increase funding for the federal Emergency Medical Services for Children (EMS-C) program to $37.5 million per year.

  • Overcrowding/surge capacity. The overcrowding of emergency departments (EDs) is a result of a hospital-wide capacity problem and was a major concern for many workshop attendees. Many communities are struggling on a daily basis with the challenges of crowding, boarding, and ambulance diversion. The absence of surge capacity to handle normal patient volumes makes it clear that the system is not well prepared to handle disasters.

  • Uncompensated care. Emergency care in the United States has become “the safety net of the safety net” for uncompensated care, and providers desperately need financial support from Congress. Uncompensated care is also contributing to a shortage of specialists willing to treat patients in the ED.

  • Liability. The IOM committee recommended studying the problem, but workshop attendees said resoundingly, “Don’t study it, just fix it.”

  • Regionalization. The single best solution to many of the problems in the emergency care system, including the shortage of nurses, physicians, and specialists, is regionalization. Regionalization would ensure that an individual who is critically ill or injured anywhere in the country would receive expeditious transport to a level of care commensurate with his or her condition. There was resounding support for regionalization at the workshops.

  • Disaster preparedness. Workshop participants agreed that for too long EMS has been left out of disaster planning and funding streams. In fiscal year 2002-2003 only 4 percent of the Department of Homeland Security’s (DHS’s) $3.8 billion budget went to EMS. Yet EMS will be at the heart of any disaster response.

  • Workforce. There is a shortage of emergency care personnel on all fronts: physicians, nurses, and emergency medical technicians (EMTs). Creative strategies are needed to address these shortages and improve provider competencies.

The main point of contention raised at the regional workshops, Dr. Eastman said, had to do with the IOM committee’s recommendation for the creation of a single federal lead agency for emergency and trauma care in DHHS. While there are a number of very dedicated individuals and agencies with responsibility for some component of emergency care at the federal level, the committee proposed this recommendation as a way to overcome the current fragmentation of authority that exists and to improve federal communication and coordination. Some constituents, however, called first

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