EMS providers There are standardized educational opportunities for EMS providers that can afford the teacher more experience with pediatric EMS, such as the PEPP curriculum through the AAP EMTs may also take the PALS course to supplement their pediatric training, and physician educators play an important role in the success of this course EMSC is an example of a national initiative designed to reduce child and youth disability and death due to severe illness and injury Medical personnel, parents, volunteers, community groups, businesses, national organizations, and foundations contribute to the effort Examples include the previously referred to list of essential pediatric EMS equipment for ambulances and the multiple toolkits that can be accessed through the EMS for Children Innovation and Improvement Center (https://emscimprovement.center/resources/toolboxes ) Many other organizations exist to serve as educational resources and as forums for discussing, teaching, and implementing policies used to promote the specific needs of pediatric EMS National organizations and their websites are listed in Table 134.6 FIGURE 134.3 EMS for children timeline (Courtesy of Elizabeth Edgerton, HRSA.) IOM REPORTS In 2006, the IOM was commissioned to analyze and report on the capabilities of both prehospital- and hospitalbased emergency care in the United States Three volumes were published: Emergency Care for Children: Growing Pains, Emergency Medical Services: At the Crossroads , and Hospital-based Emergency Care: At the Breaking Point While complimentary of the past accomplishments of the EMS system, their findings also highlighted many of the shortfalls that exist around the care of all patients in all of the components of the EMS system, and also suggested a system of interventions to address these issues The overall critique of the emergency care system is that it was severely fragmented, with an absence of system-wide coordination and planning, and a lack of accountability The reports highlighted the following: Insufficient coordination of 9-1-1 dispatch, EMS systems and hospitals Disparities in response times to emergency calls Uncertainties around the quality of EMS care, no agreed-upon measures of EMS No accountability for the performance of EMS systems A “divided” professional identity in EMS, serving both medical care and public safety, with EMS often regarded as secondary to fire, police, nurses, and physicians A limited evidence base for routine EMS practices, with evidence generalized to the prehospital field from other practice settings A general lack of disaster preparedness considering the role that EMS providers may play in a large incident or terrorist attack, and a specific lack of pediatric consideration in disaster planning