Pediatric training for EMS is underemphasized and may not be required to be part of continuing education requirements for EMS personnel Pediatric treatment patterns vary widely between EMS and hospital-based care providers In order to achieve the IOM vision in which all communities are served by high-quality, well-planned emergency care services, the report recommended the creation of a federal lead agency for emergency and trauma care, housed in the Department of Health and Human Services While FICEMS was established in 2005, it is a committee supported by NHTSA in cooperation with HRSA and the Department of Homeland Security The committee is instrumental in working toward the IOM vision of a 21st century emergency care system, but has limitations regarding impact including numbers of dedicated staff and authority to allocate funds, establish policy, or implement federal policy To help address system financing, the IOM report recommended that the Centers for Medicare and Medicaid Services appoint a work group to evaluate the reimbursement of EMS services, which is typically based upon transport distance rather than intensity of services and does not cover treatment without transport