Spotlight on Pediatric Emergency Care Volume 2, Issue 5, September 2004 Emergency Medical Services for Children: A Critical Juncture We are entering what is sure to be one of the most politically active periods in recent history. Only two months remain before the national presidential election. Although there may be only a small pool of undecided voters, that pool will likely represent the critical deciding votes--votes that will determine the future direction our country takes. Another story has been unfolding during this "high drama" political season--a story directly related to emergency care for children. Created in 1984, the national Emergency Medical Services for Children (EMSC) program has supported demonstration projects to expand and improve emergency medical services for children who need treatment for trauma or critical illness. Children and adolescents visit emergency departments more than 30 million times each year; children under 3 make up most of these visits. For the past 20 years, the EMSC program has focused tremendous efforts on reducing deficits in pediatric emergency care for children. Much of its focus has been on helping community hospitals and ambulances improve pediatric equipment and care. The existence of this excellent program is now threatened. The problem is simple- the solution is not. The EMSC program, along with its funding, has been rolled into HR 3999, a proposed bill which provides for the reauthorization and funding of the trauma system. Unfortunately, as HR 3999 is currently worded, EMSC (and its funding) would be extracted from its current home in the Health Resources and Services Administration (HRSA) and would be rolled into the trauma program: HR 3999. Thus, the specific EMSC program itself would be dissolved. Of note, the Senate version of the trauma reauthorization bill does not include a provision eliminating the EMSC program. We have seen time and time again that when emergency services for children are subsumed within the broader scope of adult emergency care, children's needs do not get met. This happens at the local level in emergency departments, and it happens at the national level with policy implementation. Removing the EMSC program would be a major step backward for pediatric emergency care. Nevertheless, improvements in trauma legislation and care are clearly important for this same vulnerable population. The American Academy of Pediatrics has made the difficult and controversial decision to not support this bill. While recognizing the importance of enhancing trauma care as it relates to children, their position is that it is unacceptable to eliminate specific EMSC funding. I believe this is a difficult, but correct position to take. If the progress for pediatric emergency care over the past two decades is to continue, efforts such as EMSC must be supported, both structurally and financially. Addendum:       As part of our heightened environment of political activity, I encourage you to consider contacting your representatives (http://www.house.gov/writerep/) if you feel moved to show your support, either way, on this issue. About Our Organization Created in 2003, Petrack Consulting is dedicated to helping physician and hospital leadership bring excellence to emergency services for children. We work collaboratively to fully understand our client’s needs, and then address programmatic initiatives with measurable outcomes. Our unique background in pediatric emergency medicine, administrative medicine, and organization development allows us to create uniquely effective solutions for enhancing emergency services for children.