that the prevailing “scoop and run” paradigm of EMS is always optimal (Orr et al., 2006). Decisions regarding the appropriate steps to take should be resolved using the best available evidence. The committee concludes that there should be a national approach to the development of prehospital protocols. Therefore, the committee recommends that the National Highway Traffic Safety Administration, in partnership with professional organizations, convene a panel of individuals with multidisciplinary expertise to develop evidence-based model prehospital care protocols for the treatment, triage, and transport of patients, including children (3.2). These protocols should be developed within 18 months of the release of this report. NHTSA should fund the process and convene the panel of emergency care experts and medical professionals to review the literature and develop the protocols. In addition, the process of updating these protocols will be important because it will determine how rapidly patients receive the current standard of care. This effort need not start from scratch. The Model Pediatric Protocols developed by the National Association of EMS Physicians and supported by the Emergency Medical Services for Children (ESM-C) program, which cover the treatment of pediatric patients in the prehospital environment, can serve as a starting point for the initiative as it relates to pediatric patients.

Treatments may require modification to reflect local resources, capabilities, and transport times; however, the basic pathophysiology of human illness is the same in all areas of the country. Once in place, the national protocols could be tailored to local assets and needs. Regional protocols should reflect the state of readiness of given facilities within a region at a given point in time. Real-time, concurrent information on the availability of hospital resources and specialties should be made available to EMS providers to inform transport decisions. Figure 3-1 shows an example of the service configuration in a regionalized system.

In addition to the use of the EMS system to direct patients to the optimum location for emergency care, hospital emergency care designations should be posted prominently. Particularly for pediatric patients, who are generally transported to the ED by their parents or caregivers rather than by EMS, public information about an ED’s pediatric capabilities is essential.

Again, the concept of categorization of hospitals based on capabilities is not new. It was recommended not only in the 1993 IOM Report Emergency Medical Services for Children, but also in the 1966 NAS/NRC report Accidental Death and Disability (NAS and NRC, 1966). According to that report:

Hospital emergency departments should be surveyed…to determine the numbers and types of emergency facilities necessary to provide optimal emergency treatment for the occupants of each region…. Once the required numbers and types of treatment facilities have been determined, it may be necessary to lessen the requirements at some institutions, increase them in others, and even



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