The workshop’s keynote speaker was Dr. Jeff Runge, former assistant secretary for health affairs at the Department of Homeland Security (DHS), former administrator of the National Highway Traffic Safety Administration (NHTSA), and now president of Biologue, Inc. Dr. Runge commented that he had high hopes for the three IOM reports on emergency care when they were released in 2006, but he acknowledged that the fundamental changes called for in the reports take time to achieve. He criticized the original committee for proposing so many recommendations, and noted that fully implementing them will require substantial cultural change.

To get a sense of who was in the audience, Runge asked the participants to raise their hands and identify themselves as practitioners of emergency care or policy makers. More than half responded that they were practitioners. He also asked the audience members to indicate if they had ever been a patient in an emergency department, or had a family member who was a patient. The vast majority of hands went up.

Runge then asked the audience to assess how we, as a community, are doing in advancing the cultural change envisioned by the IOM reports. He identified a series of topic areas that grouped together the IOM recommendations and asked the audience to assign a letter grade (A, B, C, or F) to each area based on a show of hands. The topic areas included the following:

• Operational efficiency (e.g., reducing boarding and ambulance diversion)

• Information technology

• The burden of uncompensated care

• Emergency care workforce (e.g., availability of on-call specialists)

• Research in emergency care

• Emergency care for children (e.g., defining pediatric competencies)

• Pediatric safety

• Emergency care funding

• Payment for medical care without transport

• Air medical services

• National standards for training and credentialing (e.g., accept national certification as a prerequisite of state licensure; common scopes of practice across states)

• Disaster preparedness

In virtually every case the majority of hands indicated a low letter grade, typically a C or an F.

In discussing an overall grade, Runge pointed out that a number of key indicators have not shown any improvement in the past 3 years. For example, he said that EMS diversion has not ended or even improved. There