Second, there were advances in resources for information. In the early 1980s, the U.S. Department of Education, through the National Institute of Disability and Rehabilitation Research, funded the development of the National Pediatric Trauma Registry. The registry enabled researchers to identify the demographics of pediatric trauma. Data from the registry revealed that automobile crashes were the primary source of pediatric trauma, that injuries were most often blunt, and that an injured child stood a 3 percent chance of dying from trauma. Data from the registry were also used to develop the Pediatric Trauma Score, a system used to help EMTs determine the facility to which an injured child should be transported (Harris, 1987).

Third, professional societies began to give greater attention to pediatric emergency care. In the late 1970s, pediatricians who worked in EDs began to discuss issues in pediatric emergency care; the result was the formation of a section on pediatric emergency medicine within the American Academy of Pediatrics (AAP) in 1981 (Pena and Snyder, 1995; AAP, 2000). In 1983, the American College of Emergency Physicians (ACEP) held an interspecialty conference on childhood emergencies that led to the establishment of a joint AAP/ACEP Task Force on Pediatric Emergency Medicine the following year (AAP, 2000). ACEP also formed a member section on pediatric emergency medicine in 1998 (Pena and Snyder, 1995). In 1985, a Provisional Committee on Pediatric Emergency Medicine was created within AAP; it became a full committee in 1998 (AAP, 2000). Both the Emergency Nurses Association (ENA) and the National Association of EMS Physicians (NAEMSP) had established pediatric sections by the end of the 1980s (IOM, 1993).

Fourth, there were important advances in pediatric emergency medicine. By the early 1980s, many physicians had recognized that emergency care for children was not as well advanced as that for adults and that specialized resources for the training of providers in pediatric emergency care was needed. The longest-running pediatric emergency medicine fellowship was established in 1980 (Pena and Snyder, 1995; Macias, 2005). Early experts in the field began to synthesize knowledge in the area and make it more widely available. The first pediatric emergency care textbook was published in 1983, and the first journal devoted to pediatric emergency care was launched in 1985.

A number of training courses were developed as well. In 1988, the American Heart Association and the AAP initiated the Pediatric Advanced Life Support (PALS) course. The AAP and ACEP joint task force developed and sponsored the Advanced Pediatric Life Support (APLS) manual, published in 1989. Some courses were also developed locally. An example is the Pediatric Emergency Medical Services Training Program (PEMSTP) at Children’s National Medical Center in Washington, D.C., which prepared EMT instructors to teach pediatric aspects of emergency care. Progress continued in the early 1990s when the ENA developed standardized training for



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