The future of emergency care in the United States health system.

I f one were to judge solely from popular TV shows, the nation’s emergency care system is in fine shape. Its doctors, nurses, and ambulance personnel are dedicated and competent professionals who save lives with their expertise and state-of-the-art equipment and can always be trusted to come through in a crunch. And, indeed, there is a great deal of truth to this picture: Our emergency and trauma care system has made tremendous strides over the past few decades, and today it manages to save many lives that just ten or twenty years ago would have been inevitably lost. But underneath the surface, a national crisis in emergency care has been brewing and is now beginning to come into full view. Emergency departments (EDs) across the country are overcrowded. Ambulances are turned away, and patients, once they are admitted, may wait in hallways for hours or even days before inpatient beds open up for them. Often the specialists that patients need to see are not available. And the system that transports patients to the hospitals is fragmented and inconsistent in the level of quality it provides. It was against this backdrop that the Institute of Medicine’s Committee on the Future of Emergency Care in the United States Health System convened in September 2003 to examine the state of emergency care in this country. Charged with creating a vision for the future of emergency care, the committee has responded by publishing a series of three reports that look at hospital-based emergency and trauma care, at prehospital emergency medical services (EMS), and at the special challenge of providing emergency care for children. The Future of Emergency Care series includes: Hospital-Based Emergency Care: At the Breaking Point; Emergency Medical Services At the Crossroads; and Emergency Care for Children: Growing Pains. In these three volumes, the committee has identified what it believes are the most important issues facing the nation’s emergency care system and has made a series of recommendations for how best to deal with those issues.