The evolution and current status of emergency medical services for children.

Emergency physicians have come to believe that comprehensive pediatric emergency care should be integrated into an overall medical system and organized regionally to address the special needs of children. Since our emergency medical systems have evolved in the care of adult trauma victims, we must look to that development for the origin of our present emergency medical services for children. Not until the 1970s did it became obvious that children, just as adults, should be included in an comprehensive emergency medical system for the care of their life threatening injuries. Since there is considerable overlap in the basic principles of trauma resuscitation and management of shock in children and adults, most children's regional trauma program developed as a part of an overall emergency medical system. The sharing of trauma facilities made it possible to utilize the special expertise of a very small number of pediatric surgeons who had trauma experience and to incorporate their skills into the broader concept of comprehensive regional trauma centers for children and adults. With further experience we soon realized that such emergency medical services for children's systems should include the following components: A two way communication system, a transport system with special equipment for the management of small children, a training program for first responders at the trauma site, a designated pediatric trauma center, a pediatric intensive care unit at the regional trauma center, a neurology/neurosurgery intermediate care unit at the regional center, a pediatric trauma rehabilitation unit and finally a pediatric trauma longterm rehabilitation and management unit for those with residual disabilities. With the further development of this concept of trauma units for children, pediatric surgeons, general surgeons involved in trauma care and pediatric emergency physicians have offered leadership to expand the emergency medical system for children to include life-threatening illness, as well as injuries. Thus, the organization of regional emergency medical services for children permits the highest quality management of children with life-threatening injuries and illness. This then is the final product: an inclusive, comprehensive emergency medical system for children for all life threatening conditions, both trauma and serious illness.