The Future of Emergency Care in the United States Health System
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The objectives of this study were to provide an overview of the emergency care system in the U.S., explore its strengths, limitations, and future challenges, describe a desired vision of the emergency care system, and recommend strategies needed to achieve that vision. In three consensus reports released in 2006, the Committee on the Future of Emergency Care in the United States Health System documented the state of affairs and discussed ways to improve the 9-1-1 and medical dispatch systems, prehospital emergency medical services (EMS), and hospital-based emergency and trauma care networks that serve adults and children.
To develop these reports, the staff and committee chair organized the committee into three subcommittees (that included external participation from individuals not affiliated with the primary consensus committee) to address focal areas of emergency care: prehospital services, pediatric emergency care, and hospital-based emergency care.
The prehospital EMS subcommittee contributed to the Emergency Medical Services at a Crossroads report by highlighting and suggesting changes to the administration of services, organizational infrastructure, and financing mechanisms that characterized the 2004-2006 prehospital emergency care system. This subcommittee assessed the current organization, delivery, financing of EMS services and systems, andprogress toward the EMS Agenda for the Future. The subcommittee considered the evolving role of EMS as an integral component of the overall health care system in the areas of dispatch and medical direction. They also focused on integration with trauma systems, pediatric EMS, public health, prevention, emergency department overcrowding, EMS system planning and coordination at the federal, state, and local levels; EMS funding and infrastructure investment, EMS workforce trends, professional education; EMS research priorities and funding.
The pediatric emergency care subcommittee provided insights in Emergency Care for Children: Growing Pains concerning challenges that define EMS services for youths, such as lack of pediatric training in professional education and health services and clinical research. This group also studied the shortcomings of emergency services provided to children and adolescents. Also, they evaluated the progress the country's pediatric EMS system has accomplished since the publication of the IOM's 1993 report, Emergency Medical Services for Children. The subcommittee considered the role of pediatric emergency services as an integrated component of the overall health system; system-wide EMSC planning, coordination, and funding; embedded pediatric training in professional education; health services; clinical research.
The hospital-based EMS committee informed the direction of the Hospital-Based Emergency Care: At the Breaking Point report by identifying and addressing barriers in communication between the emergency department and ancillary (inpatient) services, multidisciplinary workforce issues, patient flow, technical compatibility problems, and legal frameworks extant in emergency care. In its report, the subcommittee addressed the role and responsibilities of the emergency department within the larger hospital system; interactions between the emergency department and inpatient and ancillary services, such as lab, pharmacy, and imaging; patient flow and information technology; workforce issues across multiple disciplines, the impact of technological innovations on emergency care; the legal and regulatory framework for emergency care(EMTALA, liability issues, and reimbursement; disaster preparedness), surge capacity, and surveillance; clinical and health services research within the emergency department setting.
The report also covered geographical disparities in access to EMS .
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