findings and recommendations from the IOM reports, a panel of state and local representatives participated in a conversation about the reports based on a series of questions set in advance. The discussion was moderated by Dr. Eastman, chief medical officer of ScrippsHealth. Respondents included Leslee Stein-Spencer, former chief of EMS for Illinois and current policy advisor for the National Association of State EMS Officials; Bill Jermyn, EMS medical director for the state of Missouri; Stephen Hargarten, chair of emergency medicine at the Medical College of Wisconsin and director of the Injury Research Center; Thomas Esposito, trauma surgeon from Loyola University Medical Center; and Peter Butler, executive vice president and chief operating officer at Rush University Medical Center.

What Are the Key Messages of the IOM Reports?

Ms. Stein-Spencer identified several key messages of the report. First, she noted that the reports identified EMS as an important component of the health care system; one that should be elevated in importance. Second, ED crowding, boarding, and diversion are major system-wide problems. Third, there is a great need for improved coordination among federal, state, local, and regional levels across the various system components, including EMS, hospitals, public health, and trauma. Fourth, due to a lack of research on emergency care, we lack the ability to determine whether many interventions are making a difference for patients. Fifth, there is a need to identify facilities that are prepared to properly handle pediatric patients. Finally, disaster preparedness involves not only police and fire but also EMS and hospitals. More training, funding, and equipment are needed to improve the medical response to disasters.

Dr. Jermyn added two key messages, the first being the IOM committee’s recommendation to develop a coordinated, regionalized, and accountable emergency care system. Second, there is a need to “break down silos” between different components of the emergency care system.

Dr. Esposito and Dr. Hargarten agreed with the key messages mentioned by the previous speakers. Dr. Hargarten added that the key messages from the reports are nested in their respective titles: Emergency Medical Services at the Crossroads; Hospital-Based Emergency Care: At the Breaking Point; and Emergency Care for Children: Growing Pains.

Mr. Butler identified two other key messages. First, the problems in the emergency care system (e.g., uncertain quality, fragmentation among providers, millions without health insurance, and the need for information technology) are a microcosm of the broader problems in the health care system. Second, providers can address some of the problems, but tackling them will require leadership. The hospital community must take responsibility for addressing some of the system issues that are being discussed.

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