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Project Information

Project Information


The Future of Emergency Care in the U.S. Health System


Project Scope:

The objectives of this study are to: (1) examine the emergency care system in
the U.S.; (2) explore its strengths, limitations, and future challenges; (3)
describe a desired vision of the emergency care system; and (4) recommend
strategies required to achieve that vision. The project will identify and
address key priorities across the continuum of emergency care services,
including: 911 access and dispatch; prehospital emergency medical services
(EMS); and hospital-based emergency, trauma, and critical care. The committee
will consider a wide range of issues, including:

- the role of the emergency department (ED) within the larger hospital
and health care system;
- the interaction between the emergency department and inpatient and
ancillary services, such as lab, pharmacy, and imaging;
- patient flow and information technology;
- workforce issues across multiple disciplines, including emergency
physicians, nurses, and other members of the care team;
- the impact of technological innovations on emergency care;
- patient safety and the quality and efficiency of emergency care
services;
- the legal and regulatory framework for emergency care, including the
Emergency Medical Treatment and Active Labor Act (EMTALA), liability issues,
and reimbursement; disaster preparedness, surge capacity, and surveillance;
- basic, clinical, and health services research relevant to emergency
care; and
- special challenges of emergency care in rural settings.

The study will also examine the unique challenges associated with the provision
of emergency services to children and families, and evaluate progress since the
publication of the IOM?s 1993 report, Emergency Medical Services for Children.
The committee will consider:

- the role of pediatric emergency services as an integrated component of
the overall health system;
- system-wide EMSC planning, preparedness, coordination, and funding;
- embedded pediatric training in professional education; and
- health services and clinical research.

In addition, the study will examine prehospital EMS and include an assessment
of the current organization, delivery, and financing of EMS services and
systems, and assess progress toward the EMS Agenda for the Future. The study
will consider a wide range of issues, including:

- the evolving role of EMS as an integral component of the overall
health care system, including dispatch, medical direction, and integration with
trauma systems, pediatric EMS, public health, prevention, and ED overcrowding;
- EMS system planning, preparedness, and coordination at the federal,
state, and local levels;
- EMS funding and infrastructure investment, including equipment,
communications, new technologies, and progress toward the development of
interoperable EMS information systems;
- EMS workforce trends and professional education; and
- EMS research priorities and funding.


Sponsors:

The Josiah Macy, Jr. Foundation
U.S. Department of Health and Human Services' Health Resources and Services
Administration (HRSA), Agency for Healthcare Research and Quality (AHRQ), and
Centers for Disease Control and Prevention (CDC)
U.S. Department of Transportation, National Highway Traffic Safety
Administration (NHTSA)


The approximate start date for the project was 09/01/2003.

Note: Effective February 26, 2004, the project scope has been expanded and the
project duration has been extended to a total of 45 months. The revised project scope is as shown above. Three subcommittees have been appointed to assist the committee in the areas of Emergency Medical Services to Children and Adolescents; Prehospital Emergency Medical Services; and Hospital-Based Emergency, Trauma, and Critical Care. The activities of
each subcommittee are posted in separate project records in the Current
Projects System with Project Identification Numbers HCSX-H-03-01-B,
HCSX-H-03-01-C, and HCSX-H-03-01-D respectively. Three reports will be issued
during the course of the project, focusing on the subcommittee topic areas.

Status: Completed

PIN: HCSX-H-03-01-A

Project Duration (months): 45 month(s)

RSO: Giffin, Robert

Division(s):

Institute of Medicine

Board(s)/Committee(s):

Board on Health Care Services

Topic(s):

Health and Medicine
Policy for Science and Technology



Geographic Focus:

Committee Membership

Committee Post Date: 12/27/2004

Gail L. Warden - (Chair)
Henry Ford Health System

Gail L. Warden, M.H.A., F.A.C.H.E., is President Emeritus of Henry Ford Health System in Detroit, Michigan, one of the nation's leading vertically integrated health care systems. Warden is an elected member of the Institute of Medicine of the National Academy of Sciences. He served on its Board of Health Care Services, Committee on Quality Health Care in America, and served two terms on the Governing Council. He chairs the board of the National Quality Forum, the Healthcare Research and Development Institute, and the newly created National Center for Healthcare Leadership. Warden co-chairs the National Advisory Committee on Pursuing Perfection: Raising the Bar for Health Care Performance. He is a member of The Robert Wood Johnson Foundation Board of Trustees, the Institute for Healthcare Improvement Board, and the RAND Health Board of Advisors. He is director emeritus and past chairman of the Board of the National Committee on Quality Assurance. In 1997 President Clinton appointed him to the Federal Advisory Commission on Consumer Protection and Quality in the Health Care Industry. In 1995 Warden served as chairman of the American Hospital Association Board of Trustees. He served as a member of the Pew Health Professions Commission, the National Commission on Civic Renewal, and past chairman of the Health Research and Education Trust Board of Directors.

Warden served as president and Chief Executive Officer of Henry Ford Health System from April 1988 until June 2003. Before joining Henry Ford Health System, Warden served as president and chief executive officer of Group Health Cooperative of Puget Sound in Seattle from 1981 to 1988. Prior to that he was executive vice president of the American Hospital Association from 1976 to 1981; and from 1965 to 1976, he served as executive vice president and chief operating officer of Rush-Presbyterian-St. Luke's Medical Center in Chicago. Warden is a graduate of Dartmouth College and holds an M.H.A. from the University of Michigan. He has an honorary doctorate in public administration from Central Michigan University and is a member of the faculty of the University of Michigan School of Public Health.
Stuart H. Altman
Brandeis University

Stuart H. Altman, Ph.D. is the Sol C. Chaikin Professor of National Health Policy at the Heller School for Social Policy and Management. He served as dean of the Heller School from 1977 to a 1993. Professor Altman has had extensive experience with the federal government, serving as deputy assistant secretary for planning and evaluation/health in the U.S. Department of Health, Education, and Welfare, 1971-76, chairman of the congressionally-mandated Prospective Payment Assessment Commission, 1983-1996, and a member of the Bipartisan Commission on the Future of Medicare, 1999-2001. In addition, from 1973 to 1974, he served as deputy director for health of the President's Cost-of-Living Council and was responsible for developing the council's program on health care cost containment. Dean Altman has testified before various congressional committees on the problems of rising health care costs, Medicare reform and the need to create a national health insurance for the United States. He chaired the Institute of Medicine's Committee on the Changing Market, Managed Care, and the Future Viability of Safety Net Providers. His research activities include several studies concerning the factors causing the recent increases in the use of emergency rooms. He holds a Ph.D. in economics from the University of California, Los Angeles, and has taught at Brown University and the University of California, Berkeley.

Brent R. Asplin
Regions Hospital

Brent R. Asplin, M.D., M.P.H., F.A.C.E.P. is Department Head of Emergency Medicine at Regions Hospital and HealthPartners Research Foundation in St. Paul, MN, and is an Assistant Professor of Emergency Medicine at the University of Minnesota. After receiving his degree from Mayo Medical School, he completed the University of Pittsburgh's Affiliated Residency in Emergency Medicine. To develop his interests in research and health care policy, Dr. Asplin completed the Robert Wood Johnson Clinical Scholars Program at the University of Michigan. During this program he obtained a M.P.H. in Health Management and Policy, and also worked as a Congressional Fellow in the office of United States Senator Max Baucus. He is currently studying the causes and consequences of emergency department crowding and hospital capacity as well as patient access to the ambulatory care system.

Thomas F. Babor
University of Connecticut Health Center

Thomas F. Babor, Ph.D., M.P.H., spent several years in postdoctoral research training in social psychiatry at Harvard Medical School, and subsequently served as head of social science research at McLean Hospital's Alcohol and Drug Abuse Research Center in Belmont, Massachusetts. In 1982 he moved to the University of Connecticut School of Medicine. He has served as the Scientific Director at the Alcohol Research Center and the interim Chair of the Psychiatry Department. Dr. Babor's primary interest areas are psychiatric epidemiology and alcohol and drug abuse. In 1998, he became Chair of the Department of Community Medicine and Health Care, where he directs an active research program. Dr. Babor is Regional Editor of the international journal, "Addiction". In addition, he previously served on two Institute of Medicine committees, including "Prevention and Treatment of Alcohol-Related Problems: An Update on Research Opportunities" and "Treatment of Alcohol Problems".

Robert R. Bass
Maryland Institute for Emergency Medical Services Systems

Robert R. Bass, M.D., F.A.C.E.P., received his undergraduate and medical degree with honors from the University of North Carolina at Chapel Hill in 1972 and 1975 respectively. Prior to completing his undergraduate education, he was employed as a police officer in Chapel Hill, NC and served as a volunteer member of the local rescue squad. Dr. Bass completed an internship and residency in the United States Navy and is currently board certified in both emergency medicine and family medicine. He has served as a medical director of emergency medical services (EMS) systems in Charleston, SC, Houston, TX, Norfolk, VA, and Washington, DC. Since 1994, he has been the Executive Director of the Maryland Institute for EMS Systems, the state agency responsible for the oversight of Maryland's EMS and trauma system. He is an Associate Professor of Surgery (emergency medicine) at the University of Maryland at Baltimore and an Associate Professor in the Emergency Health Services Program at the University of Maryland, Baltimore County. Dr. Bass is a founding member and current President of the National Association of EMS Physicians. Additionally, he serves on the Board of Director of the American Trauma Society, the University of Maryland Medical System and is the immediate past chair of the EMS Committee of the American College of Emergency Physicians. In October of 2004, he was elected President of the National Association of State EMS Directors (NASEMSD) for a two year term, and is the past chair of the NASEMSD Joint Legislative Committee, Public Access Defibrillation Committee, and Communications Committee.

Benjamin K. Chu
New York City Health and Hospitals Corporation

Benjamin K. Chu, M.D., M.P.H. was appointed president, Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, Southern California Region, in February 2005. Before joining Kaiser Permanente, Dr. Chu was President of the New York City Health and Hospitals Corporation with primary responsibility for management and policy implementation at the Corporation. Prior to that, Dr. Chu was Senior Associate Dean at Columbia University College of Physicians and Surgeons. He has also served as Associate Dean and Vice President for Clinical Affairs at the New York University Medical Center managing and developing the clinical academic hospital network. Dr. Chu is a primary care internist by training with extensive experience as a clinician, administrator and policy advocate for the public hospital sector. He was Senior Vice President for Medical and Professional Affairs at the Corporation from 1990-1994. During that period he also served as Acting Commissioner of Health for the New York City Department of Health and Acting Executive Director for Kings County Hospital Center. Dr. Chu also has extensive experience in crafting public policy. He served as legislative assistant for health for Senator Bill Bradley as a 1989-90 Robert Wood Johnson Health Policy Fellow. His area of interests includes health care access and insurance, graduate medical education policy, primary care and public health issues. He has served on numerous advisory and not-for-profit boards which focused on health care policy issues. Dr. Chu received a Master in Public Health from the Mailman School at Columbia University and his Doctorate of Medicine at New York University School of Medicine.

A. B. Eastman
Scripps Health

A. Brent Eastman, M.D., is currently the Chief Medical Officer of ScrippsHealth and N. Paul Whittier Chair of Trauma. He previously served as the Medical Director of Trauma Services at Scripps Memorial Hospital, La Jolla, from 1984-2002. He is also a Clinical Professor of Surgery & Trauma at the University of California, San Diego, Adjunct Professor for the National Resource on Aging & Injury at San Diego State University, and a principal investigator for the San Diego Crash Injury Research Engineering Network (CIREN) Project.

Dr. Eastman received his medical degree from the University of California, San Francisco, where he also did his general surgical residency and served as Chief Surgical Resident. He spent one year abroad in surgical training in England at Norfolk and Norwich Hospitals.

He has recently been appointed to the American College of Surgeons (ACS) Board of Regents. Dr. Eastman served as Chairman of the Committee on Trauma for the ACS from 1990-1994. This organization sets the standards for the trauma care in the United States and abroad. The position has led to his involvement nationally and internationally in the development of trauma systems in the United States, Canada, England, Ireland, Australia, Brazil, Argentina, Mexico and South Africa. Dr. Eastman has authored or co-authored more than 25 publications and chapters principally relating to trauma. He has held numerous appointments and chairmanships over the last two decades, including Chairman, Trauma Systems Committee for the U.S. Department of Health and Human Services (HHS); Board of Directors, American Association for the Surgery of Trauma; and Chairman, Grant Review Committee, Center for Injury and Prevention and Control at the Center for Disease Control.
George L. Foltin
New York University School of Medicine

George L. Foltin, M.D., F.A.A.P., F.A.C.E.P. has been involved with the Emergency Medical Services for Children (EMSC) Program of the Health Resources and Services Administration since its inception in 1985. Board certified in pediatrics, emergency medicine, and pediatric emergency medicine, Dr. Foltin served on the Medical Oversight Committee for the EMT-Basic National Standard Curriculum project and was a subject expert for the Project to Revise EMT-Intermediate and Paramedic National Standard Curriculum. He is a former board member of the National Association of EMS Physicians and served on the Committee on Pediatric Emergency Medicine of the American Academy of Pediatrics. Currently Dr. Foltin co-chairs the Statewide AAP Committee on Pediatric Emergency Medicine and sits on the Regional Medical Advisory Committee of New York City. He has published extensively in the field of Emergency Medical Services for Children, and serves as a consultant to the New York City and State Departments of Health, as well as to federal programs such as the Maternal and Child Health Bureau (MCHB) and the National Highway Traffic Safety Administration (NHTSA). Foltin is Director of the Center for Pediatric Emergency Medicine at New York University School of Medicine. His current projects include a population based study of pediatric pre-hospital resuscitation and creation of a national resource in partnership with the AAP addressing the needs of children in regards to terrorism and disaster related events.

Shirley Gamble
Canyon Resources, LLC

Shirley Gamble, M.B.A. is served as the Senior Advisor to The Robert Wood Johnson Foundation's Urgent Matters initiative, which is working to help hospitals eliminate emergency department crowding and help communities understand the challenges facing the health care safety net. Ms. Gamble has over 20 years experience in the health care industry serving as an executive with Incarnate Word Health Services, Texas Health Plans HMO, and Tampa General Hospital. As Partner of Phase 2 Consulting, a health care management and economic consulting firm, Ms. Gamble led performance improvement and strategic planning engagements for major hospital systems, managed care entities, and university faculty practice plans. She has an M.B.A. and B.A. from the University of Texas at Austin.

Darrell J. Gaskin
Johns Hopkins Bloomberg School of Public Health

Darrell J. Gaskin, Ph.D., M.S., is deputy director of the Center for Health Disparities Solutions and Associate Professor at the Johns Hopkins Bloomberg School of Public Health in the Department of Health Policy and Management. Prior to joining the Hopkins faculty, Dr. Gaskin was an associate research professor at Georgetown University's Institute for Health Care Research and Policy. His primary research interests are the hospital safety net and access to health care for the minority, low-income, uninsured, and other vulnerable populations. In addition, he is interested in the determinants of racial and ethnic disparities in health service use and health outcomes. His other research interests include the effects of market forces and public policy on providers' behavior, mental health economics, and the treatment decisions of terminally ill patients. Dr. Gaskin has studied several issues concerning the hospital safety net. He has examined the effects of managed care and price competition of safety net hospitals' provision of care to Medicaid and the uninsured patients. He has documented the importance of safety-net hospitals' provision of essential community services. He has examined the composition of safety-net hospitals' patient census and studied their importance to minority and low-income communities. Dr. Gaskin recently received the Academy of Health Services Research and Health Policy 2002 Article-of-the-Year Award for his health services research article entitled, "Are Urban Safety-Net Hospitals Losing Low-Risk Medicaid Maternity Patients?" Dr. Gaskin is active in professional organizations. He is a member of the Academy of Health Services Research and Health Policy, the American Economic Association, the National Economics Association (NEA), the International Health Economics Association, and the American Public Health Association (APHA). Dr. Gaskin is a member of the Board of Directors of the NEA. He is a member of the Governing Council of APHA and organizes the solicited program for the Medical Care Section of APHA. Dr. Gaskin earned his Ph.D. in health economics at The Johns Hopkins University School of Hygiene and Public Health. He also holds a master's degree in economics from the Massachusetts Institute of Technology and a bachelor's degree in economics from Brandeis University.
Robert C. Gates
Orange County Health Care Agency

Robert C. Gates, M.P.A. began his career in the County of Los Angeles Chief Administrative Office, where he was the principal budget analyst for the public health, hospital, and mental health departments. He left Los Angeles to become Chief Operating Officer for the University of California, Irvine, Medical Center in Orange County. While in Orange County he was instrumental in creating their paramedic system. Mr. Gates then returned to Los Angeles County and spent 6 years as the Chief Deputy Director of the Department of Health Services, guiding the creation of the Los Angeles County Trauma Center system. Mr. Gates was then appointed Director of Health Services for Los Angeles County and served in that capacity for over 11 years. Mr. Gates is currently serving as Medical Services for Indigents Project Director for the Orange County Health Care Agency.

Marianne Gausche-Hill
Harbor-UCLA Medical Center

Marianne Gausche-Hill, M.D., F.A.C.E.P., F.A.A.P., is Professor of Medicine at David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Director of Emergency Medical Services (EMS) and of the Pediatric Emergency Medicine Fellowship Program at Harbor-UCLA Medical Center, and CoDirector of Pediatric Emergency Medicine at Little Company of Mary Hospital in Torrance, California. She is nationally known for her work as an EMS researcher and educator, and for her leadership in the field of pediatric emergency medicine. She is best known for her study of prehospital airway management for children. She has also been integral in the design and implementation of a number of educational curricula in prehospital care and pediatric emergency medicine including: the Pediatric Education for Prehospital Professionals Course, Continuing Education Modules for Basic and Advanced Prehospital Providers, Pediatric Airway Management for the Prehospital Professional, and Advanced Pediatric Life Support (APLS): The Pediatric Emergency Medicine Resource. Gausche-Hill serves as on the editorial board of Clinical Pediatric Emergency Medicine, Prehospital Emergency Care, and Pediatric Emergency Care and she is an editor for Rosen's Emergency Medicine: Concepts and Clinical Practice. She served 7 years on the subboard for Pediatric Emergency Medicine as an American Board of Emergency Medicine representative, 2 of those years as chair. She is the immediate past-Chair of the Pediatric Committee for the American College of Emergency Physicians.

John D. Halamka
CareGroup Health System

John D. Halamka, M.D., M.S., is Chief Information Officer of the CareGroup Health System, Chief Information Officer and Associate Dean for Educational Technology at Harvard Medical School, Chairman of the New England Health Electronic Data Interchange Network (NEHEN), Chief Information Officer of the Harvard Clinical Research Institute (HCRI), and an emergency physician at Beth Israel Deaconess Medical Center. Dr. Halamka completed his undergraduate studies at Stanford University where he received a degree in Medical Microbiology and a degree in Public Policy with a focus on technology issues. In 1984, Dr. Halamka entered medical school at the University of California, San Francisco, and simultaneously pursued graduate work in Bioengineering at the University of California, Berkeley, focusing on technology issues in medicine. During medical school and graduate training, he continued his business activities and developed Ibis Research Labs into a 25 person software consultancy, specializing in medical and financial information interchange. Ibis was sold to senior management in 1992. Dr. Halamka served his residency at Harbor-UCLA Medical Center in the Department of Emergency Medicine. While at Harbor-UCLA he was an active member of the information systems team and developed a hospital-wide knowledge base for policies, procedures, and protocols. Further, he was instrumental in creating an on-line medical record, a quality control system, and several systems for medical education. His research focus during residency was building automated triage tools for patients infected with HIV. In 1996, Dr. Halamka joined the faculty of Harvard Medical School and continues to integrate his knowledge of medicine and technology focusing on the use of the Internet to exchange clinical patient data.

Mary M. Jagim
MeritCare Hospital

Mary M. Jagim, R.N., B.S.N., C.E.N. is an experienced emergency/trauma nurse with extensive leadership background in program development and implementation, group facilitation, government affairs, and community based injury prevention. She is currently the Manager of the MeritCare Hospital Emergency Center in Fargo, North Dakota. Well versed in current issues affecting emergency/trauma nursing and emergency care, Jagim has served as President for the Emergency Nurses Association, and currently serves on its Managers curriculum task force. Jagim also served on the Centers for Disease Control and Prevention (CDC) National Strategies for Advancing Child Pedestrian Safety Panel to Prevent Pedestrian Injuries and is on the Board of Advocates for Auto and Highway Safety. Jagim received her B.N. from the University of North Dakota in 1984.

Arthur L. Kellermann
Emory University

Arthur L. Kellermann, M.D., M.P.H. is Professor and Chairman of the Department of Emergency Medicine at the Emory University School of Medicine, and Director of the Center for Injury Control at the Rollins School of Public Health of Emory University. His primary research focus is injury prevention and injury control. He has also conducted landmark research on prehospital cardiac care, use of diagnostic technology in emergency departments, and health care for the poor. His papers have been published in many of the nation's leading medical journals. He is a recipient of the Hal Jayne Academic Excellence Award from the Society for Academic Emergency Medicine, the Excellence in Science award from the Injury Control and Emergency Health Services Section of the American Public Health Association and the Scholar/Teacher Award from Emory University. A member of the Institute of Medicine (IOM), Dr. Kellermann served as Co-Chair of the IOM's Committee on the Consequences of Uninsurance from 2001-2004.

William N. Kelley
University of Pennsylvania School of Medicine

William N. Kelley, M.D., currently serves as Professor of Medicine, Biochemistry and Biophysics at the University of Pennsylvania School of Medicine. Previously, he served as Chief Executive Officer of the University of Pennsylvania Medical Center and Health System and Dean of the School of Medicine from 1989 to February 2000. At the University of Pennsylvania, Dr. Kelley led the development of one of the first academic, fully integrated, delivery systems in the nation. He also built and implemented the largest Health and Disease Management program in the country, with over 500 physicians and staff and 60 separate clinical sites engaged in implementing the program. Dr. Kelley also holds a patent in a frequently used gene transfer technique that has allowed for numerous advances in the application of gene therapy. Dr. Kelley received his M.D. from Emory University School of Medicine and completed his residency in Internal Medicine at Parkland Memorial Hospital in Dallas. After a fellowship with the National Institutes of Health and a teaching fellowship at Harvard Medical School, he began his academic career as an assistant professor of Medicine at Duke University School of Medicine, moving on to head Duke's Division of Rheumatic and Genetic Diseases, before becoming chair of Internal Medicine at the University of Michigan Medical School.

Peter M. Layde
Medical College of Wisconsin

Peter M. Layde, M.D., M.Sc. is Professor and Director of the Division of Research in the Department of Family and Community Medicine at the Medical College of Wisconsin. Dr. Layde has been an epidemiologist for over 20 years and an active injury control researcher for over 10 years. He has published extensively on agricultural injuries and methods for injury epidemiology, including early work on use of case-control studies for homicide and on the epidemiological representativeness of trauma center-based studies. He has been an ad-hoc reviewer for the injury Grant Review Committee for over 10 years and served as a member of that committee from 1997-2000. Dr. Layde serves as Co-Director of the Injury Research Center at the Medical College of Wisconsin and as Director of its Research Development and Support Core. He is also Principal Investigator on the Risk Factors for Medical Injury research project.

Eugene Litvak
Boston University Health Policy Institute

Eugene Litvak, Ph.D., is Professor of Health Care and Operations Management at the Boston University School of Management. He is also co-founder and director of the Program for the Management of Variability in Health Care Delivery at the Boston University Health Policy Institute. He received his doctorate in Operations Research from the Moscow Institute of Physics and Technology in 1977. Prior to joining Boston University he was a faculty member at the Harvard Center for Risk Analysis in the Department of Health Policy & Management at the Harvard School of Public Health (HSPH), where he still teaches the course "Operations Management in Service Delivery Organizations" as an Adjunct Lecturer. Dr. Litvak arrived in the U.S. in 1988, and joined HSPH in 1990. Prior to that time he was a chief of the Operations Management Group at the Computing Center in Kiev, Ukraine. His research interests include operations management in health care delivery organizations, cost-effective medical decision-making, screening for HIV and other infectious diseases, and operations research. Professor Litvak is an author of more than 50 publications in these areas. Since 1995 he has led the development and practical applications of innovative variability methodology for cost reduction and quality improvement in health care delivery systems. Professor Litvak was the Principal Investigator in the recent "Emergency Room Diversion Study" supported by the grant from the Massachusetts Department of Public Health. He also serves as a consultant on operations improvement to several major hospitals and as a faculty of the Institute for Health Care Improvement.

Richard A. Orr
Children's Hospital of Pittsburgh

Richard A. Orr, M.D., serves as Associate Professor at the University of Pittsburgh School of Medicine, Associate Director of the Intensive Care Unit at the Children's Hospital of Pittsburgh, and Medical Director of the Children's Hospital Transport Team of Pittsburgh, Pennsylvania. Dr. Orr has devoted much of his career to interhospital transportation problems of infants and children in need of tertiary care. He is a member of many professional organizations and societies and has authored numerous articles regarding the safe and effective air transport of the critically ill and injured pediatric patient. Dr. Orr is also a noted lecturer to the air transport community, both nationally and internationally. Dr. Orr is editor of Pediatric Transport Medicine, a unique 700 page book published in 1995. He is the 2001 recipient of the Air Medical Physician Association (AMPA) Distinguished Physician Award and a founding member of the AMPA.

Jerry L. Overton
Richmond Ambulance Authority

Jerry L. Overton, M.A. serves as the Executive Director of the Richmond Ambulance Authority (RAA), Richmond, Virginia, and is responsible for the overall supervision of the Richmond Emergency Medical Services system. His duties extend to planning and administering the high performance Emergency Medical Services (EMS) system design, negotiating and implementing high performance provider contracts, maximizing fee for service revenues while minimizing governmental subsidies, development of quality patient care protocols, and the implementation of innovative equipment and treatment modalities. Mr. Overton was previously the Executive Director of the Kansas City, Missouri, EMS system. In addition, he has provided technical assistance to numerous EMS systems throughout the United States and to governments and agencies in Europe, Russia, Asia, Australia, and Canada. He designed an implementation plan for an Emergency Medical Transport program in Central Bosnia-Hercegovina. Mr. Overton is a faculty member of the Emergency Medical Department of the Medical College of Virginia and the National EMS Medical Directors Course, National Association of EMS Physicians. He serves as the President of the American Ambulance Association and is on the Board of Directors of the North American Association of Public Utility Models.

John E. Prescott
West Virginia University, School of Medicine

John E. Prescott, M.D. is Senior Associate Dean of the West Virginia University (WVU) School of Medicine and will begin service as Dean effective July 2004. He also serves as the President and CEO of University Health Associates (UHA), WVU's medical/dental faculty practice plan. Dr. Prescott received both his B.S. and M.D. degrees at Georgetown University. A recipient of an Army Health Professions Scholarship Program (HPSP) scholarship, he completed his residency training in Emergency Medicine at Brooke Army Medical Center, San Antonio, Texas, and was then assigned to Fort Bragg, North Carolina. In 1990 he joined WVU and soon assumed leadership of the Section of Emergency Medicine. During that same year, Dr. Prescott founded and became the first Director of WVU's Center for Rural Emergency Medicine. In 1993 he became the first Chair of WVU's newly established Department of Emergency Medicine. As past recipient of major Centers for Disease Control and Prevention (CDC) and private foundation grants, Dr. Prescott's research and scholarly interests include: rural emergency care; injury control and prevention; medical response to terrorism; and academic and administrative medicine. In 1999, Dr. Prescott became WVU's Associate Dean for the Clinical Enterprise and assumed his current position within UHA. He has been a Fellow of the American College of Emergency Physicians since 1987 and is the recipient of WVU's Presidential Heroism Award.

Nels D. Sanddal
Critical Illness and Trauma Foundation

Nels D. Sanddal, M.S., REMT-B, is the President of Critical Illness and Trauma (CIT) Foundation and is currently on detachment as the Director of the Rural Emergency Medical Services and Trauma Technical Assistance Center (REMSTTAC). Nels has been involved in EMS since the 1970s and has held many state, regional, and national positions in organizations furthering EMS causes, including president of the Intermountain Regional EMS for Children Coordinating Council and core faculty for the Development of Trauma Systems Training Programs for the U.S. Department of Transportation. Nels is a Nationally Registered Emergency Medical Technician-Basic, volunteers with a local fire department, and has been involved with the CIT Foundation since its inception. He holds a M.S. in psychology and is currently pursuing a Ph.D. in health services.

C. W. Schwab
University of Pennsylvania Medical Center

C. William Schwab, M.D., F.A.C.S. is currently Professor of Surgery and Chief of the Division of Traumatology and Surgical Critical Care at the University of Pennsylvania. In 1987, Dr. Schwab established a Level I Regional Resource Trauma Center, Surgical Critical Care Service, the PennStar Flight Program, and the Communications Center at the University of Pennsylvania Medical Center. Today Dr. Schwab?s surgical practice focuses on caring for the severely injured patient and incorporating the most advanced techniques in trauma surgery available. He is one of the first traumatologists to study the effects of trauma in the elderly patient. In addition, Dr. Schwab is extremely active in the field of violence prevention and in developing a program in which trauma surgeons can become leaders in the public health effort to reduce firearm-related injuries. He is the Director of the Firearm & Injury Center at Penn (FICAP) and has been awarded several grants to look at the possibilities of reducing firearm and non-firearm injury. Another of his most recent projects is the formation of a trauma network. This involves setting up Level II trauma centers throughout the Delaware Valley to work with the University of Pennsylvania?s Level I trauma center in enhancing the quality of medical care for victims of injury. He has accomplished this at the Brandywine Hospital in Coatesville, PA, and at St. Luke's Hospital in Bethlehem, PA, and is currently consulting with other facilities to improve their trauma care as well. In October 2004, Schwab was elected President of the American Association for the Surgery of Trauma (AAST). He will serve as President Elect through August 2005, at which time he will assume the full duties of the presidency.

Mark D. Smith
California HealthCare Foundation

Mark D. Smith, M.D., M.B.A. has led the California HealthCare Foundation in developing research and initiatives aimed at improving California's health care financing and delivery systems since its formation in 1996. Prior to joining the California Healthcare Foundation, he was Executive Vice President at the Henry J. Kaiser Family Foundation and served as Associate Director of the AIDS Service and Assistant Professor of Medicine and Health Policy and Management at Johns Hopkins University. Dr. Smith is a member of the Institute of Medicine and is on the board of the Washington Business Group on Health. Previously, he served on the Performance Measurement Committee of the National Committee for Quality Assurance and the editorial board of the Annals of Internal Medicine. A board certified internist, Dr. Smith is a member of the clinical faculty at the University of California, San Francisco, and an attending physician at the AIDS clinic at San Francisco General Hospital.

David N. Sundwall
American Clinical Laboratory Association

David N. Sundwall, M.D., became President of the American Clinical Laboratory Association (ACLA) in September 1994, and served in this capacity until May 2003, when he was appointed Senior Medical and Scientific Officer. Prior to his current position, he was Vice President and Medical Director of American Healthcare System (AmHS), at that time the largest coalition of not-for-profit multi-hospital systems in the country. Dr. Sundwall has extensive experience in federal government and national health policy, including service as Administrator for the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) Public Health Service, and Assistant Surgeon General in the Commissioned Corps of the U.S. Public Health Service (1986-1988). During this period, he had adjunct responsibilities at HHS including: Co-Chairman of the HHS Secretary's Task Force on Medical Liability and Malpractice, and was the HHS Secretary's Designee to the National Commission to Prevent Infant Mortality. Prior to this service, Dr. Sundwall was Director of the U.S. Senate Labor and Human Resources Committee Health and Human Resources Staff (Majority) from 1981-1986; Director of Medical Student Programs in Family Medicine at the University of Utah School of Medicine (1978-1981); Chief of the Family Medicine Section of the Division of Ambulatory and Community Medicine at the University of California - San Francisco (1977-1978); and Director of the Family Practice Residency Program at the University School of Medicine in Salt Lake City (1975-1977). Dr. Sundwall was in private medical practice in Murray, Utah, from 1973-1975. Dr. Sundwall has participated in many medically related task forces and advisory groups and has authored numerous articles on medical practice, health policy, and the public interest. Sundwall currently serves as Chair of the Clinical Laboratory Advisory Committee (CLIAC) for the Centers for Disease Control and Prevention (CDC) and is also on the Advisory Committee to the Director for the CDC. He also has academic appointments at the Uniformed Services University of the Health Sciences, Bethesda, Maryland; Georgetown University School of Medicine, Washington, DC; and the University of Utah School of Medicine. Sundwall is board certified in internal medicine and family practice, and is a member of the American Medical Association (AMA) and the American Academy of Family Physician (AAFP). He is on the volunteer medical staff of Health Care for the Homeless Project and serves as a primary care physician in a shelter-based clinic.


Committee Membership Roster Comments

There has been a change in the committee membership with the additon of the following members:
Robert R. Bass, M.D., F.A.C.E.P.
A. Brent Eastman, M.D.
George L. Foltin, M.D., F.A.A.P., F.A.C.E.P.
Darrell J. Gaskin, Ph.D., M.S.
Marianne Gausche-Hill, M.D., F.A.C.E.P., F.A.A.P.
Richard A. Orr, M.D.
Nels D. Sanddal, M.S., REMT-B
David N. Sundwall, M.D.

Henri R. Manasse, Jr., Ph.D., Sc.D resigned from the committee on August 22, 2005.

Events



Location:

Arnold and Mabel Beckman Center
100 Academy Way, Irvine, CA 92617
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Anisha Dharshi
Contact Email:  emergencycare@nas.edu
Contact Phone:  202-334-2711

Agenda
The Future of Emergency Care in the U.S. Health System
Hospital-based Subcommittee Meeting #3: March 2 - 3, 2005
Pediatric Subcommittee Meeting #3: March 2 - 3, 2005
Prehospital EMS Subcommittee Meeting #3: March 2 - 3, 2005

Main Committee Meeting #4: March 3 - 4, 2005

***OPEN PLENARY SESSION: March 3, 2005, 8:00 am - 12:00 pm***
Members of the public may register to attend the open plenary session by
sending their full contact information to Anisha Dharshi via email at
adharshi@nas.edu or via phone at 202-334-2711.


Meeting Agenda

The Arnold and Mabel Beckman Center of the National Academies
100 Academy Drive, Irvine, CA

--------------------------------------------------------------------------------
Thursday, March 3, 2005

OPEN PLENARY SESSION

7:30 am
Continental Breakfast

8:00 am
Public Welcome and Introductions
- Gail Warden, Main Committee Chair
- Bob Giffin, Project Co-Director (Institute of Medicine)

8:15 am - 9:45 am
Public Health Perspectives
- Overview of EMS & Trauma System Issues presented by Dr. William Koenig,
Medical Director of EMS
- The Hospital Perspective presented by Doug Bagley, CEO, Riverside Regional
Medical Center
- The Safety Net and Community Providers Perspective presented by John
Gressman, CEO, San Francisco Community Clinics Consortium
- Mental Health and Substance Abuse presented by Barry Chaitin, Professor and
Co-Chair, Department of Psychiatry and Human Behavior, University of California
Irvine, College of Medicine
- The Patient Perspective presented by Sandy Schuhmann-Atkins, UC Irvine

9:45 am - 10:00 am
Break

10:00 am - 11:00 am
On-Call Physician Issues
- Specialty Physician Perspective: Orthopedics presented by Dr. Nick Halikis,
Orthopedic Surgery, Harbor UCLA Medical Center
- Specialty Physician Perspective: Neurosurgery presented by Dr. John Kusske,
Neurosurgery, UC Irvine
- AJEM Survey of On-Call Issues presented by Dr. Mark Langdorf, UC Irvine

11:00 am - 12:00 pm
Issues in Rural Emergency Care
- The Family Practice Perspective presented by Arlene Brown, MD
- Telemedicine in Rural Emergency Care presented by Jim Marcin, MD, UC Davis

12:00 pm - 1:00 pm
Lunch

CLOSED PLENARY SESSION (Main Committee and Subcommittees only)

1:00 pm - 5:00 pm
Committee and Subcommittee Deliberations

6:00 pm
Working Committee and Subcommittee Dinner



--------------------------------------------------------------------------------

Friday, March 4, 2005

CLOSED SESSION (Main Committee only)

7:30 am - 3:00 pm
Committee Deliberations
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

- Brent Asplin
- Thomas Babor
- Robert Bass
- Benjamin Chu
- Brent Eastman
- Shirley Gamble
- Darrell Gaskin
- Robert Gates
- Marianne Gausche-Hill
- Mary Jagim
- Arthur Kellermann
- William Kelley
- Peter Layde
- Henri Manasse
- Richard Orr
- Jerry Overton
- John Prescott
- Nels Sanddal
- William Schwab
- Mark Smith
- David Sundwall
- Gail Warden

The following topics were discussed in the closed sessions:

- Draft recommendations
- Other potential topics for recommendations
- Prioritization of recommendations
- Draft committee report
- Potential biases/conflicts of interest relative to the project
- Review and release strategy

The following materials (written documents) were made available to the committee in the closed sessions:

- Agenda
- Logistics for Meeting
- Membership Grid
- Project Calendar
- Pediatric Subcommittee Revised Statement of Task, Membership Roster, Draft
Recommendations, Draft Report
- Prehospital EMS Subcommittee Revised Statement of Task, Membership Roster,
Draft Recommendations, Draft Report
- Hospital-Based ED Subcommittee Revised Statement of Task, Membership Roster,
Draft Recommendations, Draft Report
- Main Committee Revised Statement of Task, Membership Roster, Draft
Recommendations, Draft Report
- References List
- Acronym List
- Project Timeline
- Communication Tools User's Guide

Date of posting of Closed Session Summary:
March 10, 2005
Publication(s) resulting from the event:

-


Location:

J. Erik Jonsson Woods Hole Center
314 Quissett Ave.
Woods Hole, Massachusetts
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Anisha Dharshi
Contact Email:  adharshi@nas.edu
Contact Phone:  202-334-2711

Agenda
This meeting is closed in its entirety.
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

Gail Warden
Stuart Altman
Brent Asplin
Thomas Babor
Robert Bass
Benjamin
Chu
Brent Eastman
George Foltin
Shirley Gamble
Darrell Gaskin
Robert
Gates
John Halamka
Mary Jagim
Arthur Kellermann
Peter Layde
Eugene Litvak

Henri Manasse
Richard Orr
Jerry Overton
John Prescott
Nels Sanddal
William
Schwab
Mark Smith
David Sundwall

The following topics were discussed in the closed sessions:

Reviewed background materials; discussed subcommittees' meetings and progress;
discussed workplan and report draft outline; determined next steps in
accordance with project timeline.

The following materials (written documents) were made available to the committee in the closed sessions:

Closed session agenda; subcommittee meeting updates; statement of task;
commissioned papers; project timeline.

Date of posting of Closed Session Summary:
October 18, 2004
Publication(s) resulting from the event:

-


Location:

Keck Center
500 5th St NW, Washington, DC 20001
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Anisha Dharshi
Contact Email:  adharshi@nas.edu
Contact Phone:  202-334-2711

Agenda
FRIDAY, JUNE 25, 2004

CLOSED SESSION (Committee Only)

8:00 am
Committee Deliberations

OPEN SESSION

12:00 pm
Lunch

12:30 pm
Public Welcome and Introductions
Review of Main Committee Charge
Gail Warden, Committee Chair

Luncheon Speaker ? Medical Technology in Emergency Medicine
Michael Sachs, Chairman, Sg2

1:30 pm Discussion and Questions

1:45 pm Break

CLOSED SESSION (Committee Only)

2:00 pm Committee Deliberations

4:30 pm Meeting Adjourns
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

Gail Warden
Stuart Altman
Brent Asplin
Thomas Babor
Robert Bass
Benjamin
Chu
Brent Eastman
George Foltin
Shirley Gamble
Darrell Gaskin
Robert
Gates
John Halamka
Mary Jagim
Arthur Kellermann
Peter Layde
Eugene Litvak

Henri Manasse
Richard Orr
Jerry Overton
John Prescott
Nels Sanddal
William
Schwab
David Sundwall

The following topics were discussed in the closed sessions:

Disclosure of any potential biases and conflicts of interest for new members;
reviewed expanded project and subcommittees statements of task; discussed
updated project timeline, workplan, project communication tools, and topics for
future meetings.

The following materials (written documents) were made available to the committee in the closed sessions:

Closed session agenda; committee and subcommittee rosters and statements of
task; National Academies harassment policy description; draft revised
statements of task; updated project timeline; communication tools'
instructions.

Date of posting of Closed Session Summary:
July 30, 2004
Publication(s) resulting from the event:

-


Location:

Keck Center
500 5th St NW, Washington, DC 20001
Event Type :  
-

Registration for Online Attendance :   
NA

Registration for in Person Attendance :   
NA


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  Anisha Dharshi
Contact Email:  adharshi@nas.edu
Contact Phone:  202-334-2711

Agenda
Meeting and Workshop Agenda

MONDAY, FEBRUARY 2, 2004

12:00 - 2:30 pm CLOSED SESSION (Committee Only)

OPEN SESSION - WORKSHOP

2:30 - 2:45 pm
Public Welcome and Introductions
Review of Committee Charge
Gail Warden, Committee Chair

2:45 - 4:45 pm
Panel I: Overview of Emergency Care in the U.S. Health System
Moderator: Stuart Altman (Brandeis University)
* Overview of the Emergency Care System
Arthur L. Kellermann (Emory University School of Medicine)
* Emergency Care Supply and Utilization
Charlotte S. Yeh (Centers for Medicare and Medicaid Services)
* Rural Issues in Emergency Care
John E. Prescott (West Virginia University)

4:45 - 5:00 pm Discussion and Questions

5:00 - 6:00 pm Reception (Keck Center Atrium)

6:30 - 8:00 pm CLOSED SESSION (Committee Only)


TUESDAY, FEBRUARY 3, 2004

OPEN SESSION - WORKSHOP

7:30 - 8:00 am Continental Breakfast

8:00 - 8:15 am
Introductory Comments
Gail Warden, Committee Chair

8:15 - 10:00 am
Panel II: Major Emergency Care Issue Areas
Moderator: Mary M. Jagim (MeritCare Hospital)
* Patient Flow and Emergency Department Crowding
Brent R. Asplin (University of Minnesota)
* Evolution of the Emergency Department (circa 2004): A Systems Perspective
Eric B. Larson (Group Health Cooperative)
* Mental Health and Substance Abuse Issues
Michael H. Allen (University of Colorado Health Sciences Center)

10:00 - 10:15 am Discussion and Questions

10:15 - 10:30 am Break

10:30 - 11:45 am
Panel III: Major Emergency Care Issue Areas (cont.)
Moderator: William N. Kelley (University of Pennsylvania School of Medicine)
* Workforce Education and Training
Glenn C. Hamilton (Wright State University School of Medicine)
* Information Technology in Emergency Care
Larry A. Nathanson (Beth Israel Deaconess Medical Center)

11:45 am - 12:00 pm Discussion and Questions

12:00 - 1:00 pm Lunch

1:00 - 2:45 pm
Panel IV: Pre-Hospital Care, Public Health, and Emergency Preparedness
Moderator: Jerry L. Overton (Richmond Ambulance Authority)
* Emergency Care and Public Health
Daniel A. Pollock (Centers for Disease Control and Prevention)
* Overview of the Issues Facing Pre-Hospital EMS
Robert Bass (Maryland Institute for Emergency Medical Services Systems)
* Emergency Preparedness
Joseph F. Waeckerle (University of Missouri Baptist Medical Center)

2:45 - 3:00 pm Discussion and Questions

3:00 - 3:15 pm Break

3:15 - 3:45 pm
Special Issues in Pediatric Emergency Care Services
Jane W. Ball (The EMSC National Resource Center)

3:45 - 5:00 pm
Panel V: Research Agenda
Moderator: Mark D. Smith (California HealthCare Foundation)
* Overview of Research in Emergency Care
E. John Gallagher (Montefiore Medical Center)
* Research Needs for the Future
Robin Weinick (Agency for Healthcare Research and Quality)

5:00 - 5:15 pm Discussion and Questions

5:15 - 5:30 pm
Wrap Up and Adjourn Workshop
Gail Warden, Committee Chair

6:00 - 8:00 pm CLOSED SESSION (Committee Only)


WEDNESDAY, FEBRUARY 4, 2004

7:30 am - 1:00 pm CLOSED SESSION (Committee Only)
Supporting File(s)
-
Is it a Closed Session Event?
Yes

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

Gail Warden
Stuart Altman
Brent Asplin
Thomas Babor
Benjamin Chu
Shirley
Gamble
Robert Gates
John Halamka
Mary Jagim
Arthur Kellermann
William
Kelley
Peter Layde
Eugene Litvak (via telephone)
Henri Manasse (via
telephone)
Jerry Overton
John Prescott
Mark Smith

The following topics were discussed in the closed sessions:

Disclosure of any potential biases and conflicts of interest; reviewed
committee charge and background materials; discussed project timeline,
workplan, possible commissioned paper topics, and draft agenda for April
meeting.

The following materials (written documents) were made available to the committee in the closed sessions:

Closed session agenda; committee roster; National Academies harassment policy
description; draft revised statement of task; background paper authored by
staff; project timeline; draft agenda for April 2004 meeting; list of ideas for
commissioned papers

Date of posting of Closed Session Summary:
February 12, 2004
Publication(s) resulting from the event:

-

Publications