Section I: Getting to Know the EMSC Program

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Table of Contents: Brief History | Funded Programs | Resource Centers


A Brief History of the EMSC Program

Photos of Dr Sia and Senator InouyeMore 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: An Historical Perspective.


Funded Programs

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Fast Facts:

  • Children comprise about 27% of the U.S. population and present special challenges for emergency care providers when they have a medical emergency.

  • Children account for 20% of all hospital emergency department visits.

  • About 13% of all EMS transports involve pediatric patients.

  • Although children are often thought of as “little adults,” their unique physical, behavioral, and emotional responses require special considerations when providing emergency care. For example, equipment such as oxygen masks, endotracheal tubes, and IV catheters need to be specifically sized to match the anatomic uniqueness of children. Young children are also unable to provide information about their identity, their symptoms, or previous medical history.

In an effort to continually address gaps identified in the IOM reports and other key data sources, the categories of grant funding have changed throughout the years. Currently, the EMSC Program directly funds three grant programs, including State Partnership (SP) grants, Targeted Issue (TI) grants, and State Partnership Regionalization of Care (SPROC) grants. Additionally, the Program supports the Pediatric Emergency Care Applied Research Network (PECARN). The EMSC National Resource Center (NRC) and the National EMS Data Analysis Resource Center (NEDARC) are also funded under cooperative agreement and support the Program and its grantees.

State Partnership. The purpose of the EMSC SP Program is to assist states in expanding and improving their capacity to reduce and ameliorate pediatric emergencies, taking special care to include children with special health needs, culturally distinct populations, and historically underrepresented groups, including the U.S. territories, the freely associated states, and American Indian/Native Americans. This will be accomplished using existing research-based knowledge, state-of-the-art systems development approaches, and the experience and products of previous EMSC grantees. SP grants are intended to solidify the integration of a pediatric focus within state EMS systems. States are guided by Standards of Achievement through Program-defined performance measures. The performance measures are the primary goals, objectives, and priorities of the EMSC SP Program.

Targeted Issue. TI grants are intended to address specific needs, concerns, or topics in pediatric emergency care that transcend state boundaries. Typically, the projects result in a new product, resource, or demonstrate the effectiveness of a model system component or service of value to the nation. Ideally SP Program managers are aware if their state also has a TI grant as they may be asked to participate in a TI grant activity at varying levels. The EMSC Targeted Issue Database provides an overview of TI grants awarded in individual states. Descriptions for the most current TI grant projects also are available.

State Partnership Regionalization of Care. SPROC grants are the newest of the EMSC grant programs. These grants were established for the development of regionalized systems of pediatric care that encompass the sharing of resources and improve access to emergency care for children and families in tribal, insular, and rural areas of the country and to develop models of inclusive care that may be replicated in other regions where access to specialized pediatric medical treatment is limited due to geographical distances or jurisdictional borders. A fact sheet details the first six SPROC grant funded projects.

Pediatric Emergency Care Applied Research Network. PECARN is the first federally funded, multi-institutional network for research in pediatric emergency medicine. It is comprised of six research centers that work collaboratively with Hospital Emergency Department Affiliates (HEDAs) to develop and submit nodal research proposals to PECARN and conduct PECARN-approved research at their respective institutions. Together, the represented EDs serve 1.2 million pediatric patients annually.

In 2013 an EMS research center was added to PECARN to test the feasibility of conducting effective prehospital research (read about the Wisconsin-Medical College of Wisconsin: Development of the Charlotte, Houston and Milwaukee Prehospital (CHaMP) Research Node on the fact sheet Targeted Issue Grants, 2013). A list of peer-reviewed publications and abstracts generated through PECARN research is available on the PECARN website.


Resource Centers

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EMSC National Resource Center. In 1991, MCHB established the EMSC NRC under a cooperative agreement with Children’s National Health System in Washington, DC. Working under the purview of the federal EMSC Program, the EMSC NRC historically has offered technical expertise to states and territories with EMSC funding in the areas of project development, needs assessment, coalition building, public policy, community engagement and long-term sustainability. Today, the EMSC NRC continues to assist the federal EMSC Program in:

The EMSC NRC also hosts the EMSC Program Meeting, coordinates and facilitates multiple other meetings including quarterly PECARN, SPROC, and TI meetings and teleconferences, and conducts various special meetings for grantees and workgroups as needed. One of the most important tasks of the EMSC NRC is to build and maintain strong partnerships and working collaboratives with national professional organizations and federal agencies.

The EMSC NRC staff represents a range of experience and expertise including:

National EMS Data Analysis Resource Center. Located at the University of Utah School of Medicine, NEDARC was created through a cooperative agreement with MCHB in 1995. NEDARC provides technical assistance to state and territory EMSC program managers and EMS state office directors and other staff to develop capabilities to collect, analyze, and utilize EMS data. Through building these skills in EMSC program managers, NEDARC aims to strengthen their capacity and equip them with tools and resources that will ultimately enhance the emergency care system for children in their states, territories, and regions.

The NEDARC team is comprised of individuals with diverse backgrounds including clinical, educational, statistical, communications, public health, technical, and research expertise. Staff provide grantees with technical assistance in the follows areas:

In addition to one-on-one technical assistance, NEDARC supports EMSC program managers and other EMSC stakeholders through a variety of educational offerings, including workshops and webinars and other resources related to data issues. 

While all team members are available as a resource to EMSC program managers, each state/territory has a NEDARC staff member assigned to serve as their technical assistance (TA) representative. Visit the map to determine your NEDARC TA representative.

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