This publication was prepared for the U.S. Department of Health and Human Services, Health Resources and Services Administration under contract with the Children’s National Medical Center, EMSC National Resource Center and The Lewin Group.
This document represents a three-year strategic plan for the Emergency Medical Services for Children (EMSC) Program. The plan recommends priorities for EMSC Program activities and funding for priorities from fiscal years (FY) 2008 through 2010 (inclusive).
Parameters of the Strategic Plan:
This new plan continues the former EMSC Five-year Plan. This strategic plan differs from the Five-year Plan in that it includes goals and objectives that are within the scope and authority of the EMSC Program. The strategies outlined in this document are those that can be: 1.)accomplished under the defined program budget; 2.)measurable; and 3.)achievable over the next three years.
Thus, this plan will provide a roadmap for the EMSC Program for FY 2008 through FY 2010.
The EMSC Program is designed to reduce child and youth mortality and morbidity resulting from severe illness or trauma. It aims to: 1.)ensure that state-of-the-art emergency medical care for the ill or injured child and adolescent is available when needed; 2.)ensure that pediatric services are well integrated into the existing state emergency medical services (EMS) system and backed by optimal resources; and 3.)ensure that the entire spectrum of emergency services, including primary prevention of illness and injury, acute care, and rehabilitation, is provided to children and adolescents at the same level as adults.
The EMSC Program was established under the Preventive Health Amendments of 1984 (PL 98-555). It is administered by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB). The EMSC Program is the only Federal program whose sole focus is on improving the quality of emergency care for children.
Authorized under Section 1910 of the Public Health Service Act (42 U.S.C. 300w-9), the EMSC Program began with $2 million in funding in FY 1985. In FY 2007, the Program was funded at $19.8 million. The EMSC Program allocates funds through various funding mechanisms; however, the Program is primarily a grant making program to State governments and academic medical centers. The chart below lists each of the Program’s funding mechanisms and the total funding amounts each received for FY 2007.
| EMSC Program Activity | Total Funding Amount FY 2007 |
|---|---|
| State Partnership Grants | $6.44 million1 |
| Targeted Issue Grants | $3.2 million2 |
| Pediatric Emergency Care Applied Research Network Cooperative Agreements | $3.5 million3 |
| Small Purchase Order (NAEMSP Pediatric Research Workshop) | $95,000 |
| EMSC National Resource Center Contract | $2.25 million |
| National EMSC Data Analysis Resource Center Cooperative Agreement | $1.2 million |
| Interagency Agreement — National Highway Traffic Safety Administration | $450,000 |
| Interagency Agreement — Indian Health Service | $250,000 |
| Interagency Agreement — Centers for Disease Control and Prevention | $45,0004 |
| Maternal and Child Health Research Grants | $600,0005 |
154-56 grants at $115,000 each
216-18 grants at $200,000 each
3Five cooperative agreements, including the data coordinating center
4Co-funds two research grants
5Co-funds two research grants
Descriptions of EMSC Program Funding Mechanisms in FY 2007:
The following paragraphs describe the various EMSC Program funding mechanisms. As specified by the authorizing statute, the only eligible applicants for EMSC grants or cooperative agreements are State governments or accredited schools of medicine.
State Partnership Grants fund activities to improve and integrate pediatric emergency care within a State EMS system. The typical applicant is a State government unless the State decides to delegate the responsibility to an accredited school of medicine. For FY 2007, there are 9 new and 45 continuing State Partnership Grants, each funded at $115,000 per year. Every grantee is required to collect and report data on the three program-defined performance measures.
Targeted Issue (TI) Grants are intended to address specific needs, concerns, or topics in pediatric emergency care that transcend State boundaries. The performance measure for this grant program is the development and promotion of a new product or resource (such as a peer-reviewed publication). For FY 2007, there are nine continuing TI grants, each in their third and final year of funding and nine new awards that began September 1, 2007, at $200,000 a year for three years.
Network Development Demonstration Project (NDDP) Cooperative Agreements demonstrate the value of an infrastructure or network, which conducts multi-center investigations on the efficacy of treatments, transport, and care responses for children, including those preceding the arrival of children to hospital emergency departments. The Pediatric Emergency Care Applied Research Network (PECARN) consists of four NDDP cooperative agreements, each funded at $721,000 per year in FY 2007. The project period for these cooperative agreements is from September 30, 2005, until September 20, 2008.
Central Data Management Coordinating Center (CDMCC) is funded at $1,110,000 per year. The CDMCC provides the four recipients of the EMSC NDDP cooperative agreements with data collection, data management, and data analysis services. CDMCC also serves as a central repository for NDDP-generated data.
EMSC National Resource Center (NRC) provides support to the EMSC Federal project officers and the EMSC grantees. The NRC identifies and organizes resources needed to implement national EMSC activities. The Resource Center also provides guidance to grantees on securing funds, developing strategic plans, implementing EMSC performance measures, and fulfilling grant expectations. The NRC contract is funded at $2.25 million per year.
National EMSC Data Analysis Resource Center (NEDARC) is funded through a cooperative agreement. It provides technical assistance to EMSC grantees and State EMS offices in the areas of data collection, data analysis, data communication, quality improvement, grant writing, and research design. The cooperative agreement is funded at $1.2 million per year.
Interagency Agreements
Although the EMSC Program has made significant strides over the years in improving the pediatric emergency care system, more remains to be done to ensure that children receive optimal medical care in an emergency. The Institute of Medicine’s study on the Future of Emergency Care in the United States Health System resulted in three reports that were released in June 2006. One of these reports, Emergency Care for Children: Growing Pains, highlights the existing gaps in emergency care for children.
This Strategic Plan was developed by the EMSC National Resource Center through a subcontract with The Lewin Group. To help formulate the draft goals and objectives of the plan, the following documents and materials were reviewed:
Following the development of the draft goals and objectives, focused discussions were conducted with representatives from each EMSC Program funding mechanism. The purpose of these discussions was to gather feedback on the goals and objectives and to define strategies for achieving them. With the leadership of the NRC, NEDARC, and the EMSC Program, discussions were conducted with the following groups.
Once a complete draft of the Strategic Plan was developed, the EMSC Partnership for Children Stakeholder Group (see Appendix A for a list of stakeholder group members) was given a final opportunity to provide feedback and comments to the plan during its June 21-22, 2007, meeting. Edits from the meeting were incorporated into the Strategic Plan to produce the final version.
The Strategic Plan includes the following assumption:
Definitions of particular terms used throughout the Strategic Plan are provided below:
6 Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
The EMSC Three-year Strategic Plan includes 6 goals and 29 objectives. The goals and objectives are listed in the table below. Following the table, a description of the importance and significance of each goal and objective is provided.
| Goal 1: Improve the evidence base for pediatric emergency care through the development of a research infrastructure | |
|---|---|
| Objective 1.1 | Review, update, and implement pediatric emergency care research priorities |
| Objective 1.2 | Develop and support a cadre of new prehospital pediatric emergency care research investigators |
| Objective 1.3 | Encourage the development of high-priority and rigorous prehospital-based pediatric emergency care research studies |
| Objective 1.4 | Make funding available for rigorous and definitive hospital-based pediatric emergency care research studies |
| Objective 1.5 | Disseminate pediatric emergency care research findings and results to health care leaders, policymakers (including Federal, State, and local), and practitioners in all settings |
| Objective 1.6 | Optimize the infrastructure for multi-institutional pediatric emergency care research |
| Objective 1.7 | Foster pediatric emergency care research collaboration among EMSC grantees, stakeholders, and Federal agencies |
| Objective 1.8 | Assist investigators with seeking funding outside of the EMSC Program |
| Goal 2: Ensure the operational capacity and infrastructure to provide pediatric emergency care | |
| Objective 2.1 | Develop evidence- or consensus-based on-line and off-line pediatric medical direction for basic and advance life support providers |
| Objective 2.2 | Assess the availability of essential pediatric equipment and supplies for basic and advance life support ambulances |
| Objective 2.3 | Develop a statewide, territorial, or regional standardized system that recognizes hospitals that are able to stabilize and/or manage pediatric medical emergencies and trauma |
| Objective 2.4 | Develop written pediatric inter-facility transfer guidelines for hospitals |
| Objective 2.5 | Develop written pediatric inter-facility transfer agreements to facilitate timely movement of children to appropriate facilities |
| Objective 2.6 | Develop and adopt minimum requirements for pediatric emergency education as part of the recertification requirements of all emergency medical service providers |
| Objective 2.7 | Engage EMSC stakeholder organizations in developing strategies to assist States/Territories in improving the pediatric emergency care infrastructure |
| Goal 3: Identify and disseminate strategies to improve the quality of pediatric emergency care | |
| Objective 3.1 | Assess current resources for pediatric patient care quality |
| Objective 3.2 | Disseminate currently available resources and/or implementation strategies on pediatric patient care quality to EMSC grantees and other relevant stakeholders |
| Objective 3.3 | Make funding available to develop the infrastructure for studying pediatric patient care quality |
| Goal 4: Establish permanence of EMSC in each State/Territory EMS system | |
| Objective 4.1 | Establish an EMSC Advisory Committee within each State/Territory |
| Objective 4.2 | Incorporate pediatric representation on the State/Territory EMS Board |
| Objective 4.3 | Establish one full-time equivalent EMSC manager that is dedicated solely to the EMSC Program |
| Goal 5: Improve emergency preparedness and response for children involved in disasters | |
| Objective 5.1 | Review and disseminate guidelines on how to appropriately respond to children and their families before, during, and after a disaster at the national, State, and local levels |
| Objective 5.2 | Encourage States/Territories to incorporate pediatric disaster preparedness training into initial education, continuing education, credentialing, and certification programs for emergency medical service providers |
| Objective 5.3 | Increase the capacity for States/Territories to improve their level of pediatric expertise on Disaster Medical Assistance Teams and other organized disaster response teams |
| Objective 5.4 | Review and disseminate disaster plan strategies that address pediatric surge capacity before, during, and after a disaster for both injured and non-injured children at the national, State, and local levels |
| Goal 6: Improve State/Territory and national capacity and infrastructure to collect, analyze, and utilize pediatric emergency care data | |
| Objective 6.1 | Make funding available to improve State/Territory and national capacity and infrastructure to collect, analyze, and utilize pediatric emergency care data |
| Objective 6.2 | Provide States/Territories with technical assistance for data collection, analysis, and utilization |
| Objective 6.3 | Provide data management services, consultation, and support to the Research Node Centers of PECARN |
Goal 1: Improve the evidence base for pediatric emergency care through the development of a research infrastructure
Pediatric emergency care is still in its infancy. As such, the current evidence base is limited. Additional research in pediatric emergency care will improve the quality, organization, and delivery of care for children. In particular, the expansion of the evidence base for pediatric emergency care will increase the number of lives saved, help decrease morbidity, and help develop a more efficient and effective emergency care system. This goal is based in part on the Institute of Medicine’s Emergency Care for Children: Growing Pains report recommendation 7.1, which emphasizes the importance of building the evidence base for pediatric emergency care.
| Objective 1.1 | Review, update, and implement pediatric emergency care research priorities |
| Objective 1.2 | Develop and support a cadre of new prehospital pediatric emergency care research investigators |
| Objective 1.3 | Encourage the development of high-priority and rigorous prehospital-based pediatric emergency care research studies |
| Objective 1.4 | Make funding available for rigorous and definitive hospital-based pediatric emergency care research studies |
| Objective 1.5 | Disseminate pediatric emergency care research findings and results to health care leaders, policymakers (including Federal, State, and local), and practitioners in all settings |
| Objective 1.6 | Optimize the infrastructure for multi-institutional pediatric emergency care research |
| Objective 1.7 | Foster pediatric emergency care research collaboration among EMSC grantees, stakeholders, and Federal agencies |
| Objective 1.8 | Assist investigators with seeking funding outside of the EMSC Program |
Objective 1.1 focuses on reviewing, updating, and implementing pediatric emergency care research priorities. Given that the field of pediatric emergency care is constantly evolving and that research priorities change as new findings emerge, it will be important to reassess research priorities to ensure that they are representative of contemporary issues affecting pediatric emergency care. Revised and updated research priorities that are implemented will also help the EMSC Program focus its resources to most effectively improve the evidence base for pediatric emergency care.
Objective 1.2 focuses on developing and supporting a cadre of new prehospital pediatric emergency care research investigators. There is currently a paucity of prehospital research investigators, which makes it difficult to achieve Objective 1.3: Encourage the development of high-priority and rigorous prehospital-based pediatric emergency care research studies. The success of Objective 1.3 is dependent on the development of prehospital pediatric emergency care researchers. A cadre of new prehospital investigators will help to increase the number of prehospital research studies and, consequently, build the evidence base for pediatric emergency care.
Objective 1.3 targets prehospital-based pediatric emergency care research. Currently, the infrastructure and support available for prehospital pediatric emergency care research is limited. Therefore, an emphasis on prehospital research will ensure the development of an evidence base for pediatric emergency care research that spans across the continuum of care.
Objective 1.4 makes funding available for hospital-based pediatric emergency care research. The EMSC Program has been a leader in this area, and it is important to continue to support the infrastructure for hospital-based pediatric emergency care research, which will help build a more comprehensive evidence base for pediatric emergency care.
Objective 1.5 emphasizes the dissemination of pediatric emergency care research findings and results to health care leaders; Federal, State, and local policymakers; and practitioners in all settings. An increased awareness of pediatric emergency care research findings and results among these groups will help to expand and improve the evidence base for pediatric emergency care. Furthermore, information dissemination may help to bolster cross-collaboration in pediatric emergency care research among various stakeholders.
Objective 1.6 aims to optimize the infrastructure for multi-institutional pediatric emergency care research. The ability to conduct rigorous, high-priority pediatric emergency care research across institutions requires the most efficient and effective infrastructure. A robust infrastructure can help to promote multi-center studies, support research collaboration among EMSC investigators, and promote informational exchanges between EMSC investigators and providers.
Objective 1.7 emphasizes the importance of fostering pediatric emergency care research collaboration among EMSC grantees, stakeholders, and Federal agencies. Collaboration among these groups can help to ensure that pediatric emergency care research is conducted in the most efficient and productive manner.
Objective 1.8 focuses on assisting pediatric emergency care research investigators with seeking funding outside of the EMSC Program. Given that EMSC Program funds are limited, pediatric emergency care research investigators need to seek and secure additional external funding in order to advance the field of pediatric emergency care.
Goal 2: Ensure the operational capacity and infrastructure to provide pediatric emergency care
Gaps currently exist in the pediatric emergency care system. For example, while pediatric patient care protocols and equipment guidelines are available, standardized adoption and use of the guidelines among providers remains inconsistent. These gaps can result in poor pediatric outcomes (e.g., increased morbidity and mortality). In addition, pediatric care constitutes a small portion of the training and education requirements for many emergency providers, including but not limited to: emergency medical technicians (EMTs), nurses, emergency department physicians, and trauma surgeons. To make matters worse, many emergency care providers treat critically ill or injured pediatric patients on a limited basis, making it difficult to maintain their skill and comfort levels. Arming the emergency care workforce with the necessary knowledge and skills to appropriately treat children remains an important issue for the EMSC Program. This goal will ensure that providers across the prehospital and hospital settings are trained to deliver optimal pediatric emergency care based on a standardized set of guidelines, which will ultimately improve the quality of pediatric emergency care. This goal reflects State Partnership grantee performance measures #66 and #67.
| Objective 2.1 | Develop evidence- or consensus-based on-line and off-line pediatric medical direction for basic and advance life support providers |
| Objective 2.2 | Assess the availability of essential pediatric equipment and supplies for basic and advance life support ambulances |
| Objective 2.3 | Develop a statewide, territorial, or regional standardized system that recognizes hospitals that are able to stabilize and/or manage pediatric medical emergencies and trauma |
| Objective 2.4 | Develop written pediatric inter-facility transfer guidelines for hospitals |
| Objective 2.5 | Develop written pediatric inter-facility transfer agreements to facilitate timely movement of children to appropriate facilities |
| Objective 2.6 | Develop and adopt minimum requirements for pediatric emergency education as part of the recertification requirements of all emergency medical service providers |
| Objective 2.7 | Engage EMSC stakeholder organizations in developing strategies to assist States/Territories in improving the pediatric emergency care infrastructure |
Objective 2.1 focuses on the importance of the EMSC Program having on-line and off-line pediatric medical direction at the scene of an emergency for Basic Life Support (BLS) and Advance Life Support (ALS) providers. On-line and off-line pediatric medical direction is needed to assist and direct prehospital providers in the treatment and timely movement of children at the scene of an emergency. With real-time medical direction and established protocols, prehospital providers can respond to pediatric emergencies efficiently and effectively. Furthermore, off-line medical direction helps to standardize care across prehospital providers and assists in providing optimal care based on current pediatric clinical recommendations and guidelines. This objective will help to ensure that prehospital providers are adequately equipped to care for children in an emergency and, thereby, reduce the risk of pediatric morbidity and mortality.
Objective 2.2 targets the availability of essential pediatric equipment and supplies for BLS and ALS providers. Prehospital providers must have the appropriate pediatric equipment and supplies to care for ill and injured children in order to achieve optimal pediatric outcomes. Consequently, two national organizations (AAP and ACEP) have developed essential equipment and supply lists and guidelines for prehospital providers based on current evidence and expert opinion. This objective is an important indicator of prehospital provider preparedness to care for children.
Objective 2.3 emphasizes the importance of the existence of a statewide, territorial, or regional standardized system that recognizes hospitals that are able to stabilize and/or manage pediatric medical emergencies and trauma. A standardized categorization and/or designation process is necessary to assist hospitals in determining their capacity and readiness to effectively deliver pediatric emergency and specialty care. This objective will help ensure that mechanisms are in place so that pediatric patients receive emergency and trauma care only from those hospitals that have been appropriately categorized and/or designated as qualified to provide such care.
Objective 2.4 and Objective 2.5 focus on the importance of written pediatric inter-facility transfer guidelines and agreements. Timely access to pediatric specialty services in the acute stages of illness and/or injury is critical to reducing poor pediatric outcomes (e.g., morbidity and mortality). When a child’s needs are beyond those available at a receiving facility, inter-facility transfer guidelines and agreements help to ensure that children are transferred to facilities with the appropriate resources and competencies to effectively treat pediatric emergencies and to provide high-level and high-quality pediatric care.
Objective 2.6 highlights the value of developing and adopting minimum requirements for pediatric emergency education for the recertification of all emergency medical service providers. Minimum requirements help to ensure the provision of appropriate pediatric emergency care. This, as a result, helps to improve the quality and adequacy of pediatric emergency care, and thereby, improves pediatric outcomes (e.g., reduced morbidity and mortality).
Objective 2.7 seeks to engage EMSC stakeholder organizations in developing strategies to assist States/Territories in their improving pediatric emergency care infrastructure. Given the experience, knowledge, and expertise of these stakeholder organizations, they are a valuable resource that can provide input on how States/Territories can improve their pediatric emergency care infrastructure in at least one of the following areas: on-line and off-line pediatric medical direction; essential pediatric equipment and supplies; pediatric medical/trauma facility recognition program; pediatric inter-facility transfer guidelines and agreements; minimum requirements for pediatric emergency education for the recertification of all emergency medical service providers; minimum pediatric emergency care training requirements for hospital staff (including physicians and nurses); and/or communicating the importance of pediatric emergency coordinators in EMS agencies and hospitals.
Goal 3: Identify and disseminate strategies to improve the quality of pediatric emergency care
As EMS agencies and hospitals improve the infrastructure to support pediatric patients, it will be equally important to improve the quality of emergency care services for children. Active steps to improve the quality of pediatric emergency care will help reduce the burden of pediatric morbidity and mortality. This goal is based in part on the Institute of Medicine’s Emergency Care for Children: Growing Pains report recommendations 5.1, 5.2, 5.3, 5.4, and 5.5.
| Objective 3.1 | Assess current resources for pediatric patient care quality |
| Objective 3.2 | Disseminate currently available resources and/or implementation strategies on pediatric patient care quality to EMSC grantees and other relevant stakeholders |
| Objective 3.3 | Make funding available to develop the infrastructure for studying pediatric patient care quality |
Objective 3.1 assesses current resources for pediatric patient care quality in at least one of the following areas: reducing errors for children, family-centered care, treating children and youth with special health care needs, working effectively across cultures, language access, and/or health literacy. Many organizations have already developed resources including policies, procedures, and guidelines for these patient quality issues. Therefore, it is important for the EMSC Program to review and assess these resources for its grantees.
The six areas of pediatric patient care quality listed above are equally important.
Reducing errors for children: The risk for error in the emergency care setting is high due to crowding and limited personnel and equipment. Thus, the Institute of Medicine’s Emergency Care for Children: Growing Pains report suggests using provider policies, training initiatives, and technology to achieve error reduction and improve the quality of pediatric emergency care.
Family-centered care: Family-centered care encourages providers to involve parents and families in the care and treatment of their children by listening to and honoring family perspectives and decisions and by incorporating family knowledge, values, beliefs, and cultural backgrounds into the care for the child. Involving families and keeping them informed about their child’s condition, prognosis, and treatment can result in improved outcomes and satisfaction for families, patients, and health care providers.
Treating children and youth with special health care needs: Currently, research and knowledge is limited on how to most effectively treat children and youth with special health care needs in the prehospital, emergency department, and hospital settings. Special focus on this important population will help improve the quality of pediatric emergency care for all pediatric patients.
Working effectively across cultures: The ability to work effectively across cultures complements efforts to integrate family-centered-care in the prehospital, emergency department, and hospital settings. Cultural understanding, sensitivity, and respect in the planning and delivery of care can lead to improved patient outcomes and satisfaction.
Language access: Language access services, such as oral interpretation and written translation, are an important factor in assuring patient quality for persons with limited English proficiency.
Health literacy: Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. The lack of health literacy can compromise patient quality.
Objective 3.2 emphasizes the importance of disseminating to EMSC grantees and other relevant stakeholders currently available resources and/or implementation strategies on pediatric patient care quality in at least one of the following areas: reducing errors for children, family-centered care, treating children and youth with special health care needs, working effectively across cultures, language access, and/or health literacy. Dissemination of this information will help EMSC grantees and other relevant stakeholders to be more knowledgeable about pediatric patient care quality issues and how to implement strategies to ensure pediatric patient care quality.
Objective 3.3 targets making funding available to develop the infrastructure for studying pediatric patient care quality in at least one of the following areas: reducing errors for children, family-centered care, treating children and youth with special health care needs, working effectively across cultures, language access, and/or health literacy. Although the EMSC Program is not a research program, funds can be used to support the infrastructure for studies on pediatric patient care quality.
Goal 4: Establish permanence of EMSC in each State/Territory EMS system
Establishing permanence of EMSC in the State/Territory EMS system is important for building the infrastructure of the EMSC Program and is fundamental to its success. For the EMSC Program to be sustained in the long-term and reach permanence, it is important that States/Territories establish an EMSC Advisory Committee to ensure that the priorities of the EMSC Program are addressed. It is also important that a full-time equivalent be allocated for an EMSC manager who is dedicated solely to the EMSC Program. Moreover, by ensuring pediatric representation on the State/Territory EMS Board, pediatric issues will more likely be addressed. This goal reflects State Partnership grantee performance measure #68.
| Objective 4.1 | Establish an EMSC Advisory Committee within each State/Territory |
| Objective 4.2 | Incorporate pediatric representation on the State/Territory EMS Board |
| Objective 4.3 | Establish one full-time equivalent EMSC manager that is dedicated solely to the EMSC Program |
Objective 4.1 focuses on establishing an EMSC Advisory Committee within each State/Territory. For the EMSC Program to be sustained in the long-term and reach permanence, it is important to establish an EMSC Advisory Committee within each State/Territory. An EMSC Advisory Committee would ensure that the priorities of the EMSC Program are addressed and that EMSC Program goals are realized. Family participation on an EMSC Advisory Committee would also help to ensure that family issues are not overlooked.
Objective 4.2 aims to incorporate pediatric representation on the State/Territory EMS Board. For the EMSC Program to be sustained in the long-term and reach permanence, it is important to incorporate pediatric representation on the State/Territory EMS Board. By doing so, pediatric issues will more likely be addressed in EMS agendas, goals, practices, and policies.
Objective 4.3 emphasizes the establishment of one full-time equivalent (FTE) EMSC manager that is dedicated solely to the EMSC Program. The EMSC manager is an integral staff member of the EMSC Program, who is responsible for managing and coordinating the activities of the program. One FTE that is dedicated solely to the EMSC Program is an indication that the EMSC Program is achieving permanence in the State/Territory EMS system.
Goal 5: Improve emergency preparedness and response for children involved in disasters
Traditionally, children have not been included in disaster planning efforts. Evidence demonstrates that the current emergency care system is unprepared to address pediatric emergency care before, during, and after disasters. Multiple deficiencies have been identified during normal conditions such as the lack of pediatric-appropriate equipment and medication. Furthermore, a lack of pediatric training makes the proper provision of care even more challenging during a disaster. This goal is based in large part on the Institute of Medicine’s Emergency Care for Children: Growing Pains report recommendation 6.1, which highlights the importance of improving the emergency preparedness and response for children involved in disasters. The EMSC Program funding is too limited to support large scale disaster planning activities. Therefore, these objectives focus on collaborations and partnerships that the Program can support or activities that the Program can supplement.
| Objective 5.1 | Review and disseminate guidelines on how to appropriately respond to children and their families before, during, and after a disaster at the national, State, and local levels |
| Objective 5.2 | Encourage States/Territories to incorporate pediatric disaster preparedness training into initial education, continuing education, credentialing, and certification programs for emergency medical service providers |
| Objective 5.3 | Increase the capacity for States/Territories to improve their level of pediatric expertise on Disaster Medical Assistance Teams and other organized disaster response teams |
| Objective 5.4 | Review and disseminate disaster plan strategies that address pediatric surge capacity before, during, and after a disaster for both injured and non-injured children at the national, State, and local levels |
Objective 5.1 focuses on reviewing and disseminating guidelines on how to appropriately respond to children and their families before, during, and after a disaster at the national, State, and local levels. A review and dissemination of these guidelines will help standardize pediatric disaster care and ensure that children and their families receive optimal care before, during, and after a disaster.
Objective 5.2 highlights the importance of encouraging States/Territories to incorporate pediatric disaster preparedness training into initial education, continuing education, credentialing, and certification programs for emergency medical service providers. Given that children have unique needs, the inclusion of a pediatric component in disaster preparedness training will ensure that emergency medical service providers know how to appropriately and adequately respond to, treat, and care for children in the event of a disaster.
Objective 5.3 aims to increase the capacity for States/Territories to improve the level of pediatric expertise on Disaster Medical Assistance Teams (DMAT) and other organized disaster response teams. Currently, few DMAT teams have members that are trained and experienced in caring for and treating pediatric patients. By enhancing the level of pediatric expertise on disaster response teams, the quality and efficiency of pediatric emergency care during a disaster can be improved.
Objective 5.4 focuses on reviewing and disseminating disaster plan strategies that address pediatric surge capacity before, during, and after a disaster for both injured and non-injured children at the national, State, and local levels. Having adequate capacity (e.g., number of beds available, number of pediatric specialists and providers, and availability of equipment) to handle pediatric patient volume before, during, and after a disaster is vital to the success of a comprehensive disaster preparedness plan.
Goal 6: Improve State/Territory and national capacity and infrastructure to collect, analyze, and utilize pediatric emergency care data
The development of an effective emergency medical service system requires the ability to collect, analyze, and utilize emergency data in order to identify care deficiencies and effectively plan system improvements. Furthermore, emergency care information and data systems are an important component for building the evidence base for pediatric emergency care. The ability of States/Territories to collect, analyze, and utilize pediatric emergency care data will help to improve the pediatric emergency care system. This goal is based in part on the Institute of Medicine’s Emergency Care for Children: Growing Pains report recommendation 7.2, which stresses the importance of standard pediatric-specific data elements for statewide and national trauma registries.
| Objective 6.1 | Make funding available to improve State/Territory and national capacity and infrastructure to collect, analyze, and utilize pediatric emergency care data |
| Objective 6.2 | Provide States/Territories with technical assistance for data collection, analysis, and utilization |
| Objective 6.3 | Provide data management services, consultation, and support to the Research Node Centers of PECARN |
Objective 6.1 makes funding available to improve State/Territory and national capacity and infrastructure to collect, analyze, and utilize pediatric emergency care data. Data collection, analysis, and utilization are necessary for States/Territories to make informed decisions that objectively guide EMS and EMSC practice and promote enhanced patient outcomes. In addition, data collection, analytic capacity, and utilization help to build the evidence base for pediatric emergency care.
Objective 6.2 provides States/Territories with technical assistance for data collection, analysis, and utilization. Creating an effective emergency medical services information system requires considerable planning, knowledge, and research. Data collection, analysis, and utilization are complex processes, and there are no simple “recipes for success.” Therefore, States/Territories require assistance to guide and optimize their data collection, analysis, and utilization efforts.
Objective 6.3 provides data management services, consultation, and support to the Research Node Centers of PECARN. Currently, CDMCC of PECARN provides a central repository for data generated by each of the PECARN Research Nodes and their hospital affiliates. The CDMCC also works with each Research Node Center’s principal investigators to implement PECARN-wide standards for data collection and analysis in order to ensure uniformity and quality of the data and to monitor the safety and timely progress of PECARN studies.
In 2003, the NRC formed the EMSC Partnership for Children (PFC) Stakeholder Group. The stakeholder group is composed of representatives from three U.S. government agencies (the National Highway Traffic Safety Administration’s Office of Emergency Medical Services, the Indian Health Service, and the Agency for Healthcare Research and Quality), six EMSC grantees, and the following 21 national organizations:
The purpose of the PFC Stakeholder Group is to improve the emergency medical care of children through the exchange of knowledge, development of partnerships, and provision of input and counsel to the EMSC Program.