Future of Emergency Care Dissemination Workshop Summaries (2007) / Chapter Skim
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6 Capstone Workshop in Washington, D.C.
6 Capstone Workshop in Washington, D.C.
Pages 80-112
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From page 80... ...
Research in the areas of emergency medical services • (EMS) , emergency medicine, and trauma are at a disadvantage.
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There is a shortage of emergency care personnel on all • fronts: physicians, nurses, and emergency medical technicians (EMTs)
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Dr. Eastman also said that workshop participants noted that the IOM reports paid insufficient attention to certain topics, namely geriatrics, mental health and substance abuse, the nursing shortage, and a single-payer system.
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Region 13 is a DHS and FEMA-designated best practice model. Within the region is the Center for Emergency Medicine at the University of Pittsburgh, which
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Mr. Cannon spoke of several initiatives that FEMA is working on that will strengthen its relationships with the health care community and medical emergency services.
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Finally, Dr. Gustafson said that a technical advisory group will be issuing recommendations for changes to the Emergency Medical Treatment and Active Labor Act (EMTALA)
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He added that the recently passed Pandemic and All Hazards Preparedness Act calls for the secretary of DHHS to promote improved emergency medical services, medical direction, system integration, research, uniformity of data collections, treatment protocols, and policies with regard to public health emergencies. He said that DHHS has made a commitment to building regional capabilities and supporting regional activities.
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Dr. Runge responded by saying that "it is not a crisis until the people feel it," and those in the trauma and emergency medicine communities "have done such a great job of making lemonade out of lemons that the people don't yet feel it." He described the IOM reports as the canary in the coal mine and a harbinger of things to come, but until the public feels it, they will not demand reform.
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Panelists included Jennifer Bryning, public health preparedness policy director for the Senate Health, Education, Labor and Pensions (HELP) Committee, Subcommittee on Bioterrorism and Public Health Preparedness; Debbie Curtis, chief of staff for Representative Pete Stark (D-CA)
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From page 89... ...
Through the reauthorization of the Emergency Medical Services for Children Act, Senator Inouye hopes that there will be continued improvements in EMS for children nationwide. She told the audience that the senator intends to represent their interests at the beginning of the 110th Congress by offering a bill to reauthorize the act.
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, noted that in the six months since the release of the IOM reports, nothing has changed. The IOM did a remarkable job of identifying
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Steve Krug, chair of the Committee on Pediatric Emergency Medicine for the American Academy of Pediatrics, noted that there are two ways to address the IOM committee's recommendations: from the bottom up and from the top down. He said that providers can work together more effectively at the grassroots level to improve emergency care and better integrate their processes; however, the majority of the recommendations are targeted at the federal level.
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From page 92... ...
Representative Pete Stark, incoming chair of the Health Subcommittee of the House Ways and Means Committee, said the IOM reports describe a lot of problems, many of which may not really exist, but the reports do not offer many solutions. Regarding the recommendations that pertain to JCAHO, Representative Stark encouraged the IOM committee to "not waste your time" with JCAHO, describing the organization as "a useless, toothless tiger." Representative Stark said that someone at CMS recently made a determination that EMTALA does not apply to a child of illegal parents.
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Open Discussion Judd Hollander, president-elect of the Society for Academic Emergency Medicine, clarified that the problem of ED overcrowding is due not only to uninsured patients seeking care; overcrowding is also caused by insured patients being referred to the ED by their primary care physicians. Representative Stark responded by saying that he believes primary care physicians are underpaid and addressing reimbursement issues might alleviate some of the problem.
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the majority of Americans feel that having a trauma center nearby is at least as important as having a fire department or a police department; and (d) Americans are willing to spend their own money to have trauma centers and systems in place in their state.
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Ms. Dubow described a recent article by the Society for Academic Emergency Medicine (SAEM)
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He described the pitfalls and failures of the emergency medical system for children. For example, parents do not know whether they should take their children to the closest hospital or to the children's hospital.
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Therefore, many of the recommendations need to be packaged together in a bill under the guise of something more urgent to consumers, "The Emergency Medicine Improvement Act of 2007" or the "Save a Million Lives Bill." Mr. Lindberg noted that consumers and Congress may relate more to the findings and recommendations on disaster preparedness, and it should be the cornerstone of any public awareness effort.
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A key unaddressed issue in the IOM reports, Mr. Vaughan said, is specialty hospitals.
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Mr. Vaughan said he could not commit Consumers Union to that yet; however, he noted that the IOM reports caused some ferment within the organization for emergency care scorecards.
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Emergency Care Researchers Three emergency care researchers were invited to speak about the challenges and opportunities involved in emergency care research. Panelists included William Barsan, professor and chair of the Department of Emergency Medicine, University of Michigan; Nathan Kuppermann, professor in the departments of Emergency Medicine and Pediatrics and chair and director of research of the Department of Emergency Medicine, University of California, Davis, School of Medicine; and Daniel Patterson, research associate at the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.
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Infrastructures are needed to test the efficacy of treatment, to test the efficacy of transport and prehospital care, and to promote collaboration, and a mechanism is needed to study the transfer of research results to treatment settings. One multicenter research network is the Pediatric Emergency Care
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From page 102... ...
The National Registry of Emergency Medical Technicians has a strong history of collecting workforce data on EMTs and paramedics. If the registry had the capacity to collect data on nonnationally registered EMTs, it would allow researchers to conduct more meaningful studies on the EMS workforce.
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From page 103... ...
If NIH and the academic institutions that support emergency medicine research would recognize EMS as a vehicle for improving and increasing community-based research, it would help a great deal. As for systems-level research, many federal agencies have the capacity to support a competitive grant program and demonstration projects focused on EMS systems and workforce research.
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He also noted that there has been some talk about an initiative to create a home for emergency medicine that spans multiple institutes at NIH rather than creating a specific institute for emergency medicine research. Response from Federal Agencies Involved in Emergency Care Research Representatives from several federal agencies were invited to discuss their reactions to the research findings and recommendations in the IOM reports as well as from earlier panels.
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From page 105... ...
That will require strong, linked data on robust measures, evidence of how to improve the care systems themselves, and systematic collection and implementation of the evidence. A DHHS study recently found 91 data sources with information on emergency care and preparedness, including two highlighted extensively in the IOM reports: CDC's National Hospital Ambulatory Medical Care Survey and AHRQ's Healthcare Cost and Utilization Project (HCUP)
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With regard to the committee's call for emergency and trauma care research for prehospital EMS with an emphasis on systems and outcome research, Dr. Hunt said that CDC is looking at
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Academic centers have a moderate interest in research, but military medical treatment facilities have less interest in conducting research. Operational barriers to conducting research include the multidisciplinary nature of emergency medicine research, enrolling research subjects, and obtaining informed consent waivers.
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Dr. Marler described two major projects that demonstrate how emergency medicine can help in the development of clinical treatments.
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Tammy Estrada, a senior nurse at Memorial Health University Medical Center in Savannah, said that senior leadership from her hospital believed in the IOM reports so much that they sent a delegation to the workshop with the hope that they would return with a plan to support ED improvement efforts. She said during the course of the day she learned that CMS is unlikely to make many changes to Medicare reimbursement, Congress wants more specific recommendations to act on, outside agencies may need to be employed to raise public awareness, and more research in emergency care is needed.
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Marler whether the success of the efforts at the NINDS in terms of incorporating emergency medicine research could be leveraged to incorporate similar efforts at other institutes.
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Both proposals called for a transNIH research network using the NINDS model to promote emergency care and emergency medicine research. He urged the workshop attendees to go to the roadmap website, look at the proposals, and post a public comment, noting that this is an opportunity for NIH to hear from emergency care stakeholders.
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