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Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
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Index

A

Accidental Death and Disability: The Neglected Disease of Modern Society, 17, 3637, 105

Accountability

fragmentation of EMS system and, 135

importance of, 5, 115

model EMS systems, 121, 123, 124, 125

new lead agency for EMS system and, 138, 140

obstacles to, 5, 115

performance measurement and, 5

recommendation for, 117

strategies for enhancing, 116

Accreditation

disaster drill requirements, 238

EMS system components, 116117

pediatric emergency care, 162163

Adolescent patients, 211212

Advanced life support (ALS)

field stabilization vs. transport, 112113

pediatric, 158

role of emergency medical technicians, 152

in rural areas, 7980

shortcomings of pediatric care capabilities, 5051

training for, 154, 155, 164165

Adverse events

current state of pediatric emergency care, 193194

language difference as cause of, 210

mandated reporting, 198

in prescription or administration of drugs, 196197

recommendations for reducing, 198, 212

risk in EDs, 188190

risks for children in emergency care, 190193

strategies for reducing, 197198

Agency for Healthcare Research and Quality, 27, 132, 141, 195, 197, 201, 227, 249, 261

Airbags, 254255

Ambulance services

appropriateness of dispatch, 6364

diversion, 7172, 115, 129

origins and development, 37

payer mix, 82

pediatric utilization, 62, 6364

response times, 75

shortcomings of pediatric care capabilities, 5051

See also Transport of patients

American Academy of Pediatrics, 39, 227, 247, 265, 268

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

American Board of Emergency Medicine, 41

American Board of Pediatrics, 41

American College of Emergency Physicians (ACEP), 39, 105, 165, 264

American College of Surgeons, 13, 110111, 271, 273

American Pediatric Surgical Association, 43

American Trauma Society, 43

Anthrax, 229

Asthma management, 176

Atropine, 237

Automated external defibrillator, 202203

Automobile crashes, 39, 52, 54

airbag research, 254255

B

Bag mask ventilation, 158

Balanced Budget Act, 80

Bar code technology, 199200

Basic life support

role of emergency medical technicians, 152

shortcomings of pediatric care capabilities, 50

training for, 154, 155

Best Pharmaceuticals for Children Act, 195196

Bicycle accidents, 54

Biochemical events

antidotes, 237

health care system preparedness, 227–22

training for, 238

vulnerability of children, 25

Boarding, 7172

Bomb injuries, 225

C

Carbon monoxide poisoning, 191192

Cardiac arrest, 202203

Cardiopulmonary resuscitation, 253

Categorization of emergency medical services

goals, 111

implementation, 113115

pediatric acute care facilities, 47, 49

recommendations for, 4, 111112, 146

regionalization of pediatric emergency care, 109110, 111

shortcomings of current system, 24, 51

trauma centers, 43

trauma system, 110111

Causes of ED visits, 1819, 5559, 59

Causes of prehospital calls, 20, 63, 79

Centers for Disease Control and Prevention (CDC)

National Center for Injury Prevention and Control, 40, 132, 262

new lead agency for EMS system and, 141

recent funding cuts, 135137

research activities, 27, 262, 268

structure and operations, 262

transition to new lead agency for EMS system, 143

Centers for Medicare and Medicaid Services (CMS)

EMTALA review, 130

payment system, 128129

public reporting activities, 119

research support from, 263

See also Medicaid;

Medicare

Centers of excellence, 266267

Child, defined, 29

Child abuse/neglect

ED utilization related to, 6970

risk, 54, 55

Children’s hospitals

capacity and utilization, 19

Medicaid reimbursement, 85

teaching in, 8687

Children’s Oncology Network, 268

Clinical Practice Guidelines for Pediatric Emergency Care, 176

Committee on the Future of Emergency Care, 23, 2728

Communication, interpersonal, cultural competency of providers, 210211

Communications technologies and systems

current shortcomings, 3, 103, 222

for disaster response, 222

to improve coordination of care, 107108

model EMS systems, 120121, 123

risk of error in emergency care, 189

Computed tomography, 201202

Congress, recommendations for, 6, 7, 13, 14, 126, 139, 142143, 144, 146147, 257, 273

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

Coordination of care

communications system for, 107108

current shortcomings, 34, 102104

establishment of new lead agency for EMS system, 7, 138

goals, 4, 106

model systems, 106107, 120121, 122, 123, 124

previous efforts to improve, 105106

regulatory impediments to, 129130

County Hospital Alert Tracking Systems, 121

Crossing the Quality Chasm: A New Health System for the 21st Century, 10, 204, 251

Crowding, ED, 7072, 75

payment incentives to reduce, 129

Cultural competency, 210211

D

Data Elements for Emergency Department Systems (DEEDS), 116

Decontamination equipment, 224, 229

Defibrillators, automated external, 202203

Dehydration treatment, 176

Demonstration program

funding, 6, 127

granting agency, 127128

grant recipients, 126

proposals, 126

purposes, 126127

rationale, 125126

recommendations for, 6, 126, 146

Department of Defense, 263

Department of Health and Human Services (DHHS)

in categorization of emergency services, 4, 111112, 146

in development of clinical practice guidelines, 176177, 179

disaster preparedness funding, 223

new lead agency for EMS system in, 7, 139, 140, 146

recommendations for, 4, 5, 7, 8, 9, 11, 1213, 111112, 117, 131, 139, 146, 176, 179, 195, 197, 212, 229230, 239, 257

research program, 9, 27, 261263

structure of EMS system oversight and support, 131, 132, 135

See also Agency for Healthcare Research and Quality;

Centers for Disease Control and Prevention;

Health Resources and Services Administration

Department of Homeland Security (DHS)

disaster preparedness funding, 223

FEMA, 132, 263264

recommendations for, 229230, 239

research support from, 263264

role of, 132, 263

structure of EMS system oversight and support, 6, 131, 140

Department of Transportation (DOT)

structure of EMS system oversight and support, 6, 131, 140, 263

training standards for EMS providers, 155

See also National Highway Traffic Safety Administration

Depression, 195

Disaster Medical Assistance Teams (DMATs), 12, 132, 232234, 238, 239

Disaster preparedness

challenges in, 221222

definition of “disaster,” 221

drills, 12, 238239, 239

enhancing pediatric expertise for, 232234

establishment of new lead agency for EMS system, 7, 139, 141, 146

federal funding, 223

goals for pediatric care, 12, 230, 239

minimizing family separation in, 230232

needs of children in, 11, 25, 30, 223224, 236238

pediatric considerations in planning, 11, 12, 25, 104, 223, 226227, 236238

recommendations for, 1112, 229230, 239

shortcomings of current system, 2, 11, 16, 25, 51, 222223, 227229

studies, 224226

surge capacity, 234236

Disease and illness, pediatric

causes of hospital ED visits, 5559

epidemiology, 52, 5559

preventive efforts, 4041

Dispatch of emergency services

appropriateness, 6364

establishment of new lead agency for EMS system, 7, 139, 141, 146

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

model EMS systems, 120121

research needs, 112

See also Ambulance services;

Transport of patients

Diversion, ambulance, 7172

accountability for, 115

economic incentives to reduce, 129

E

Economics

demonstration program funding, 6, 126, 127, 146

disaster preparedness funding, 223

efficiency of care, 7677

EMS-C funding and grant distribution, 38, 4446

establishment of new lead agency for EMS system oversight and support, 138, 142143

funding for researcher training, 266, 267

hospital ED payer mix, 6769

nonurgent care in ED, 66

origins and early development of EMS system, 36, 37, 38

payment incentives to improve provider performance, 128129

problems of current EMS system, 12

recommendations for EMS-C funding, 14, 144145

regionalization outcomes, 108109

research funding, 12, 51, 251, 257264, 266

rural EMS systems, 80

rural poverty, 78

teaching hospital funding, 8687

See also Reimbursement

EDs. See Hospital emergency departments

Effectiveness of pediatric emergency care, 7374, 252

Efficiency of emergency care, 7677, 252

Emergency care, defined, 29

Emergency care system, defined, 29

Emergency Department: A Regional Medical Resource, 17

Emergency departments approved for or accepting pediatrics, 109110

Emergency ID Net, 268

Emergency Medical Services Agenda for the Future, 137, 250

Emergency Medical Services at Midpassage, 17

Emergency medical services (EMS), 190.

See Prehospital care

Emergency medical services (EMS) system

coordination of care in, 34

current shortcomings, 12, 16, 17, 2426

definition, 29

demonstration program recommendations, 6, 126, 146

establishment of new lead agency for, 137143, 146147

future reforms, 14

goals, 3, 24, 101

linkage with other medical care providers, 104105

model systems, 120125

origins and development, 3637, 131132

performance measurement, 116117, 118

public health agencies and, 104105

readiness for reform, 18

recent efforts to improve, 1718

status of pediatric care in, 2024

structure, 249

Emergency Medical Services for Children, 3, 18, 35, 4951, 108, 246247

Emergency Medical Services for Children (EMS-C) program

accomplishments, 13, 4749, 51

administration, 44

clinical practice guidelines, 113, 176

coordinators, 51

disaster preparedness in, 228

five-year plan, 46

funding and grant distribution, 4446, 4647, 132, 144, 147

in future of pediatric emergency care system, 1314

new lead agency for EMS system and, 138, 141

origins, 38, 44, 246

purpose, 3, 38, 44, 144

recommendations for funding, 14, 144145, 147

research support from, 46, 246, 256

Emergency Medical Services for the Future, 106

Emergency Medical Services Systems Act, 37, 106

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

Emergency medical technicians (EMTs)

classifications, 152, 153

continuing education and skills maintenance, 2, 157158, 159, 160

hospital ED staff, 170

recruitment and retention, 153154

risk of error in emergency care, 190

in rural areas, 154

training and certification, 154158

volunteers, 153, 154

working conditions, 153

See also Paramedics

Emergency Medical Treatment and Active Labor Act (EMTALA)

implications for coordination of care, 129130

purpose, 129

recommendations for, 130131, 146

revisions, 130

Emergency Medicine Cardiac Research and Education Group International, 268

Emergency Medicine Foundation, 264

Emergency Medicine Network, 268

Emergency Nurses Association, 259264

Emergency pediatric centers, 109110

EMS. See Emergency medical services;

Prehospital care

EMS-C. See Emergency Medical Services for Children (EMS-C) program

EMS Performance Measures Project, 116

Endotracheal intubation, 1, 172173

Equity in care access and outcomes, 7778, 252

F

Family-centered care

barriers to, 208

conceptual development, 205

cultural competency, 210211

defining characteristics, 1011, 74, 205

effectiveness, 205

in emergency care, 205210

family presence during medical procedures, 206207, 208

implementation, 208

rationale, 10, 11

recommendations for, 11, 204205, 212

shortcomings of current system, 26, 7475, 204

staff attitudes, 207208

Federal Emergency Management Agency (FEMA), 132, 263264

Federal government

establishment of new lead agency for EMS system, 7, 137143, 146147

interagency collaboration in EMS system, 132133, 135

research funding, 257258, 260

strategies for improving EMS system leadership, 135

structure of EMS oversight and support, 67, 131132, 133135

See also specific governmental entity

Federal Interagency Committee on EMS (FICEMS)

mission, 133

new lead agency for EMS system and, 142

prospects for EMS system leadership, 135137

Fire departments, EMS personnel and, 104

First responders, 151152, 155.

See also Emergency medical technicians

Florida, model EMS system, 124125

Fluoxetine, 195

Food and Drug Administration (FDA), 195, 197, 201

Fostering Rapid Advances in Health Care: Learning from System Demonstrations, 125126

Fragmentation of EMS system, 1, 24, 102103

accountability and, 5

effects, 34, 67, 103, 134135

sources of, 103104

structure of government oversight and support, 67, 131132, 133134, 135137

See also Coordination of care

H

Health Insurance Portability and Accountability Act (HIPAA)

implications for coordination of care, 129, 130

purpose, 130

recommendations for, 130131, 146

Health Plan Employer Data and Information Sets (HEDIS), 119

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

Health Resources and Services Administration (HRSA)

demonstration program administration, 6, 128, 146, 261

in development of EMS system, 41, 176

disaster planning, 228

interagency collaborations, 132

mission, 261

recommendations for, 6, 126, 146

research activities, 27, 195, 197, 261262

structure and operations, 261

trauma registry, 270

See also Emergency Medical Services for Children (EMS-C) program

Health Services, Preventive Health Services, and Home Community Based Services Act, 44

Health status of children in U.S., 52

insurance status and, 59, 83

neonatal health problems, 59

with special health care needs, 61

Hill-Burton Act, 36

Hospital-Based Emergency Care: At the Breaking Point, 167

Hospital emergency departments (EDs)

causes of ED visits, 1819, 5559

characteristics of pediatric patients, 1819

community service obligations, 36, 105

design, 209

disease surveillance role, 104105

establishment of new lead agency for EMS system, 7, 139, 141, 146

family-centered care in, 208

hospital admissions from, 19, 7071

Medicaid reimbursement, 8385

non-physician care providers, 170171

nonurgent care in, 105

nursing staff, 168170

origins and development, 36, 37

payer mix, 84

pediatric emergency coordinators, 8, 177179

pediatric visits, 2, 15

pharmacists in, 171172

physicians’ pediatric training, 161165

physician supply, 160, 164

provider skill maintenance, 172173

public health linkages, 104

risk of adverse events in, 188190, 193

shortcomings of pediatric care capabilities, 2, 16, 50

specialized pediatric EDs, 19, 37

surge capacity, 234236

utilization, 65, 249, 256

See also Causes of ED visits

Hospital Quality Alliance, 119

Hurricanes, 225

Katrina, 11, 221222, 226, 230231

Hypothermia/hyperthermia, 191

I

Indian Health Service, 262

Infants, 29, 65

Infectious disease

causes of ED visits, 18, 55

population surveillance, 104105

vulnerability of pediatric EMS system, 42

Information technologies and systems

clinical information systems, 107, 118

for continuity of care, 107, 251

current shortcomings, 3, 251

future prospects, 250

goals, 250

Health Insurance Portability and Accountability Act effects, 130

to improve patient safety, 199200

model EMS systems, 121, 123

pediatric considerations in emerging technologies, 10, 203204

risk of error in emergency care, 189190

role of new lead agency for EMS system, 140

special needs children, 6162

trauma registries, 13, 39, 270273

utilization of EMS and EDs, 249250

See also Communications technologies and systems;

Outcomes research;

Performance measurement

Infusion pump, 26, 200201

Injury, pediatric

causes of ED visits, 1819

causes of prehospital calls, 63

data sources, 52

early prevention efforts, 40

epidemiology, 5255

goals of EMS-C program, 44

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

mortality, 39, 4344, 52, 54, 270

prehospital calls, 20

preventive interventions, 254255

recommendations for trauma registry, 13, 272273

research needs, 13

trends, 5455

vulnerabilities of children, 25

Injury in America: A Continuing Health Problem, 40

Insight (clinical information system), 107

Insurance

coverage in rural areas, 7879

health status and, 59, 83

hospital ED payer mix, 6769

hospital utilization and, 36, 81

pediatric emergency care payer mix, 81

See also Medicaid;

Medicare;

Uninsured children

Intensive care units, pediatric, 106107

origins and early development, 37

tertiary-level, 108

Interagency Committee on Emergency Medical Services for Children Research, 133

J

Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 238

Josiah Macy, Jr. Foundation, 27

K

Korean conflict, 36

L

Language differences, 210211

Legal liability

medication errors, 197

shortage of on-call specialists and, 167

Licensure and certification

emergency medical technician training and credentialing, 154

emergency medicine specialty, 161, 163

nurses, 168169, 171

pediatric surgery, 165

recommendations for, 78, 174

M

Major Trauma Outcome Study, 271

Maryland, 37

EMS and trauma system, 106, 120122

Medicaid

coverage, 8283

enrollment, 83

features, 82

hospital ED utilization and reimbursement, 6768, 8384

prehospital service reimbursement, 6364, 8586, 128129

reimbursement problems, 8486, 103104

significance of, for emergency care, 81

Medicare

graduate medical education funding, 8687

prehospital service reimbursement, 128129

purpose, 86

reimbursement system, 86

Medicare Rural Hospital Flexibility Program, 80

Meningococcemia, 191

Mental health problems

causes of ED visits, 5559

disaster preparedness, 12, 224, 237

pediatric risks, 54

pharmacotherapy for, 195

prevalence, 59

quality of ED care, 6061

shortcomings of pediatric emergency care, 5960

training of EMS providers for, 60

trends, 59

Metropolitan Medical Response System (MMRS), 132

Military medicine, 36

Model Pediatric Protocols, 113

Mortality

early pediatric EMS research, 38

leading causes, 55

neonatal intensive care, 109

pediatric injury, 39, 4344, 52, 54, 158159, 270

N

National Advisory Committee on Children and Terrorism, 227228

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

National Association of Children’s Hospitals and Related Institutions, 166

National Association of Emergency Medical Technicians, 156157, 259264

National Association of EMS Physicians, 113

National Association of State EMS Officials (NASEMSO), 49

National Bioterrorism Hospital Preparedness program, 132

National Cancer Institute, 268

National Disaster Medical System, 232

National Emergency Medicine Association, 264265

National EMS Data Analysis Resource Center, 247

National EMS Education Standard, 156

National EMS Information System, 49, 131132, 250

National EMS Research Agenda, 49

National Highway Traffic Safety Administration

EMS-C program support, 44, 46, 49

enhanced 9-1-1 system, 138

recommendations for, 4, 5, 9, 111112, 113, 146, 197, 212, 229230, 239

research program, 27, 263

structure of EMS system oversight and support, 131132, 135

transition to new lead agency for EMS system, 143

National Hospital Ambulatory Medical Care Survey, 249, 250

National Institutes of Health (NIH), 12, 141, 201, 258, 260, 265, 266

National Pediatric Trauma Registry, 39, 270271

National Surgical Care Improvement Project, 116

National Trauma Data Bank, 13, 271272

National Trauma Registry for Children, 272

Neonatal care, 109

9-1-1 system

establishment of new lead agency for EMS system and, 7, 138, 139, 141, 146

utilization, 62

Nonurgent utilization of EMS, 6567

causes of, 105

wait times, 192

Nurse practitioners, 170171

Nurses

advanced practice, 171

current ED staffing, 168

demographic patterns, 168

family presence policies and attitudes, 207

job stress, 168

pediatric emergency coordinators, 178

roles and responsibilities, 168

staffing challenges, 169170

training and certification, 168169, 174

O

Omnibus Budget Reconciliation Act (OBRA), 83

On-call specialists

legal liability concerns, 167

quality-of-life concerns of, 167

reimbursement problems, 85, 166167

roles and responsibilities, 165166

strategies for improving supply, 167168

supply problems, 72, 166167

Outcomes research

current state, 250251

early pediatric EMS research, 38, 39, 41

obstacles to, 251

pediatric ED visits, 19

pediatric pharmacotherapy, 195

pediatric prehospital care, 158159

performance indicators, 5

performance measurement data, 117118

regionalization outcomes, 108

trauma registries, 270273

P

Pain management, 7576

Paramedics

risk of medication errors, 194

roles and responsibilities, 152153

training and certification, 154, 155156

Paroxetine, 195

Patient-centered care

adolescent patients, 211212

characteristics of, 10, 74, 204

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

current state of pediatric emergency care, 252

See also Family-centered care

Pediatric Academic Societies, 259

Pediatric Advanced Life Support, 39, 208

Pediatric Disaster Life Support, 232

Pediatric Education for Prehospital Providers, 155

Pediatric emergency care

child abuse–related visits, 6970

current state, 2, 1617, 2930, 3536, 4142, 7278

defined, 29

disparities in equity, 7778

effectiveness, 7374

efficiency of care, 7677

family-centered care in, 7475

findings of 1993 study, 4951, 248249

goals, 30, 44, 101

historical and technical development, 35, 37, 3841

model systems, 120

nonurgent utilization, 6567

obstacles to improvement, 101102, 128

patient leaving before being seen, 75

payer mix, 6769, 8182

recommendations for practice guidelines and standards, 8, 175177, 179

recommendations for protocol development, 5, 113, 146

research needs, 26

rural areas, 69, 7880

safety concerns, 89, 30, 73, 188, 190193

special demands of, 1, 86

timeliness of care, 7576

trends, 87

utilization, 1920, 26, 6263, 6465, 69

See also Prehospital care

Pediatric Emergency Care Applied Research Network, 2526, 46, 141, 145, 247248, 257, 269

Pediatric emergency coordinator(s)

current implementation, 178, 179

recommendations for appointment of, 8, 177

roles and responsibilities, 8, 177179

Pediatric emergency medical services. See Pediatric emergency care

Pediatric Emergency Medical Services Training Program (PEMSTP), 39

Pediatric Prehospital Care course, 156157

Pediatric Research Equity Act, 195196

Pediatric Trauma Score, 39

Performance measurement

access to data, 6

to build accountability, 5

collaborative entity for, 117

current efforts, 116117, 121, 250, 251

data collection and analysis, 118, 250

goals, 117119

pediatric information systems, 204

public reporting, 56, 119120

recommendations for, 5, 117, 146

shortcomings of current efforts, 117

system-wide, 117, 118

Pharmacotherapy

clinical pharmacy specialists, 171172

disaster preparedness, 236237

dosing errors, 196

infusion pumps, 26, 200201

medication errors in EDs, 73

off label use, 2, 9, 16, 194

pain management, 7576

pharmacists in ED, 171172

recommendations for improving pediatric care, 9, 195, 197, 212

research needs, 9, 197, 212

shortcomings in pediatric emergency care, 2, 9, 16, 26

strategies for improving safety, 198, 199200

threats to patient safety in, 194195, 196197

Physician assistants, 170

Physicians

current emergency department staffing, 160, 164

moonlighting in EDs, 161

pediatric emergency care training, 161165, 173175

psychiatric training, 60

referrals to EDs for nonurgent care, 105

risk of error in emergency care, 188190

skills for emergency department, 160

See also Specialties, medical

Physiology of children

pharmacotherapy considerations, 195

risks in emergency care, 190193

special medical considerations, 1, 2024

vital signs, 1

vulnerability in disasters, 11, 25, 223224

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

Plane crash, 225226

Poisoning, 54

Poison Prevention Packaging Act, 40

Post-traumatic stress, 237

Potassium iodide, 236

Pralidoxime, 237

Prehospital care

categorization for regionalization, 111

child abuse identification and treatment, 70

emerging technologies, 910

EMT training, 154158

family-centered care in, 205208

field stabilization vs. transport, 112113

historical and technical evolution, 3637, 38

Medicaid reimbursement problems, 8586

model EMS information systems, 123124

new lead agency for EMS system and, 7, 139, 141, 146

payer mix, 82

pediatric. See Pediatric emergency care

pediatric percentage, 158

recommendations for protocol development, 5, 113, 146

in rural areas, 7980

threats to patient safety in, 190, 193194

utilization, 249250

wait times, 75

workforce, 151160

See also Ambulance services;

Dispatch of emergency services;

9-1-1 system;

Training of EMS providers

Prehospital Trauma Life Support, 155

Preventive Health and Health Services Block Grant, 38

Preventive interventions

with adolescents, 212

automated external defibrillator, 202203

early efforts, 40

pediatric illness, 4041

public health agency resources for, 104

rationale, 254

research needs, 255256

role of EMS, 254255

Private research, 264265

Public health and safety

communications shortcomings, 3

EMS linkages, 104105

preventive interventions, 254256

surveillance, 222

Public Health Security and Bioterrorism Preparedness and Response Act, 227228

Public perceptions and understanding

accountability in health care and, 115

EMS system performance, 15

expectations for EMS system performance, 15

Public reporting

access to data, 119

aggregation of performance data for, 6, 119

current efforts, 119, 121

forms of, 119

goals, 56, 119120

obstacles, 119

rationale, 119

Q

Quality of care

ambulance diversion and, 71

challenges in pediatric emergency care, 26, 7072

family-centered care, 1011

infrastructure for, 26, 187

mental health interventions, 6061

pediatric prehospital care, 158159

primary care delivered in ED, 66

recommendations for guidelines and standards, 8, 175177, 179

regionalization and, 108

role of pediatric emergency coordinator(s), 8, 177

shortcomings of pediatric emergency care, 2, 1617, 1819, 7278

skill maintenance among ED providers, 172173

variation in physician practice patterns, 74, 173

workforce interventions to improve, 173179

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

R

Race/ethnicity

cultural competency of providers, 210211

disparities in care access and outcomes, 7778

hospital ED utilization, 65

wait times and, 77

Radiation exposure, 202, 236

Regionalization of EMS

categorization of emergency medical services and, 4, 111

concerns, 110

goals, 4, 108

implementation, 109110

model systems, 109, 110111, 121, 122, 123125

quality of care and, 108

rationale, 4, 108

transport protocol development, 113, 146

Regional variation in EMS systems

current state, 1516, 4142, 125

emergency medical technician training and credentialing, 154

Reimbursement

characteristics of pediatric EMS system, 8081

fragmentation of EMS system and, 103104

incentives to improve provider performance, 128129

Medicaid system, 8386

Medicare system, 86

payer mix, 6769, 8182

resource-based relative value scale, 86

shortage of on-call specialists related to, 85, 166167

Research

barriers to, 257

basic, 252

benefits, 245

in centers of excellence, 266267

cross-cutting nature of emergency care research, 258259

development of clinical practice guidelines, 175176

disaster preparedness and response, 224226

dissemination of findings, 248, 259264

early pediatric EMS research, 39, 245248

EMS-C program, 46

establishment of new lead agency for EMS system and, 141

funding, 12, 51, 257264

infrastructure development, 247248

medical technology development, 10, 201, 203, 204, 212

needs. See Research needs

network approach, 12, 13, 267270

organizational collaboration and coordination, 259

organizational leadership, 256

potential sources of support, 260264

private support for, 264265

rationale for increasing, 256

recommendations for improving, 1213, 201, 257, 273

shortcomings of current data collection, 51, 248, 251252, 252, 267

shortcomings of current evidence base, 12, 2526, 7374, 195

training for, 13, 258, 264267

translational, 253

trauma data collection for, 270273

Research needs

basic research, 252

effects of preventive interventions, 255256

organization and delivery of emergency care, 253254

for patient safety improvement, 9

pediatric pharmacotherapy, 9, 195196, 197, 212

pediatric trauma, 13, 270

technology-related risks, 201202

translational research, 253

transport protocols, 112

Reye’s syndrome, 40

Rhode Island night club fire, 235

Robert Wood Johnson Foundation, 176

Rural areas

barriers to care, 78

causes of prehospital care, 79

challenges for emergency care providers, 80

demographic characteristics, 78

ED utilization, 69, 7980

EMS workforce problems, 154, 174

shortcomings of pediatric emergency care, 2, 19, 7880

volunteer EMS providers, 80

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

S

Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU), 133

Safety, patient

current state of pediatric emergency care, 73, 193194, 251

goals, 187

medical technologies to improve, 199204

in prescription and administration of drugs, 9, 194195, 212

provider policies to improve, 198

provider training to improve, 198199

radiation exposure, 201202

recommendations for improving, 9, 195196, 197, 212

research needs, 9, 201202, 212

risks in emergency care, 188190

risks in pediatric care, 8, 30, 188, 190193

strategies for improving, 197198

Safety net providers

burdens on hospitals, 72

hospital EDs as, 105

Medicaid reimbursement, 85

San Francisco Community Clinic Consortium, 107

Seat belts, 40, 104

Severe acute respiratory syndrome (SARS), 42

Shock, 191

Smoke inhalation, 191192

Society for Academic Emergency Medicine (SAEM), 248, 259, 264, 265

Special Children’s Outreach and Prehospital Education, 157

Specialties, medical

acute care surgical specialist, 167168

clinical pharmacy specialists, 171172

emergency medicine specialists, 160162, 163

origins of pediatric EMS specialties, 39, 41

surgical, 165

suture technicians, 172

variation in physician practice patterns, 74, 173

See also On-call specialists

Stand-by emergency departments approved for pediatric, 109110

State Children’s Health Insurance Program, 8182, 83, 85

State Emergency Department Databases, 249, 250

State governments

demonstration program grants, 6, 126

disaster preparedness, 228229

EMS-C grants, 4446

EMS-C-supported programs and policies, 4749

EMS information collection systems, 250

evolution of EMS funding, 38

Medicaid administration, 82, 83

model EMS systems, 120125

trauma registries, 270

Strategic national stockpile, 236237

Sudden infant death syndrome, 40

Suicide, 5455, 60

Supplies and equipment for pediatric emergency care

disaster preparedness, 11, 222223, 224, 236238

findings of 1993 study, 5051

shortcomings of hospital EDs, 2, 16, 187

Surge capacity, 12, 222, 234236

Surveillance, public health, 104105, 107, 222

T

Teaching Resource for Instructors in Prehospital Pediatrics, 156

Technology development and adoption

dissemination of research findings, 259264

future prospects, 910, 200

to improve patient safety, 199204

recommendations for, 10, 201, 212

shortcomings in pediatric emergency care, 26, 201, 202203

Terrorist threat, 227228, 238.

See also Biochemical events

Tertiary-level pediatric intensive care, 108

Texas, model EMS system, 122123

Timeliness of care, 7576, 252

risks in pediatric emergency care, 190193

Training of emergency care providers

child abuse identification and treatment, 70

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

children with special health care needs and, 157

continuing education in pediatric care, 2, 8, 16, 25, 42, 157158, 172173, 174175, 179

disaster preparedness, 222, 232234, 238239

early pediatric-focused programs, 37, 3940

emergency department physicians, 162165

emergency medical technicians, 154158

emergency medicine specialty, 160161, 163

EMS-C efforts, 47

for family-centered care, 208

findings of 1993 study on pediatric EMS, 4950

first responders, 151152, 155

goals, 173175

graduate medical education, 85, 8687

to improve patient safety, 198199

instructor support, 156

National Standard Curricula, 155156

nurses, 168169

origins of pediatric specialties and subspecialties, 39, 41

pediatric emergency medicine subspecialty, 161162

pediatric surgery, 165

psychiatric, 60

recommendations for, 8, 174, 179

for research, 13, 258, 264267

shortcomings of current system, 7, 16, 25, 73, 157158

simulation exercises, 199

teamwork training, 198199

Transfer agreements, 2

accountability and, 5, 115

shortcomings of current EMS system, 16, 24, 51, 103

Transport of patients

developments in history of, 36

disaster response, 225226

Emergency Medical Treatment and Active Labor Act and, 129130

field stabilization and, 112113

interfacility transfers, 19

Medicaid/Medicare reimbursement, 6364, 8586, 128129

model EMS systems, 121, 123124

parental involvement, 206207

payer mix, 82

recommendations for protocol development, 5, 112113, 146

research needs, 112

role of emergency medical technicians, 152

See also Ambulance services

Trauma care

defined, 29, 4243

development of pediatric trauma care, 4344

establishment of new lead agency for EMS system, 139, 141, 146

historical development, 36

pediatric, 109

trauma registries, 13, 39, 270273

Trauma center

defined, 29

features, 43

pediatric, 109

Trauma registries, 13, 39, 270273

Trauma system

defined, 29

as model of regionalization, 110111

origins and development, 37

regionalization, 109

Triage, pediatric, 192

disaster response, 228

U

Uninsured children

emergency transports, 82

health status, 59

prevalence, 81

Utilization

data sources, 249250

deterrents to ED use, 6869

early research, 245246

historical trends, 36

insurance coverage and, 36, 81

Medicaid patient ED visits, 6768, 81

nonurgent ED care, 6567, 105

pediatric ED visits, 2, 15, 18, 19, 6465, 256

prehospital care, 1920, 6264, 158

rural EDs, 69, 7980

surge capacity, 222

trends, 70

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
×

V

Vaccines, 4041

Vermont Oxford Network, 268

Vietnam conflict, 36

Violence, exposure to, 52, 54, 192193

Vision, of committee, 37, 30

Vital signs, 1

Volunteer EMS providers

credentialing within regional EMS system, 122

emergency medical technicians, 153, 154

in rural areas, 80, 154

Vomiting, 192, 223

W

Wait times, 71, 77

average ED wait, 192

nonurgent care in ED, 66

patient departure before being seen, 75

risks for children, 192193

Workforce, 30

credentialing within regional EMS system, 122

cultural competency, 210211

current shortcomings in pediatric emergency care, 7, 8, 2425, 151

family presence during medical interventions, attitudes toward, 206207, 208

friction within EMS system, 104

goals for pediatric EMS system, 78

knowledge required for pediatric care, 24

non-physician care providers in hospital EDs, 170171

pediatric disaster expertise, 232234

pediatric emergency coordinators, 8, 177179

prehospital care, 151160

risk of error in emergency care, 190

in rural areas, 80

skill maintenance among ED providers, 172173

strategies to improve pediatric care, 173179

See also Emergency medical technicians (EMTs);

Nurses;

On-call specialists;

Physicians;

Training of emergency care providers

Suggested Citation:"Index." Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. doi: 10.17226/11655.
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Emergency Care for Children: Growing Pains Get This Book
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Children represent a special challenge for emergency care providers, because they have unique medical needs in comparison to adults. For decades, policy makers and providers have recognized the special needs of children, but the system has been slow to develop an adequate response to their needs. This is in part due to inadequacies within the broader emergency care system. Emergency Care for Children examines the challenges associated with the provision of emergency services to children and families and evaluates progress since the publication of the Institute of Medicine report Emergency Medical Services for Children (1993), the first comprehensive look at pediatric emergency care in the United States. This new book offers an analysis of:

• The role of pediatric emergency services as an integrated component of the overall health system.

• System-wide pediatric emergency care planning, preparedness, coordination, and funding.

• Pediatric training in professional education.

• Research in pediatric emergency care.

Emergency Care for Children is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency health care providers, professional organizations, and policy makers looking to address the pediatric deficiencies within their emergency care systems.

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