As I write this message, it has only been a week since the Institute of Medicine (IOM) released 3 reports that are important for trauma care. On June 14, 2006, the following reports were released, Emergency Care for Children: Growing Pains, Emergency Medical Services (EMS) at the Crossroads, and Hospital-based Emergency Care: At the Breaking Point. A panel of emergency, trauma, and emergency medical service experts that included physicians, nurses, prehospital providers, and hospital administrators started work on these reports in early 2004. The finished reports represent innumerable hours of work to complete the research, analysis, and discussion to publish these findings.
WHAT IS THE IOM?
Many of us have heard of IOM reports in the past-however, I wonder how many are aware of what the IOM is. If you check the National Academies Web site, http://nationalacademies.org, you will find that the IOM, along with the National Academy of Sciences, the National Academy of Engineering, and the National Research Council make up the National Academies. Although the National Academies were created by the federal government in 1970 to advise on science, engineering, and medicine, they are a private, nongovernmental group that does not receive direct federal appropriations.
Reports are usually written at the request of the federal government and use a rigorous and formal peer review process. The academy Web site states that findings and recommendations are evidence-based whenever possible and noted as expert opinion when that is not possible. Most of the IOM committees come to their conclusions by consensus. Where there are insufficient published data to support a conclusion, the committee uses its knowledge to argue for conclusions.
SUMMARY OF THE CURRENT REPORTS
The 3 reports released this June acknowledge that our emergency and trauma care systems have made great strides in just 10 to 20 years but also state that a national crisis is brewing. A number of issues support this stand: emergency departments are overcrowded, they frequently close to patients; specialists are unavailable due to a number of issues, including malpractice insurance concerns; and the quality of care in the transport of patients is inconsistent.
The authors cite the fact that there is no one agency in the Federal government that oversees the emergency and trauma care system. Responsibility is scattered among a number of agencies, including Health and Human Services, Transportation, and Homeland Security. Consequently, they maintain that accountability is also lacking.
Problems in disaster preparedness are addressed in depth and the reports cite the fact that very little of the preparedness funding that was allocated since 9/11 have reached either the prehospital providers or the hospitals. The IOM committee states that the money has been funneled through public safety agencies and these groups see prehospital and hospital funding as a low priority. In addition, the money that has reached the direct care providers has been largely earmarked for bioterrorism, which is less likely to occur than other disasters.
One entire report is dedicated to the emergency care of children-pointing out the lack of adequate standards, protocols, appropriately sized equipment, and healthcare provider education in pediatrics despite the fact that 27% of emergency department visits are by children younger than the age of 18.
The group makes numerous recommendations. These include improving hospital efficiency and patient flow by using business practices more common in other industries; calling upon the Joint Commission on Accreditation of Hospitals Organization to improve their standards so that boarding of patients in the emergency department is eliminated; and diversion of patients with the exception for the most extreme circumstances (eg, disasters).
A coordinated, regionalized, accountable oversight system is called for. This would separate areas into regions where the 911 system, prehospital dispatch, and the ambulance personnel would be in continuous communication with each other as well as all of the hospitals, trauma centers, and specialists in the region. To initiate this communication system, it is recommended that 10 pilot sites be set up to test and streamline this system.
In addition, the Committee asks for the creation of a lead federal agency that would consolidate many government programs that deal with emergency and trauma care, increased resources to support hospitals and trauma centers that bear a disproportionate amount of the cost of taking care of uninsured patients, and dedicated funding for disaster preparation. Congress is also called upon to improve the current malpractice situation.
Finally, it is recommended that the pediatric emergency patient be addressed by the development of standards, protocols for triage and transport, disaster plans, training, and research.
WHY ARE THESE REPORTS IMPORTANT TO THE TRAUMA COMMUNITY?
So, why is all of these important to you? I am sure that, as a health professional with an interest in trauma, you experience many of the issues cited in this report on a daily basis. It may even be frustrating for you to hear this report since it entailed a considerable amount of time and money to produce and it only confirms what we already know. However, the IOM is a respected organization that people listen to and give credence to. It operates with strict controls so the IOM reports serve to confirm and validate what we already know in a format that holds tremendous credibility for people who can make a difference. It also has the ability to catch the interest of the popular press and, consequently, the public. Anything that we can do to continue the drumbeat of public education on many of the challenges that confront our trauma centers is vital.
So, if you have not already done so, take a few minutes to familiarize yourself further with these reports and spread the word to others. A direct link to these and other reports can be found at http://www.iom.edu/CMS/2955.aspx. I encourage you to refer to these documents as you educate those around you, including your patients, other members of the lay public, your hospital administrators, local legislators, and the press.