Despite the lifesaving feats performed every day by emergency departments and ambulance services, the nation's emergency medical system as a whole is overburdened, underfunded, and highly fragmented, says this series of three reports from the Institute of Medicine. 

As a result, ambulances are turned away from emergency departments once every minute on average and patients in many areas may wait hours or even days for a hospital bed.  Moreover, the system is ill-prepared to handle surges from disasters such as hurricanes, terrorist attacks, or disease outbreaks.

The Institute of Medicine's Committee on the Future of Emergency Care in the United States Health System was convened in 2003 to examine the state of emergency care in the U.S., to create a vision for the future of emergency care, including trauma care, and to make recommendations to help the nation achieve that vision.  Their findings and recommendations are presented in three reports:

1. Hospital-Based Emergency Care: At the Breaking Point explores the changing role of the hospital emergency department and describes the national epidemic of overcrowded emergency departments and trauma centers.
2. Emergency Medical Services At the Crossroads describes the development of EMS systems over the last forty years and the fragmented system that exists today.
3. Emergency Care for Children: Growing Pains describes the unique challenges of emergency care for children.

The wide range of issues covered in this report, Hospital-Based Emergency Care: At the Breaking Point, includes:

• The role and impact of the emergency department within the larger hospital and health care system.
• Patient flow and information technology.
• Workforce issues across multiple disciplines.
• Patient safety and the quality and efficiency of emergency care services.
• Basic, clinical, and health services research relevant to emergency care.
• Special challenges of emergency care in rural settings.