termine the best ways to organize the delivery of emergency care services, particularly prehospital EMS. And, given that many closings of hospitals and EDs can be attributed to financial losses caused by the cost of emergency and trauma care, Congress should consider providing greater reimbursements to the large, safety-net hospitals and trauma centers that bear a disproportionate amount of the cost of taking care of uninsured patients.

An area in which greater funding is needed is disaster preparedness. To date, despite their importance in any response to disaster, the various parts of the emergency care system have received very little of the funds that Congress has dispensed for disaster preparedness. In part this is because the money tends to be funneled through public safety agencies that consider medical care to be a low priority. Congress should therefore make significantly more disaster preparation funds available to the emergency system through dedicated funding.

Finally, as these improvements are made to the nation’s emergency care system, it will be important to keep pediatric patients in mind in all aspects of emergency care. The needs of pediatric patients should be taken into account in developing standards and protocols for triage and the transport of patients; in developing disaster plans; in training emergency care workers to ensure that they are competent and comfortable providing emergency care to children; and in conducting research to determine which treatments and strategies are most effective with children in various emergency situations.

There is no “one size fits all” solution to building the best possible emergency care systems from state to state and region to region. In order to explore different approaches and see what works best in different situations, the committee recommends that Congress establish a 5-year demonstration program to provide funding for states or regions to develop coordinated, regionalized, and accountable emergency care systems in various parts of the country. Over time these projects will help identify best practices that can address the problems facing today’s emergency systems and point the way toward a future emergency care system that ensures high-quality, efficient, and reliable care for all who need it.