History of the EMSC

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More than 30 years ago, emergency medical service (EMS) systems were created to provide rapid intervention for sudden cardiac arrest in adults and rapid transport for motor vehicle crash victims. Experiences from the Korean and Vietnam Wars demonstrated that survival rates of seriously injured soldiers could be dramatically increased by stabilizing them and providing them with immediate transport to a well-equipped trauma center. Attempting to duplicate the success in communities across America, the EMS system was created.

Initially, the medical community failed to recognize that children required specialized emergency care. The most glaring deficiency in past emergency care for children among emergency workers is simply being unaware of the pediatric population’s special needs.

In 1972, Calvin Sia, MD, president of the Hawaii Medical Association, urged the American Academy of Pediatrics (AAP) to develop EMS systems that would decrease disability and death among children. Dr. Sia worked with Senator Daniel Inouye who later was joined by Senators Orrin Hatch and Lowell Weicker in sponsoring the first Emergency Medical Services for Children (EMSC) legislation, which passed in 1984. This landmark legislation provided federal grant funds starting in fiscal year 1985 to help states improve the emergency care given to children suffering from a life-threatening illness or injury. EMSC funding was and continues to be secured largely due to the work of the AAP and other national organizations that continue to advocate for EMSC.

The Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB) has been the administrating government agency for the EMSC Program since the passage of the legislation. EMSC’s mission is to reduce child and youth mortality and morbidity resulting from severe illness or trauma. It is the only federal program that focuses specifically on improving the quality of emergency care for children. The Program aims to enhance currently existing EMS systems with a pediatric focus.

Throughout the 1990s, the EMSC Program continued to utilize federally designated funds, which ranged from $19 million to $20 million, and made grant funds available to states and territories to address the needs identified by the 1993 HRSA-sponsored Institute of Medicine (IOM) report. The EMSC Program initiatives addressed such areas as: injury prevention, development of clinical protocols and practice guidelines, creation of training curricula and products, data collection and analysis to support injury surveillance and quality improvement in pediatric emergency care, pediatric facility designation guidelines, hospital recognition programs, pediatric equipment standards for ambulances and emergency departments (ED), model patient transfer agreements, model regulations, and demonstration programs for special populations.

Although much progress continued to be made, the EMSC Program was part of an overall fragmented EMS system. In 2004, the IOM studied the broader spectrum of emergency care infrastructure in the United States. This led to the “Future of Emergency Care” series published in 2006. The series included Emergency Medical Services at the Crossroads, Hospital Based Emergency Care: at the Breaking Point, and Emergency Care for Children: Growing Pains. The reports comprehensively described the system of emergency care with emphasis in the pediatric report on the “uneven” nature of emergency care for children.

Into the second decade of the new millennium, appropriations for the EMSC Program have remained even. However, guided by the “Future of Emergency Care” reports, the Program has continued to grow. Currently 58 states, territories, and freely associated states are funded under the State Partnership Grant Program with the most recent addition of Palau, The Republic of the Marshal Islands, and the Commonwealth of the Northern Mariana Islands. The Program continues to leverage partnerships with federal agencies and national organizations to develop new programs and products; conduct novel research; publish hundreds of articles; provide education and training for thousands of emergency care providers; and improve access to safe, effective, efficient, timely, equitable, family-centered emergency care for all children. For additional information about the history of the Program, read EMSC: A Historical Perspective