The objectives of this study are to: (1) examine the emergency care system in the U.S.; (2) explore its strengths, limitations, and future challenges; (3) describe a desired vision of the emergency care system; and (4) recommend strategies required to achieve that vision. The project will identify and address key priorities across the continuum of emergency care services, including: 911 access and dispatch; prehospital emergency medical services (EMS); and hospital-based emergency, trauma, and critical care. The committee will consider a wide range of issues, including: - the role of the emergency department (ED) within the larger hospital and health care system; - the interaction 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, including emergency physicians, nurses, and other members of the care team; - the impact of technological innovations on emergency care;- patient safety and the quality and efficiency of emergency care services;- the legal and regulatory framework for emergency care, including the Emergency Medical Treatment and Active Labor Act (EMTALA), liability issues, and reimbursement; disaster preparedness, surge capacity, and surveillance; - basic, clinical, and health services research relevant to emergency care; and- special challenges of emergency care in rural settings. The study will also examine the unique challenges associated with the provision of emergency services to children and families, and evaluate progress since the publication of the IOM?s 1993 report, Emergency Medical Services for Children. The committee will consider: - the role of pediatric emergency services as an integrated component of the overall health system; - system-wide EMSC planning, preparedness, coordination, and funding; - embedded pediatric training in professional education; and - health services and clinical research. In addition, the study will examine prehospital EMS and include an assessment of the current organization, delivery, and financing of EMS services and systems, and assess progress toward the EMS Agenda for the Future. The study will consider a wide range of issues, including: - the evolving role of EMS as an integral component of the overall health care system, including dispatch, medical direction, and integration with trauma systems, pediatric EMS, public health, prevention, and ED overcrowding; - EMS system planning, preparedness, and coordination at the federal, state, and local levels; - EMS funding and infrastructure investment, including equipment, communications, new technologies, and progress toward the development of interoperable EMS information systems; - EMS workforce trends and professional education; and - EMS research priorities and funding.Sponsors:The Josiah Macy, Jr. FoundationU.S. Department of Health and Human Services' Health Resources and Services Administration (HRSA), Agency for Healthcare Research and Quality (AHRQ), and Centers for Disease Control and Prevention (CDC)U.S. Department of Transportation, National Highway Traffic Safety Administration (NHTSA)The approximate start date for the project was 09/01/2003.Note: Effective February 26, 2004, the project scope has been expanded and the project duration has been extended to a total of 45 months. The revised project scope is as shown above. Three subcommittees have been appointed to assist the committee in the areas of Emergency Medical Services to Children and Adolescents; Prehospital Emergency Medical Services; and Hospital-Based Emergency, Trauma, and Critical Care. The activities of each subcommittee are posted in separate project records in the Current Projects System with Project Identification Numbers HCSX-H-03-01-B, HCSX-H-03-01-C, and HCSX-H-03-01-D respectively. Three reports will be issued during the course of the project, focusing on the subcommittee topic areas.