a desired vision for the system; and (4) recommend concrete, actionable strategies for realizing that vision.

The 2006 committee identified many challenges and problems with the existing system:

  • Emergency department crowding and frequent EMS diversions.

  • Fragmentation of care—not only geographically, but across disciplines, in the continuum of care, and within levels and agencies of state and federal government.

  • Inadequate disaster preparedness.

  • Deficiencies in the care of children.

  • An inadequate base of emergency care research.

  • Serious challenges to emergency care financing, including the liability environment, and workforce issues that threaten the long-term viability of our nation’s emergency and trauma care system.

The 2006 IOM committee offered a number of concrete, actionable recommendations (see Appendix C). Kellermann highlighted five:

  1. Establish a lead federal agency in the Department of Health and Human Services that would ultimately be accountable for promoting and advancing emergency care.

  2. Promote strategies to advance and strengthen pediatric emergency care, not only in pediatric hospitals, but across the U.S. health system, both in prehospital settings and through hospital-based emergency care.

  3. Improve the organization and funding of emergency care research.

  4. End the practices of boarding and EMS diversion.

  5. Regionalize the delivery of emergency and trauma care throughout the country, drawing on past successes with trauma care systems but extending the concept in other dimensions.

“The committee’s vision, then and now, was of a ‘regionalized, coordinated, and accountable emergency care system’” Kellermann said. “Our task is to flesh out what this concept means and how it can be actualized at the state and local level, within geographic regions, and across the nation. The attendees at this conference have the opportunity to help inform and advise the federal government as they set out to achieve this vision.”

A number of questions remain, Kellermann pointed out. “What does regionalization entail? Is it simply transporting patients to higher-level hospital facilities? Is it diffusing knowledge throughout a region? Is it identifying specific institutions with the expertise to handle specific patient problems? Is it always about the most severely ill or injured? How does

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