Emergent and critical care of infants and children may not be well integrated and regionalized within our health care system, suggesting that there is room for improvement in the quality of care for children encountering emergent illness and trauma.

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High-quality pediatric emergency care can be provided only through the collaborative efforts of many health care professionals and child advocates working together throughout a continuum of care that extends from prevention and the medical home to prehospital care, to emergency department stabilization, to critical care and rehabilitation, and finally to a return to care in the medical home. At times, the office of the pediatric primary care provider will serve as the entry site into the emergency care system, which comprises out-of-hospital emergency medical services personnel, emergency department nurses and physicians, and other emergency and critical care providers. Recognizing the important role of pediatric primary care providers in the emergency care system for children and understanding the capabilities and limitations of that system are essential if pediatric primary care providers are to offer the best chance at intact survival for every child who is brought to the office with an emergency. Optimizing pediatric primary care provider office readiness for emergencies requires consideration of the unique aspects of each office practice, the types of patients and emergencies that might be seen, the resources on site, and the resources of the larger emergency care system of which the pediatric primary care provider's office is a part. Parent education regarding prevention, recognition, and response to emergencies, patient triage, early recognition and stabilization of pediatric emergencies in the office, and timely transfer to an appropriate facility for definitive care are important responsibilities of every pediatric primary care provider. In addition, pediatric primary care providers can collaborate with out-of-hospital and hospital-based providers and advocate for the best-quality emergency care for their patients. INTRODUCTIONPediatricians and pediatric primary care providers (PPCPs) are vitally important members of the emergency care system for children. Children with potentially life-threatening illnesses and injuries are sometimes taken to primary care offices, which often serve as the child's medical home, by parents or caregivers seeking help from health care professionals they know and trust. The office site then serves as an entry into the emergency care system, and it is there that vital, perhaps even life-saving, care is provided.Studies have shown that emergencies are common in primary care practices that provide care to children. In 1 study, the authors surveyed 52 pediatric offices and found that these practices saw a median of 24 emergencies per year. 1 Most of the offices (82%) reported that they encountered, on average, at least 1 emer-

Improvements in care to injured children associated with the PECFR program were limited to the interval between pain assessment and pain medication for children with extremity immobilization and to radiation use 1 year after the implementation of the PECFR program.