Because of the reduced call volume in rural areas, fewer ground ambulances are available to cover the wide expanses involved. In addition, the Atlas and Database of Air Medical Services indicates that many rural areas still do not have sufficient access to air ambulance providers. Given the inherent difficulty of providing timely care in remote areas, crash fatalities in these locales are more frequent. In 2001, 61 percent of all crash fatalities occurred along rural roads, even though only 39 percent of vehicle-miles were traveled in such areas (Flanigan et al., 2005).


The IOM’s study of the Future of Emergency Care in the United States Health System was initiated in September 2003. Support for the study was provided by the Josiah Macy, Jr. Foundation, the National Highway Traffic Safety Administration (NHTSA), the Health Resources and Services Administration (HRSA), the Agency for Healthcare Research and Quality (AHRQ), and CDC. Given the broad scope of the effort, the work was divided among a main committee and three subcommittees (see Figure 1-1).

The main committee provided primary direction for the study and was responsible for investigating the systemwide issues that span the continuum of emergency care in the United States. The 13-member subcommittee on hospital-based emergency care was created to examine issues specific to the ED setting, including workforce supply, patient flow, use of information technologies, and disaster preparedness and surge capacity. The 11-member subcommittee on prehospital EMS was created to assess the current organization, delivery, and financing of EMS and EMS systems and to advance NHTSA’s Emergency Medical Services Agenda for the Future (NHTSA, 1996). Finally, the 11-member subcommittee on pediatric emer-

FIGURE 1-1 Committee and subcommittee structure.

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