Critical issues in urban emergency medical services for children.

In order to be effective those wishing to improve emergency care of children in an urban environment must be aware of barriers as well as resources. Urban children are at high risk for requiring emergency care as a result of both illness and injury. These children face a dangerous environment resulting from the problems of poverty, homelessness, overcrowded living conditions, drug abuse, and a shrinking tax base. They face this nation's highest rates of violent injury (intentional and unintentional), immunization delays, and preventable infectious diseases such as TB and measles. In addition, they have poor access to quality primary health care and suffer the greatest morbidity rates from chronic diseases such as asthma and diabetes. On the other hand, there is great opportunity to ensure that urban children receive quality emergency health care. The urban environment is rich in "centers of pediatric excellence," which often have paid full-time EMS systems in operation, and is the locale in which the majority of pediatric emergency medicine specialists and prehospital advanced life support providers practice. The child advocate must work to ensure that the urban child can benefit from these resources.