BOX 3-1

A Vision of Pediatric Emergency Care in 2010

In a rural area, a car slides off the road and crashes 30 minutes from the nearest town. An automated crash notification system provides an emergency response center with detailed information about the location and characteristics of the crash. Passenger weights indicate that an adult and child, both properly restrained, are in the car. A dashboard displays information about the crash to air and ground response teams, emergency departments, and trauma facilities throughout the region. Because of the large impact of the crash, the automated triage system launches two advanced life support (ALS) response teams. An air medical response team is placed on standby.

Once the EMS teams are on the scene, patients’ complete medical histories and alerts, obtained through a regional information system, are instantly available. Using an evidence-based triage protocol, one of the EMS teams determines that the child, an 8-year-old boy, is suffering from serious injuries. In accordance with regional transport protocols, the first responders call for air transport to bring the boy to the nearest trauma center. The paramedics stabilize the boy using age- and size-scaled equipment and drugs, and begin transmission of telemetry and on-board diagnostic scans to the trauma center. The other EMS team assesses the child’s father and determines that although he requires a lower level of care, he should be transported to the trauma center to accompany his son.

An air transport team arrives at the scene and transports the child and father to a level I trauma center with the resources and medical experts needed to handle high-level pediatric and adult trauma cases. Care continues to be

certed, cooperative efforts at multiple levels of government and the private sector are necessary to finally break through and achieve these goals.

This chapter is dedicated to describing the three goals of the committee’s vision for the emergency care system of the future, with a special focus on pediatric emergency care. In some areas of the country, states and regions are already developing coordinated, regionalized systems that incorporate elements of accountability; some of these efforts are described as well.

GOAL 1: COORDINATION

The current emergency care system faces a number of problems, but among the most long-standing of these is that emergency services are fragmented, resulting in poor communication and delayed services. EMS,



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