma care system is highly fragmented, with little coordination among prehospital emergency medical services (EMS)
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Many urban areas have children's hospitals or hospitals with pediatric EDs staffed by pediatric emergency medicine specialists and equipped with the latest technologies for the care and treatment of children. However, the vast majority of ED visits made by children are not to children's hospitals or those with a pediatric ED, but to general hospitals, which are less likely to have pediatric expertise, equipment, and policies in place.
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In addition, this report serves as a follow-up to the 1993 IOM report Emergency Medical Serices 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.
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A few states have taken steps to regionalize pediatric emergency care, allowing advanced life support ambulances to bring such patients only to hospitals designated as having pediatric capabilities. However, a stateby-state analysis shows that many states still have not formally regionalized pediatric intensive or trauma care.
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To build accountability into the system, the committee recommends that the Department of Health and Human Services convene a panel of individuals with emergency and trauma care expertise to develop evidencebased indicators of emergency and trauma care system performance, including the performance of pediatric emergency care (3.3)
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Achieving the Vision States and regions face a variety of different situations with respect to emergency and trauma care, including the level of development of adult and pediatric trauma systems; the effectiveness of state EMS offices and regional EMS councils; and the degree of coordination among fire departments, EMS, hospitals, trauma centers, and emergency management. Thus no single approach to enhancing emergency care systems will accomplish the three goals outlined above, and it will be necessary to explore and evaluate a number of different avenues for achieving the committee's vision.
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It will be necessary to strengthen the capabilities of the emergency care workforce to treat pediatric patients, improve patient safety, exploit advances in medical and information technology, foster family-centered care, enhance disaster preparedness, and improve the evidence base. Strengthening the Workforce Ideally, because of the unique way in which pediatric patients should be triaged and treated, all children should be served by emergency care providers with formal training and experience in pediatric emergency care.
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Thus the committee believes that pediatric leadership is needed in each provider organization. The committee recommends that emergency medical services agencies appoint a pediatric emergency coordinator, and that hospitals appoint two pediatric emergency coordinators -- one a physician -- to provide pediatric leadership for the organization (4.3)
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To address this problem for pediatric patients, the committee recommends that the Department of Health and Human Services and the National Highway Traffic Safety Administration fund the development of medication dosage guidelines, formulations, labeling guidelines, and administration techniques for the emergency care setting to maximize effectiveness and safety for infants, children, and adolescents. Emergency medical services agencies and hospitals should incorporate these guidelines, formulations, and techniques into practice (5.2)
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A market for products designed specifically for pediatric patients has not been well developed. To this end, the committee recommends that federal agencies and private industry fund research on pediatric-specific technologies and equipment for use by emergency and trauma care personnel (5.4)
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The committee recommends that federal agencies (the Department of Health and Human Services, the National Highway Traffic Safety Administration, and the Department of Homeland Security) , in partnership with state and regional planning bodies and emergency care providers, convene a panel with multidisciplinary expertise to develop strategies for addressing pediatric needs in the event of a disaster.
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. Improving the Evidence Base Pediatric emergency care is a young field; even in the late 1970s, there were no pediatric emergency medicine textbooks or journals.
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It has initiated hundreds of injury prevention programs; provided thousands of hours of training to EMTs, paramedics, and other emergency medical care providers; developed educational materials covering every aspect of pediatric emergency care; and established a pediatric research network. Still, as discussed earlier, certain segments of the emergency care system continue to be poorly prepared to care for children, and the work of the program continues to be relevant and vital.
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. The proposed 5-year period is not intended as a limit on federal funding dedicated to improving pediatric emergency care; indeed, there will always be a need to monitor and study pediatric emergency care.
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