one-page form with the child’s medical information. The form is then faxed to the EMS agency, where the information is entered into the 9-1-1 call center’s computers. The EMS stations closes to the child’s home also receive the information. The program was expanded to provide all such children with a vinyl index card containing their medical information so that they would have the information with them when away from home. The program also encourages prehospital providers to make home visits so they can become familiar with the children’s special needs and establish relationships with both children and parents. In its first year, EMS Outreach enrolled 450 special needs children (Smith et al., 2001).

Similar programs exist in other areas. An EMS-C demonstration grant in New Hampshire was used to develop the Special Needs Identification Project (SNIP). Resources developed through the project are now available online to other states through the EMS-C program’s clearinghouse (EMS-C Program, 2003). Certainly as electronic health records advance in the coming years, special needs identification programs are likely to advance as well.

Use of Emergency Care Services by Children

Prehospital Services

Approximately 200 million emergency calls are received by 9-1-1 call centers each year (National Emergency Number Association, 2004); that number includes calls for medical, police, and fire needs. There are no reliable data on the number of pediatric medical calls made to 9-1-1 annually. (The dispatch system is discussed in depth in the committee’s companion report, Emergency Medical Services at the Crossroads.) However, some data are available on the use of prehospital EMS by children, revealing that in general, their use of such services is relatively low compared with that of adults. The vast majority of pediatric patients under age 15 come to the ED by private vehicle or public transportation and therefore do not receive prehospital emergency care. In 2003, only 3.8 percent of pediatric ED patients under age 15 arrived by ambulance, compared with 11 percent of patients aged 24–44 and 41 percent of those over age 74 (McCaig and Burt, 2005).

Although pediatric patients account for approximately 27 percent of all ED visits, studies suggest that they represent only 5 to 10 percent of all prehospital transports (Seidel et al., 1984; Federiuk et al., 1993). One important source of variation in that percentage is the differing definitions of “child” used by various studies. National data on prehospital calls are not presently collected; therefore, our understanding of pediatric calls is based on studies of individual EMS systems. One of the largest such stud-

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