Our nation’s emergency care system is full of cracks, and one mass disaster could cause the break that sends our nation into a major tailspin. As emergency physicians, you know the reasons it’s happening, and you want to help.

But what’s working against emergency medicine is an issue that’s common in corporate organizations today—work is being done in silos, without each organization really knowing what goals other organizations are working toward.

“What the 2006 Institute of Medicine (IOM) report recognized was that responsibility for emergency care is widely dispersed across three federal departments and numerous agencies, yet none of them is responsible for advancing emergency care,” said Art Kellermann, M.D., M.P.H., professor and associate dean for health policy at the Emory School of Medicine in Atlanta, Ga.

‘for the first time, there is a focal point to coordinate federal activities on emergency care issues.’

Dr. Kellermann is a past ACEP Board member and a key member of the IOM’s Committee on the Future of Emergency Care in the U.S. Health System. “There was no mechanism to bring federal officials together to ask, ‘What are the things that matter?’ and, ‘Who’s taking care of this issue?’ or even, ‘Is this issue worth considering?’” Dr. Kellermann continued.

That all changed Jan. 8, 2009, with the establishment of the Emergency Care Coordination Center (ECCC), formed in response to Homeland Security Presidential Directive #21, signed by President George W. Bush in October 2007. The ECCC serves as the principal coordination and communications hub for federal departments and agencies working on emergency care-related activities, and is designed to promote collaboration, joint strategies, and cohesive policies.

The ECCC harnesses the power of agencies previously working in silos and puts them on the same page to promote collaboration, coordination, and common goals—and gaining the much-needed attention and willing action of the federal government while doing it.

Dr. Michael Handrigan, acting director of the ECCC, sums it up simply by saying, “The ECCC is a federal home for emergency care.”

David Marcozzi, M.D., MHS-CL, former ECCC director, said the ECCC is a positive step to address the care delivered to all patients suffering emergent conditions.

“Emergency care is the link between the delivery of daily health care and the care of victims during a disaster. For the first time, there is a focal point to coordinate federal activities on emergency care issues,” he said. “In coordination with the Federal Interagency Committee of Emergency Medical Services (FICEMS), the ECCC will improve our nation’s delivery of the entire spectrum of emergency care, from the field to the hospital.”

The ECCC may be less than a year old, but the center is already taking action. It immediately established the Council on Emergency Care (CEMC), a strategic body whose goal is to bring together federal representatives who are directly responsible for agency initiatives aimed at addressing emergency care. In bringing these individuals to the table, the ECCC and CEMC have already begun the primary tasks of increasing transparency, avoiding duplication of efforts, and promoting strategic partnerships throughout the U.S. government.

The ECCC also reaches out to fellow emergency care agencies and organizations, recently completing an H1N1-related project with ACEP.

“When it became clear that H1N1 was going to need some response and preparedness in advance of a potentially large outbreak, we developed a contract agreement and a collaboration that led to some H1N1 guidance and a list of FAQs that ACEP put together,” said Dr. Handrigan. “It was a great example of how the ECCC can partner with the emergency community to accomplish our common goals.”

The ECCC and CEMC are moving forward with ambitious agendas, focusing on areas such as surge capacity, regionalized emergency care services, and health care reform.

Dr. Kellermann has sat in on several CEMC meetings. “I’ve been incredibly impressed, both at the caliber of people in the room and the fact that I’m not seeing the kind of game-playing and personal agendas that one normally sees occur within federal agencies.

“People are far more concerned with doing the right thing and making progress, and they all recognize that none of them have the resources to do the job themselves, but that collectively they can make changes happen.”

Dr. Kellermann has high hopes for what the ECCC can accomplish.

“Having been involved in emergency care for 25 years, I think the ECCC is the most significant development on a national level regarding improving and advancing emergency care in the U.S. since the Emergency Medical Services Systems Act of 1973,” he said.

There is much that ACEP members can do to help ensure the ECCC’s future success.

“The most important thing ACEP members need to do right now is not take this new agency for granted,” said Dr. Kellermann.

“This is an embryonic program that can potentially have enormous impact on our ability to care for patients,” he added. “ACEP members need to encourage their elected officials, including members of Congress, to learn about this agency, its important mission, and why it deserves their support.

“The ECCC is staffed by people who understand and value emergency care, and who have the wherewithal to tackle issues of importance to ACEP members and our patients,” Dr. Kellermann continued. “But it’s still in its infancy. Hopefully, Congress will ratify the presidential directive that created the ECCC by authorizing its existence and directly appropriating funding.”

The ECCC is supported by the Obama administration, but it needs ACEP’s support as well, Dr. Kellermann said. “That’s the best way to ensure that this program becomes the ‘lead federal agency’ envisioned by the IOM.”

More information on the ECCC and CEMC is available at www.hhs.gov. Dr. Handrigan also suggests looking to professional societies for additional information. n