Legislative language to provide funding for this effort has been included as part of the health reform bills debated during 2009-2010. The proposed demonstration program would be broad in scope but would focus on learning more about the development, day-to-day operation, and maintenance of regionalized emergency care systems.

A nationwide effort to establish regional systems of emergency care was also undertaken in the 1970s. Two federal departments, the Department of Transportation (DOT) and the Department of Health, Education, and Welfare (DHEW, now Department of Health and Human Services [HHS]) administered grant programs that provided assistance to states and regional systems. The DHEW program established 303 contiguous emergency care regions across the country. Some of the regionalized systems established by this program survive to this day; others withered when federal funding was folded into state block grants in 1980. As a result, fragmentation of care remains a persistent problem in many parts of the country.

One of the key Committee recommendations in the 2006 reports was the establishment of a “lead federal agency” within the Department of Health and Human Services to provide overall coordination of federal activities to strengthen emergency care. While regionalization often centers on the important role of states, patient transports frequently involve crossing state lines and these can highlight deficiencies in areas such as communication, coordination, and performance measurement. Some argue that accountability at the regional system level may require leadership from the federal level, while others see this as a state responsibility.

The concept of a federal lead agency in emergency care was advanced by Homeland Security Presidential Directive-21 (HSPD-21), which was issued in October 2007 and directed that an office dedicated to emergency care be created within HHS. In January 2009, Secretary Michael Leavitt signed the charter establishing the Emergency Care Coordination Center (ECCC) in the Office of Assistant Secretary for Preparedness and Response, within HHS. When the Obama Administration took office, it affirmed its support of the nascent ECCC. Since that time, the Center has engaged a variety of federal agencies in joint problem solving through the creation of a federal Council on Emergency Medical Care (CEMC). This interagency working group has focused on strengthening hospital-based emergency care and has also worked in conjunction with the Federal Interagency Committee on Emergency Medical Services (FICEMS), which serves a similar role in strengthening prehospital EMS care.

During 2009, the newly formed ECCC sponsored three IOM workshops to examine the U.S. emergency care system and assess the progress made since the release of the 2006 reports. The first workshop, held in May 2009 in Washington, DC, focused on the Emergency Care Enterprise, the joint effort between FICEMS and ECCC to improve prehospital and hospital-



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