member physicians comply with continuing education requirements from state medical boards. For example, ACEP, which represents EM physicians, has a number of educational offerings designed to help members earn 150 hours of continuing education credits every 3 years. Of the 800 courses approved for credit, 23 percent are on pediatric topics, the most popular being PALS and APLS. Several other pediatric courses are offered at the ACEP annual meeting. According to a 1997 ACEP survey, however, 17 states had not offered APLS, PALS, or other similar pediatric courses in the previous 2 years (Santamaria et al., 1997). Having to travel a long distance to attend a pediatric training course naturally places an added burden on physicians who might wish to obtain the training.
The other medical specialties of particular relevance to pediatric emergency care are the surgical subspecialties of trauma surgery and pediatric surgery. In a 5-year residency training program in general surgery, surgeons receive training in a number of specialty areas, including trauma and pediatric surgery, after which they are expected to be able to manage the commonly encountered and less complex cases associated with these content areas (The American Board of Surgery, 2004). They may subsequently choose to undertake advanced training in trauma surgery or pediatric surgery (The American Board of Surgery, 2005).
Trauma surgeons perform emergent surgical procedures, usually but not exclusively involving life- or limb-threatening injuries to the neck, chest, abdomen, pelvis, and vasculature. Trauma surgeons generally complete 2 years of fellowship training in trauma surgery and surgical critical care following the completion of the 5-year surgical residency. The ACS estimates that there are about 3,000 trauma surgeons practicing in the United States today (Personal communication, C. Williams, February 17, 2006). Trauma surgeons tend to focus their practice in trauma centers.
The American Board of Surgery awards Certification in Pediatric Surgery to surgeons who complete a 2-year fellowship in pediatric surgery and pass an examination in pediatric surgery following the 5-year surgical residency (The American Board of Surgery, 2004). Pediatric surgery residents are required to meet specific curricular goals and objectives in pediatric trauma care and must help provide definitive pediatric trauma care to large numbers of pediatric trauma patients.
Hospitals that offer specialist services, such as neurosurgery and orthopedic surgery, to inpatients must also have the same services available