[Congressional Record Volume 144, Number 39 (Tuesday, March 31, 1998)]
[Senate]
[Pages S2872-S2873]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                         ADDITIONAL STATEMENTS

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              PEDIATRIC EMERGENCY MEDICAL SERVICES PROGRAM

 Mr. INOUYE. Mr. President, the Pediatric Emergency Medical 
Services Program was enacted into public law on a truly bipartisan 
basis on October 30, 1984. Children are not ``merely little adults.'' 
They have their own unique health care needs, respond to illness and 
trauma in their own individualized manner, and although children 
constitute between 20 to 35 percent of hospital emergency department 
services, too often their families are not really considered an 
integral component of their treatment and eventual rehabilitation. When 
President Reagan signed Public Law 98-555, a new era of hope and 
opportunity had arrived.
  Over the years, I have been very pleased with the steady growth this 
program has experienced. The landmark 1993 Institute of Medicine report 
reminded us, however, that much more still needs to be done. ``Each 
year, injury alone claims more lives of children between the ages of 1 
and 19 than do all forms of illness. . .. Overall, some 21,000 children 
and young people under the age of 20 died from injuries in 1988. . .. 
Clearly, preventing emergencies is the best `cure' and must be a high 
priority, but as yet, prevention is far from foolproof. When prevention 
fails, families should have access to timely care by trained personnel 
within a well-organized emergency medical services (EMS) system. 
Services should encompass prevention, prehospital care and transport, 
ED and inpatient care at local hospitals and specialty centers, and 
assistance in gaining access to appropriate follow-up care including 
rehabilitation services. For too many children and their families, 
however, these resources have not been available when they were needed. 
. ..'' I would suggest that the Institute of Medicine has raised a very 
critical issue for all of us in our nation, and particularly for the 
well-being of our families.
  This year, the Administration in its Fiscal Year 1999 budget 
requested $11 million to continue the Pediatric Emergency Medical 
Services Program. This figure represents a decrease of $2 million from 
last year and we might be somewhat distressed by the recommendation. 
However, I am very pleased that in this time of significant budgetary 
constraints, Secretary Shalala requested funding. And, I am confident 
that again this year our colleagues serving on the Appropriations 
Committees, on both sides of the aisle and in the House and Senate, 
will enthusiastically respond to the truly pressing needs of our 
nation's children. I am also confident that we will continue to have 
the vocal support of the American Academy of Pediatrics and the 
National Association of Children's Hospitals. But for their active 
support in the past, it is fair to say that Congressman Bill Young and 
I would not have been able to be as effective as we have wished.
  The Department's budget justification continues to point out all too 
graphically the real need for this program. They point out that: ``Each 
year over 20,000 children die from injuries. Another 31,447,000 
children and adolescents are seen in emergency departments, accounting 
for $8.6 billion per year in medical costs. Government sources pay all 
or part of 40 percent of the pediatric emergency department visits, or 
about $3.4 billion. . ..'' Without question, having appropriate and 
high quality care available in a timely fashion is an investment in our 
nation's future.
  Every one of us should be aware that there is still much to be 
accomplished in our efforts to protect the lives and future of our 
loved ones. Even today, only two states require that Basic Life Support 
vehicles carry all the equipment needed to stabilize a child and

[[Page S2873]]

only five states require all such equipment for Advanced Life Support 
ambulances. 34 percent of EMTs and paramedics report that they still do 
not feel comfortable treating children. In 1996, 66 percent of persons 
who failed the national EMT exam did so because they failed the 
pediatric/OB section. A recent study found that paramedics' skills and 
knowledge for treating critically ill or injured children completely 
decayed by six months post-training; yet no state requires even annual 
retraining in pediatric care. Children with special health care needs 
present major complications for emergency treatment. Yet, only six 
states have approved continuing education courses that address this 
topic. Only nine states have the capacity to produce reports on 
pediatric emergency medical services care using statewide emergency 
medical services data. Perhaps most significantly, however, is the 
finding that LESS THAN HALF (46 percent) of hospitals with emergency 
departments have necessary equipment for stabilization of ill and 
injured children, and only 40 percent of our nation's hospitals with 
emergency departments have written transfer agreements with a higher 
level facility to ensure that children receive timely and appropriate 
hospital care when they need it. Many public policy experts have also 
raised the issue of how pediatric emergency care is being covered under 
managed care programs.
  Earlier, I referred to the impressive report which the Congress had 
received from the experts at the Institute of Medicine. In my judgment, 
perhaps the most critical Institute of Medicine recommendation is that 
the Congress should provide $30 million annually for this special 
program. Those of us from Hawaii truly appreciate on a first-hand basis 
the many far reaching health policy recommendations that have been made 
over the years by our visionary pediatrician, Dr. Calvin Sia. I, as one 
U.S. Senator, shall continue to do my best to implement Dr. Sia's 
recommendations. Our nation's children and families deserve no 
less.

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