FUTURE OF EMERGENCY CARE

DISSEMINATION WORKSHOP SUMMARIES

Megan McHugh and Peter Slavin, Rapporteurs

The Future of Emergency Care Workshop Planning Group

Board on Health Care Services

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C. www.nap.edu



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Future of Emergency Care: Dissemination Workshop Summaries FUTURE OF EMERGENCY CARE DISSEMINATION WORKSHOP SUMMARIES Megan McHugh and Peter Slavin, Rapporteurs The Future of Emergency Care Workshop Planning Group Board on Health Care Services INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Future of Emergency Care: Dissemination Workshop Summaries THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This study was supported by Contract No. HHSH25056047, TO#2 between the National Academy of Sciences and the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the National Highway Traffic Safety Administration. Support was also provided by the American Academy of Pediatrics, the American College of Emergency Physicians, the American College of Surgeons, the Association of Academic Chairs of Emergency Medicine, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents’ Association, the Emergency Nurses Association, the National Association of EMS Physicians, the Robert Wood Johnson Foundation, and the Society for Academic Emergency Medicine. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-10468-5 International Standard Book Number-10: 0-309-10468-8 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2007 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2007. Future of Emergency Care: Dissemination Workshop Summaries. Washington, DC: The National Academies Press.

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Future of Emergency Care: Dissemination Workshop Summaries “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Advising the Nation. Improving Health.

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Future of Emergency Care: Dissemination Workshop Summaries THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Future of Emergency Care: Dissemination Workshop Summaries THE FUTURE OF EMERGENCY CARE WORKSHOP PLANNING GROUP NELS D. SANDDAL (Chair), President, Critical Illness and Trauma Foundation, Bozeman, Montana RAY BIAS, Government Relations Manager, Acadian Ambulance Service, Lafayette, Louisiana A. BRENT EASTMAN, Chief Medical Officer, N. Paul Whittier Chair of Trauma, ScrippsHealth, San Diego, California MARIANNE GAUSCHE-HILL, Clinical Professor of Medicine and Director, Prehospital Care, Harbor-UCLA Medical Center, Torrance, California ARTHUR L. KELLERMANN, Professor and Chair, Department of Emergency Medicine, and Director, Center for Injury Control, Emory University School of Medicine, Atlanta, Georgia JANE F. KNAPP, Vice Chair Graduate Medical Education, Children’s Mercy Hospital, Kansas City, Missouri BRIAN W. LINDBERG, Executive Director, Consumer Coalition for Quality Health Care, Washington, DC RICARDO MARTINEZ, Executive Vice President for Medical Affairs, The Schumacher Group, Kennesaw, Georgia GAIL L. WARDEN, President Emeritus, Henry Ford Health System, Detroit, Michigan Study Staff MEGAN McHUGH, Project Director and Senior Program Officer ANISHA S. DHARSHI, Research Associate DANITZA VALDIVIA, Program Associate

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Future of Emergency Care: Dissemination Workshop Summaries Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: David Jaffe, Washington University School of Medicine, Saint Louis Children’s Hospital Linda McKibben, Independent Consultant, Arlington, Virginia Robert O’Connor, Emergency Medicine Residency Program, Christiana Care Health System Nels Sanddal, Critical Illness and Trauma Foundation, Bozeman, Montana Charlotte Yeh, Centers for Medicare and Medicaid Services, United States Department of Health and Human Services Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Dr. Melvin Worth, Scholar-in-Residence, Institute of Medicine. Appointed

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Future of Emergency Care: Dissemination Workshop Summaries by the National Research Council and Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution.

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Future of Emergency Care: Dissemination Workshop Summaries Acknowledgments We are grateful to the members of the workshop planning group, who volunteered their time and intellectual efforts to shape the workshop programs, identify topics, and select contributors. We would also like to express our appreciation to the many individuals that participated on workshop panels as well as other speakers and discussants who contributed to the workshops (see Appendixes A and B for the workshop agendas and list of participants). Finally, the workshops were organized with the generous assistance of many individuals and organizations in Utah, Illinois, and Louisiana. We acknowledge in particular the logistical support and hospitality provided by the staffs of Primary Children’s Medical Center, the University of Utah Health Sciences Center, the Utah Department of Health, Northwestern Memorial Hospital, and Tulane University School of Public Health and Tropical Medicine.

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Future of Emergency Care: Dissemination Workshop Summaries Contents 1   INTRODUCTION   1 2   THE INSTITUTE OF MEDICINE STUDY ON THE FUTURE OF EMERGENCY CARE   4      Emergency Care in the United States,   4      The Committee’s Findings,   5      The Committee’s Recommendations,   11      Achieving the Vision,   13 3   WORKSHOP IN SALT LAKE CITY, UTAH   14      Reactions to the IOM Reports,   14      Leading Change,   20      Advancing Pediatric Emergency Care,   22      Emergency Care in Rural Areas,   28      Closing,   34 4   WORKSHOP IN CHICAGO, ILLINOIS   35      Reactions to the IOM Reports,   35      The Emergency Care Workforce,   43      Hospital Efficiency,   51      Lessons Learned from Trauma System Development,   57      Closing,   59

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Future of Emergency Care: Dissemination Workshop Summaries 5   WORKSHOP IN NEW ORLEANS, LOUISIANA   60      Reforming Health Care,   60      Reactions to the IOM Reports,   61      A Federal Perspective,   67      A State Perspective,   68      Advancing Prehospital Emergency Medical Services,   69      Advancing Disaster Preparedness and Response,   74      Closing,   79 6   CAPSTONE WORKSHOP IN WASHINGTON, DC   80      Summary of the Three Regional Workshops,   80      Reactions to the IOM Reports,   82      Challenges and Opportunities in Emergency Care Research,   99      Closing,   111     APPENDIXES     A   WORKSHOP AGENDAS   113 B   WORKSHOP ATTENDEES   125 C   LIST OF ACRONYMS   149