scant evidence regarding the impact on patient outcomes of not having all essential pediatric equipment; however, having this equipment available is an essential element of preparedness.
The 1993 IOM report also recommended that states address the issue of categorization and regionalization in overseeing the development of pediatric emergency care. In many states, however, hospitals are not categorized based on their ability to care for critically ill or injured children. Additionally, many hospitals lack transfer agreements in case a critically ill or injured child arrives at a hospital that lacks pediatric expertise (Middleton and Burt, 2006). This issue is discussed further in the next chapter.
One of the great successes of the EMS-C program has been that all states now have an EMS-C coordinator, whose job it is to oversee grant funding received from the program. In many states, the coordinator position is full-time and involves other activities, including making sure that the state EMS system considers children’s needs. However, there are still signs of deficiencies in trauma and disaster planning (MCHB, 2004a; NAEMSD, 2004). As mentioned earlier, about half of hospitals that lack a separate pediatric ward also lack written interfacility transfer agreements (Middleton and Burt, 2006). Moreover, although most state disaster plans address the need for pediatric equipment and medications at hospitals, only six states report that hospitals have those resources in place (NAEMSD, 2004).
Certainly there has been some expansion of pediatric emergency care research since 1993, but efforts to track patient outcomes have been hampered by the absence of an infrastructure for the systematic collection of a uniform set of data elements and by the inability to link datasets of different providers (prehospital, ED, others) as recommended in the 1993 IOM report. Research funding for pediatric emergency care is also highly limited. It is of note that the annual appropriation for the entire EMS-C program is less than the annual cost of some single large-scale National Institutes of Health (NIH) clinical trials (National Center for Complementary and Alternative Medicine, 2002; National Cancer Institute, 2005). As a result of the dearth of funding for emergency care research, many emergency medical interventions that are regularly provided to children have not been subjected to rigorous scientific trials. This issue is discussed further in Chapter 7.
This section describes the emergency care system for children in 2006. The focus is on the need for and use of pediatric emergency care.