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The Emergency Medical Services for Children (EMSC) program was first authorized and funded by the U.S. Congress in 1984 as a demonstration program under Public Law 98‐555. The EMSC program is administered by the DHHS Health Resources and Services Administration’s Maternal and Child Health Bureau; many of the EMSC programs are jointly funded by the Health Resources and Services Administration (HRSA) and NHTSA. This program is a national initiative designed to reduce child and youth disability and death caused by severe illness or injury [61] and serves as an example of a successful collaboration between government and academic forces.

In the late 1970s, the Hawaii Medical Association laid the groundwork for the EMSC program by urging members of the American Academy of Pediatrics to develop multifaceted EMS programs that would decrease morbidity and mortality in children. It worked with Senator Daniel Inouye (D‐HI) and his staff to write legislation for a pediatric EMS initiative.

In 1983, a particular incident demonstrated the need for these services. One of Senator Inouye’s senior staff members had an infant daughter who became critically ill. Her case showed the serious shortcomings of an average emergency department when caring for a child in crisis. A year later, Senators Orrin Hatch (Republican‐UT) and Lowell Weicker (Republican‐CT), backed by staff members with disturbing experiences of their own, joined Senator Inouye in sponsoring the first EMSC legislation.

Initial funding from the EMSC program supported four state demonstration projects. These state projects developed some of the first strategies for addressing important pediatric emergency care issues, such as disseminating educational programs for prehospital and hospital‐based clinicians, establishing data collection processes to identify significant pediatric issues in the EMS system, and developing tools for assessing critically ill and injured children. In later years, additional states were funded to develop other strategies and to implement programs developed by their predecessors. This work progressed through the 1990s when all 50 states and the territories received funding to improve EMSC and integrate it into their existing EMS systems. In response to the available money, in many areas, prehospital care of children became the focus of all EMS innovation.

After several years, with projects developing many useful and innovative approaches to taking care of children in the prehospital setting, a mechanism was needed to make these ideas and products more easily accessible to interested states. In 1991, two national resource centers were funded to provide technical assistance to states and to manage the dissemination of information and EMSC products. In 1995, the EMSC National Resource Center in Washington, DC was designated the single such center for the nation. Additionally, with the recognition of the dire need for research and the lack of qualified individuals in each state to perform it, a new center was funded, the National EMSC Data Analysis Resource Center (NEDARC) located at the University of Utah School of Medicine. Created through a cooperative agreement with the Maternal and Child Health Bureau, the NEDARC was established to “help states accelerate adoption of common EMS data definitions, and to enhance data collection and analysis throughout the country” [62].

As the 1980s ended, members of Congress requested information that justified continued funding of the EMSC program. The Institute of Medicine (IOM) of the National Academy of Sciences was commissioned in 1991 to conduct a study of the status of pediatric emergency medicine in the nation. A panel of experts was convened to review existing data and model systems of care, and to make recommendations as appropriate. The findings from this national study revealed continuing deficiencies in pediatric emergency care for many areas of the country and listed 22 recommendations for the improvement of pediatric emergency care nationwide [63]. These recommendations fell into the following categories: education and training, equipment and supplies, categorization and regionalization of hospital resources, communication and 9‐1‐1 systems, data collection, research, federal and state agencies and advisory groups, and federal funding. These findings convinced Congress to raise funding for the EMSC program.

In response to the IOM report, the EMSC program developed a strategic plan. With the assistance of multiple professionals, including physicians, nurses, and prehospital clinicians, major goals and objectives were identified. The EMSC 5‐year plan for 1995–2000 served as a guideline for further development of the program [64]. The plan had 13 goals and 48 objectives. Each objective had a specific plan that identified national needs, suggested activities and mechanisms to achieve the objective, and listed potential partners. In 1998, the plan was updated with baseline data, refined objectives, and progress in completing activities [65].