in 1966 (NAS and NRC, 1966). The report described the epidemic of injuries and deaths from automobile crashes and other causes in the United States and lamented the deplorable system for treating those injuries nationwide. In 1966, prehospital and hospital services were largely inadequate or nonexistent. Although a few communities were providing ambulance services through their fire or police departments, it is estimated that morticians provided about half of such services. No specific training was required for ambulance attendants. Most emergency rooms could offer only advanced first aid, and only a few hospitals appeared to have the infrastructure necessary to provide complete care for the critically ill and injured.

The 1970s: Rapid Development of EMS Systems

The 1966 NAS/NRC report stimulated a flood of public and private initiatives designed to enhance highway safety and improve the medical response to accidental injuries. These initiatives included the development of the national trauma system, the creation of the specialty of emergency medicine, and the establishment of federal programs to enhance the nation’s emergency care infrastructure and research base. Perhaps most significant was passage of the Emergency Medical Services Systems (EMSS) Act of 1973 (P.L. 93-154), which created a categorical grant program that led to the nationwide development of about 300 regional EMS systems (IOM, 1993). Despite these achievements, the need to treat pediatric emergencies in a unique way was not fully appreciated at the time. The EMSS Act led to the development of systems that were focused primarily on adult trauma and adult cardiac care. Specialized pediatric needs received little attention; indeed, only limited expertise in pediatric emergency medicine existed (Foltin and Fuchs, 1991).

Nonetheless, some initial efforts were made in the 1970s in certain geographic areas to incorporate the needs of children into emergency medicine and EMS systems. Dedicated pediatric emergency departments (EDs) began to develop, staffed by pediatricians who were willing to devote their full attention to emergency care. Also, some hospitals established pediatric intensive care units (PICUs) and began conducting research on pediatric emergency care. In 1975, Maryland established a regional pediatric trauma center, one of the first in the country. Physicians in Los Angeles, along with local professional societies and the county EMS agency, developed a pediatric-focused training curriculum for paramedics and management guidelines for pediatric emergency care (IOM, 1993). The level of sophistication of emergency rooms generally improved during this time, and the term shifted from “emergency room” to “emergency department” as emergency services began to constitute a full department within hospitals.

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