research directions. However, first, a brief historical background and recent perspective are presented.
In 1966, a seminal treatise issued by the National Research Council identified trauma as “. . . the neglected disease of modern society.”1 The publication of this monograph ushered in support for the development of modern-day emergency medical services (EMS) and the idea that patients could benefit from coordinated systems of field triage and organized transport. These systems would not only facilitate rapid transport of ill and injured patients to hospital-based centers for definitive clinical care, but also include rehabilitation, prevention, and research as essential infrastructure elements. The early years of EMS development were focused primarily on field training and hospital coordination to form regionalized networks of care. The care of children in these systems was largely integrated into adult models using principles and approaches extrapolated from adult experience.2
In the 1980s, the first subspecialty training programs in pediatric emergency medicine began in Philadelphia, Kansas City, and Washington, DC. Simultaneous to the emergence of these fellowship programs, Senator Daniel Inouye (D-HI), with the help of the president of the Hawaii Pediatric Society, Dr. Cal Sia, was instrumental in focusing congressional attention on the gaps in emergency care for children in this country. In 1984, federal legislation (P.L.-98-555) was passed establishing the Emergency Medical Services for Children program under the Health Resources and Services Administration of the Department of Health and Human Services.3 Over the past 18 years, the federal EMSC program has maintained a steady appropriation and successfully disseminated grant funding for program development in all 50 states and 6 territories. In accordance with the recommendations of the 1993 Institute of Medicine (IOM) report Emergency Medical Services for Children, the programmatic priorities have focused on four areas: (1) education and training; (2) equipment and supplies; (3) regulation and funding; and (4) evaluation and research.4
Summary of the high-priority topics for an EMSC research agenda emanating from the IOM report did not drill down to topics directly related to end-of-life care.5,6 However, the recommendation “psychosocial support for families of injured or sick children,” taken broadly, is certainly