• Home
• Program Activities
• State Activities
• Funding Opportunities
• Legislation
• Performance Measures
• Research
  • Research
  • Federal Resources
  • Database Resources
• For Families
• EMSC Products & Resources
• Grant Management
• ToolBox
• Resource Centers

Emergency Medical Services for Children Program Highlights
Fiscal Year 2002

When a child or adolescent is seriously ill or injured, an effective and timely response by emergency medical services is critical. The positive impact of providing appropriate pediatric emergency care reaches children, their families and communities, states, and the entire nation. The Emergency Medical Services for Children (EMSC) Program continues to dedicate its resources and energies to ensuring that all children, in all communities, receive appropriate care when faced with medical emergencies.

The last year has been a challenging time for the United States. The tragic events of September 11, 2001 resulted in an increased national awareness of the need to have an emergency response system that is fully prepared for small, large, and catastrophic emergencies. The emerging threat of biological, chemical and nuclear terrorism has lead to an urgent need to improve disaster preparedness by medical centers, public health systems, and emergency medical services. In addition to ensuring that all pediatric emergencies are appropriately addressed, the EMSC Program is working collaboratively with all national initiatives aimed at improving disaster preparedness and making sure the unique needs of children are included in disaster plans.

The following report highlights many of the significant accomplishments of the EMSC Program during fiscal year 2002. Due to the large number of excellent programs conducted by EMSC grantees and national partners, this report should be considered an overview rather than a comprehensive listing of EMSC initiatives and accomplishments.

EMSC GRANT ACTIVITIES

Program Development and Technical Assistance

Program development and provision of technical assistance to grantees are the keystones of the relationship between EMSC and its grantees. This year has witnessed unprecedented levels of support provided to the grantees. Forty-three EMSC grantees will compete for new partnership grant funds in Fiscal Year 2003. The EMSC Program, based on feedback generated from current grantees, developed a new guidance that focuses applicants on developing core tenants of the EMSC Program within their proposed projects.

In Fiscal Year 2002, one new development (formerly implementation) grant was awarded to American Samoa. Six new partnership grants were awarded (Idaho, Louisiana, Commonwealth of the Northern Mariana Islands, Michigan, Mississippi, and Pennsylvania. Sixty-four EMSC grantees received continuation funding for current projects (48 partnership, 10 targeted issue, 2 enhancing pediatric patient safety, and 4 network development demonstration projects). Six new targeted issue grants were awarded to Connecticut Children's Medical Center (Model Training for Safe Transportation of Children with Special Health Care Needs); University of Iowa (Beyond the Barriers: Project EQUIP); Michigan State University (Pediatric Continuous Quality Improvement Model Project); New York University, Harlem Hospital (Model Pediatric Component for State Disaster Plans); University of Pennsylvania, School of Medicine (Screening and Secondary Prevention for Psychological Sequelae of Pediatric Injury); Wisconsin Department of Health and Human Services (Basic Emergency Lifesaving Skills in Schools - A Model for Replication in WI, MN, ND, and SD).

Grantee Assessment

The National EMSC Data Analysis Resource Center (NEDARC) has analyzed and created the 2001 National EMSC Grantee Assessment and a report on current usage of the NHTSA Pre-hospital Dataset. The Grantee Assessment was issued to all grantees in 2001 in an attempt to determine the status and progress of the EMSC Program nationally in specific areas. This assessment will be completed annually to further track program progress with the objectives of the EMSC 5-Year Plan.

In addition, NEDARC gathered data dictionaries from 43 state EMS offices (all that had dictionaries to send) to determine how frequently each of the 81 data elements in the NHTSA Uniform Pre-hospital Dataset is being used. This analysis serves as an important basis for efforts to revise the existing data set and in determining what elements ought to be present in a national EMS database.

Spotlight on Completed EMSC Targeted Issue Projects

Outcomes Based Office Practice Emergency Self Assessment Tool (University of Texas Southwestern Medical Center at Dallas), Patricia A. Primm, MD. The purpose of the project is to improve the preparedness for emergency response to children in the office setting. The first goal is to establish and confirm the current status of preparedness for pediatric emergencies in physicians' offices. The second goal is to produce a tool for office preparedness for emergency response to children. The project produced a survey of over 2,000 physicians in a five-state area who treat children regarding their office preparedness to manage emergencies. Office PERC (Preparedness for Emergency Response to Children) CD-ROM was produced containing tools to prepare the physician's office to respond to pediatric emergencies. The CD-ROM is available through the EMSC Clearinghouse. The target audience for this CD-ROM is pediatric and family physicians in office practice, physician extenders such a physician assistants and nurse practitioners, office nurses, and office staff (including receptionists).

New York City EMSC - Pediatric Teaching Resource (New York University School of Medicine), George L. Foltin, MD. The Center for Pediatric Emergency Medicine (CPEM) has developed the Paramedic TRIPP (Teaching Resource for Instructors in Prehospital Pediatrics), a comprehensive teaching resource that will enable instructors in the United States to teach the pediatric portions of the newly revised Paramedic National Standard Curriculum. In addition, CPEM developed a national distribution and communication network centered around its web site (www.cpem.org not a U.S. Government Web site) that helps paramedic instructors keep their knowledge of pediatric patient care up to date. The major system change that has resulted from this project has been the adoption of both versions of the TRIPP by many State departments of health as part of their curriculum and continuing education efforts in prehospital pediatrics. The primary product resulting from this grant was the Paramedic TRIPP (Teaching Resource for Instructors in Prehospital Pediatrics), a publication that has been released in CD-ROM format and is available for downloading from the CPEM web site. In addition to paramedic instructors, the Paramedic TRIPP can be used by any professional or paraprofessional who delivers emergency care to children in any capacity.

Special Grant Initiatives

Enhancing Pediatric Patient Safety and EMSC -- With the Institute of Medicine Report, To Err is Human (1999), raising awareness and data, and recognizing that error rates in children and emergency medicine are particularly high, the EMSC Program established funding for initiatives to improve pediatric patient safety. In early 2001 a stakeholders group was gathered to determine priorities in enhancement of Pediatric patient safety. In early fall, two specialty grants focusing upon the unique needs of the pediatric patient and safety enhancements were awarded.

One of these awards went to Duke University, with Dr. Karen Frush being the primary investigator. Dr. Frush is in the process of developing an E-Learning Program for use of the Broselow-Luten Pediatric System. Dr. Frush's overall project goal is to develop and evaluate an educational course focusing upon use of the Broselow - Luten Pediatric Program and training program for emergency providers. The second successful grantee was Breck Rushton from the Utah Department of Health. The intent of his project is to look at the impact of education and use of a color coded pediatric system in reducing medical errors in emergency situations. Utilizing a research design, this project will track medical errors in three separate groups of twelve hospitals via case control studies.

Enhancing Pediatric Emergency Care Through the Use of Evidenced Based Clinical Guidelines -- The Institute of Medicine Report, Crossing the Quality Chasm, released in 2001, once again provided momentum for another specialty EMSC initiative. Clinical Practice Guidelines provide a means for delivering medical care that is based on both existing evidence and expert consensus. During the summer of 2001 a multidisciplinary group of stakeholders was convened to discuss the concept of Evidence - Based Clinical Guidelines in pediatric emergency care. As a result of this meeting, two special funding opportunities were announced in the fall of 2001. Early in 2002 two awards were announced. The first went to Washington University, School of Medicine in St. Louis. Dr. Dee Hodge, the primary investigator, is conducting a study focusing upon re-hydration of children with moderate dehydration due to acute gastroenteritis. Dr. Hodge plans to modify a guideline developed by the American Academy of Pediatrics for oral rehydration of children with moderate dehydration to include rapid IV hydration for treatment. A second award was granted to Dr. Daniel Isaacman of Eastern Virginia Medical School. Dr. Isaacman and his staff plan to implement and evaluate the use of the National Heart, Lung and Blood (NHLBI) pediatric asthma guideline in 5 adult emergency rooms in both urban and rural settings and evaluate patient outcomes.

Enhancing the Care of Injured Children thru Research and Studies Based on Data -- National Trauma Registry for Injured Children

Trauma continues to be the number one cause of pediatric death in the United States. Clinical management of pediatric injuries may differ significantly from optimal management of adult trauma victims. In the spring of 2002, HRSA directed the EMSC Program to provide funds for the planning of an initiative to 1.) Determine a process for the collection of a uniform set of data regarding pediatric trauma and injury care, and 2.) Design a strategy for data dissemination for quality measurement, research purposes and injury prevention planning. In April of this year a request for proposals was issued that allowed applicants to pursue a Registry Design and Technology Planning Grant or a Data Identification, Collection and Use Planning Grant. One award was available in each category. The Registry Design and Technology Planning Grant was awarded to the University of Pittsburg and the Data Identification, Collection and Use Planning Grant was awarded to the University of Wisconsin. Both of these grantees will be working together to develop a process for data identification and submission to a national registry designed specifically for the injured child.

Continued Support for Family-Centered Care:

The EMSC Program continues to focus attention on the importance of family-centered care. Family Advocacy Network (FAN) members and EMSC Program representatives continue to participate and speak at national and regional meetings to increase the awareness and importance of family involvement in the emergency care of injured children. FAN members attended the 3^rd National Congress on Childhood Emergencies where the Guidebooks for EMSC Project Coordinators and EMSC Family Advocates were distributed for final comment. FAN Mail, the quarterly newsletter, was sent to FAN members to provide additional insights on their various roles and responsibilities.

EMSC Regional Symposia:

FY 02 saw the inception of a new mechanism for EMSC regional activities to move forward. The EMSC Program provided support for seven regional symposia designed to provide a forum for the exchange and dissemination of knowledge in the field of pediatric emergency care. These regional symposia focus on the demonstrated need for the knowledge within the geographic region or regions to be served by the symposium and promoted interstate collaboration on EMSC issues. While these conferences drew from regional audiences, participants from other regions across the country attended as well.

• Southcentral EMSC Region
  Member States: Texas, Louisiana, Oklahoma, Arkansas
  Meeting Dates: August 8-9, 2002 in San Antonio, TX
  Topic: EMS and Emergency Department protocols and guidelines for pediatric patients, EMSC data collection, system design and analysis, family centered care and integration of EMSC into EMS.

• Intermountain Regional EMSC Coordinating Council (IRECC)
  Member States: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming
  Meeting Dates: September 11-14, 2002 in Park City, UT
  Topic: Information Sharing on topics such as suicide and injury prevention, data systems, technology-driven systems and training/ education.

• Heartland EMS for Children Coalition (HECC)
  Member states: Iowa, Kansas, Minnesota, Nebraska, North Dakota, South Dakota
  Meeting date: September 12-14, 2002 in Minneapolis, MN
  Topic: Trauma/EMS, injury prevention, poison control centers, grant writing, rural health, systems development, Basic Emergency Lifesaving Skills (BELS), and family-centered care.

• Southeast EMSC Regional Council (SERC)
  Member states: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Puerto Rico
  Meeting date: September 16-18, 2002 in Orlando, FL
  Topic: Mass casualty planning, communication during a disaster, trauma system assessment, and addressing pediatric issues in state disaster plans.

• Mid-Atlantic Regional EMSC
  Member States: Maryland, District of Columbia, Virginia, West Virginia, New Jersey, New York, Delaware, Pennsylvania
  Meeting Dates: October 10-11, 2002 in Columbia, MD
  Topic: Data and research, injury prevention and control, clinical models of excellence in the emergency care of children and systems, and policy development.

• New England EMSC Region
  Member states: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont
  Meeting Date: January 4-5, 2003 in Ascutney Mountain Resort, Vermont
  Tentative Topic: Regional Informational Sharing

• Center of America Regional EMSC (CARE)
  Member States: Illinois, Indiana, Michigan, Missouri, Ohio, Wisconsin
  Meeting Dates: January 23-24, 2003 in Indianapolis, IN
  Tentative Topic: Information sharing and exchange

THE RIGHT CARE WHEN IT COUNTS IS FOCUS OF NATIONAL CHILD HEALTH DAY

This year, the Department of Health and Human Services and its Health Services and Resources Administration adopted the EMSC theme, The Right Care When It Counts, as the theme of its annual observance of Child Health Month (October 2002). The centerpiece of this year's celebration is the EMSC national Public Information and Education (PIE) campaign, a three-year initiative designed to (a) help prepare caregivers for addressing the distinctive needs of children in medical emergencies; and (b) raise awareness among parents about the critical need to work closely with their healthcare providers to better prepare for a pediatric medical emergency.

National Child Health Day has been celebrated each year since 1928, when, under a Joint Resolution of the Congress, the President of the United States proclaimed National Child Health Day the first Monday of October. President Calvin Coolidge issued the first proclamation. The goals and messages of this year's Child Health Day observance include:

Goals:

• Increase parent and caregiver preparedness for pediatric medical emergencies.

• Increase the visibility of HRSA/MCHB's Emergency Medical Services for Children (EMSC) program across the United States and its jurisdictions.

• Increase parent and caregiver knowledge of pediatric injury prevention.

• Increase parent and caregiver knowledge of post-traumatic stress disorders.

Messages:

• Each year, 30 million children need emergency care due to acute illness and injury. No matter how hard parents try to protect their children, emergencies happen.

• Parents have a responsibility to their children to know how to handle an emergency and to be a partner in getting the right care when it counts.

• Our emergency preparedness system has the responsibility to provide top-of-the-line emergency care for children throughout the continuum of care. It is working system-wide to meet and exceed standards of care.

• Having a preparedness plan in place to handle a pediatric medical emergency provides a sense of control during an uncertain and frightening time… be prepared not scared.

DHHS, through HRSA and the EMSC Program, will roll out the key messages of the PIE campaign during a special launch event on October 7. A major part of that activity will include the national distribution of television, radio, and print Public Service Announcements, the release of a national video news release (VNR), a national Child Health Day poster, and an E-Kit of collateral and support materials downloadable from the HRSA and EMSC websites. The E-Kit will include Child Health Day activity books, factsheets on pediatric emergency preparedness, a series of EMSC reference materials on injury prevention, post-traumatic stress disorder, children in disasters, and handy tips for parents who want to be equipped to handle a pediatric medical emergency.

Parental preparedness is the major focus of the national Child Health Day observance. Through this initiative, the DHHS encourages parents to work closely with their family and community healthcare providers to develop family plans to help their children when a medical emergency happens. They will be encouraged to develop plans that could be made available in the various environments where their children spend significant time: school, home, with relatives, and in automobiles.

The PIE campaign has made significant progress during the past three years in preparation for this national launch.

• During fall 2000, the EMSC Program collaborated with the American College of Emergency Physicians (ACEP) and more than 19 government, national, and professional organizations, to create a comprehensive, state-of-the-art Pediatric Resource Toolkit for professionals. The toolkit, in CD-ROM format and downloadable from the EMSC website, was designed to help ensure medical professionals have the resources they need to provide the most current pediatric emergency care possible. It also provided the tools that professionals need to evaluate and bring organizations, communities, and states into compliance with accepted standards for pediatric emergency care.

• The campaign began the research phase of its outreach in February 2001 with a series of 12 one-hour focus groups that would drive all subsequent materials development. The focus groups research was conducted to assess the levels of awareness and preparedness among parents regarding pediatric emergencies. The focus groups -- eight general markets and four Hispanic markets -- were conducted in six U.S. cities: New York City, Chicago, Jackson (rural), Seattle, Minneapolis, and Tampa.

• In collaboration with Equals Three, a series of mall intercepts were conducted to determine how effectively the focus group research was executed in the concepts. The mall intercepts were conducted in Philadelphia (PA), Wichita (KS), Redondo Beach (CA), and Cleveland (OH), with participants reflecting the demographics of the focus groups. Responses from these participants have been integrated into the final communications tools, which will now be rolled out as part of the national Child Health Day observance.

Following the national observance in October, the EMSC Program will be working closely with its grantees and other stakeholders over the upcoming year to raise awareness of pediatric emergency medical preparedness throughout their communities.

EMSC PROGRAM CELEBRATES NATIONAL EMS WEEK

The EMSC Program again enthusiastically joined the American College of Emergency Physicians (ACEP), a wide range of other national organizations, and emergency medical professionals across the nation to recognize the heroic work of first responders during the crisis of September 11, 2001. The recognition came as part of the national observance of Emergency Medical Services Week (May 19-25) and Emergency Medical Services for Children Day (May 22). This year's theme, Help is Just a Heartbeat Away, took on a special significance considering the disastrous events 2001.

By designating a specific day within the EMS celebration, the emergency medical services community provided resources to organizations to heighten awareness of EMSC initiatives and to draw national attention to the essential need for specialized emergency care for children.

EMSC worked closely with ACEP to develop and distribute its EMS Week planning guide that contained ideas for special events and activities, ad slicks, and fact sheets that were useful as organizations planned EMS-related activities and events in their communities. The information was used to educate staff and volunteers, parents and caregivers, healthcare providers, and other community members about how to best prepare for a pediatric emergency.

EMSC developed a two-page fact sheet for the ACEP toolkit and a four-page planning guide and an EMSC Day proclamation template that were downloadable from the EMSC website, www.ems-c.org.

The EMSC Program also partnered with District of Columbia Fire and EMS Department to host an EMSC Day exhibit at Children's National Medical Center. The exhibit also featured the Hospital's Special Children's Outreach & Prehospital Education (SCOPE) Program, the EMSC Product of the Year.

EMSC AND HEALTHY PEOPLE 2010

The EMSC Program continues to be very involved with activities designed to achieve the goals of Healthy People 2010. The Program participated in roundtable discussions and provided speakers for the Healthy People 2010 Consortium meeting held in Atlanta, Georgia on October 19, 2001. The Consortium consists of more than 400 national membership organizations, all State and Territorial health departments, and key national associations of State health officials working to advance health. Additionally, the EMSC Program hosted the EMS Healthy People 2010 Progress Review and Companion Document meeting on March 12, 2002. More than 30 participants convened in Silver Spring, Maryland to review the progress of the EMS Healthy People 2010 objectives, examine data sources for measuring the objectives, determine strategies for including EMS objectives in a state's public health agenda, and develop recommendations for an EMS Companion document. The companion document is a guide that will include action steps and recommendations for local involvement in improving the EMS system. The Program also participated in numerous steering committee meetings and the "Access to Quality Health Services Progress Review" conducted by the Assistant Secretary for Health, Eve Slater, MD on June 4, 2002 in Washington, DC. The progress review provided an opportunity to discuss challenges and strategies for success.

SPECIAL MEETINGS AND CONFERENCES

3^rd National Congress on Childhood Emergencies

The EMSC Program convened the 3rd National Congress on Childhood Emergencies, Taking Action, Saving Lives, on April 15-17, 2002 at the Adams Mark Hotel in Dallas, Texas. Nearly 800 participants attended the conference to learn about emerging issues for pediatric emergency medical services, best practices for enhancing pediatric patient safety, research results for priority pediatric emergency medical issues and methods for enhancing medical center and EMS systems preparedness for bioterrorism events and mass casualty disasters. The 3rd National Congress included four preconference workshops, over 60 educational sessions, two poster sessions, a networking luncheon, special committee meetings, and the EMSC Expo comprised of 59 exhibitors. Topics covered at the conference included pediatric asthma care, emergency department overcrowding and diversions, border health, prehospital family care, evaluating EMS education, data linkage, youth suicide, and pediatric trauma triage. Highlights of the 3rd National Congress included the opening keynote address on patient safety by John Nance, ABC News Airline Safety Consultant, the EMS Data Collection Systems Showcase, and the closing session on improving emergency medical services for mass casualty disasters.

2002 Annual EMSC Grantee Meeting

On Sunday, April 14, over 200 EMSC grantees attended the Annual EMSC Grantee Meeting prior to the 3rd National Congress on Childhood Emergencies. The meeting provided an opportunity for grantees to hear from Cindy Doyle, RN, and Dan Kavanaugh, MSW about important EMSC Program updates. The meeting also included presentations from the EMSC National Resource Center and the National EMSC Data Analysis Resource Center. Other meeting highlights included presentations on the EMSC Network Development Demonstration Project (NDDP), the new federal Trauma-EMS Program, and a special recognition to Guam, American Samoa, and the Commonwealth of Northern Mariana Islands for their successful collaboration with EMSC site visits teams. Grantees also enjoyed a networking reception on Sunday evening and met as regional groups early Monday morning before the opening session of the 3rd National Congress.

Pediatric Emergencies in Disasters

On January 31, 2002, the EMSC Program co-sponsored Pediatric Disasters, a preconference workshop to the 23rd Annual International Disaster Management Conference (IDMC), at the Rosen Plaza Hotel in Orlando, FL. More than 45 participants attended the conference to learn about the unique needs of children who are involved in natural or intentional disasters. The workshop include presentations by Dan Kavanaugh, MSW, project officer for MCHB and Phyllis Stenklyft, MD, principal investigator for the Florida EMSC project, who opened the workshop and provided an overview of the Program's most recent EMSC disaster-related initiatives. Tom Lawrence, NREMT-P, EMSC project coordinator for Rhode Island and deputy team leader for the Rhode Island Disaster Medical Assistance Team (DMAT), provided a summary of the new Rhode Island Disaster Initiative, a well-funded state initiative to improve overall state disaster preparedness. Lou Romig, MD, medical director for the South Florida Regional DMAT, presented on pediatric issues in terrorism and also provided information on the JumpStart triage tool. Connie Wells, Executive Director for the Florida Institute for Family Involvement provided valuable information integrating families into disaster planning. Betsy Smith, RN, NREMPT based at Children's National Medical Center (CNMC) presented on the EMS outreach program for children with special health care needs (CSHCN). The workshop also included a presentation by Cheryl Gurley, LCMH, NCC, from the Devereux Mental Health Services for Children in Orlando, FL. Gurley discussed the impact disasters have on a child's mental health and the common signs and symptoms associated with development of mental health issues in children.

EMSC Evaluation Framework Meeting

On November 29-30, 2002, a meeting of EMS system experts and EMSC grantees was conducted to begin exploring the potential for development of an EMSC Evaluation Framework. The framework was envisioned as a self-evaluation tool that EMSC grantees can use to identify the status of pediatric integration into a state's EMS system. The tool may also guide grantees in the identification of priorities for system development for future grant initiatives. The meeting participants recommended the development of a tool that integrated descriptors of a mature EMS system for each EMS system component. Stages of pediatric integration for each component could then potentially be described, enabling grantees to assess the evolution of pediatric integration into their state's EMS system. Recommendations from meeting participants were carefully considered and options for an evaluation framework were explored. Further development of an evaluation framework will continue in the next fiscal year.

Data Workshops

In the effort to broaden understanding of the importance of data collection, the EMSC Program through NEDARC continues to conduct workshops for EMSC grantees and the EMS community that focus on using data to drive quality improvement processes. This past year, workshops were conducted in Portland, Oregon; Providence, Rhode Island; and San Diego, California. These workshops guided attendees through the quality improvement process, from problem identification and research design to data analysis and presentation of data. A three-day scientific grant writing workshop was conducted in Salt Lake City, Utah to help grantees and EMS researchers become more familiar with the grant writing process and receive feedback on their grant proposals. The EMSC Program hopes to enhance the future research capabilities within the EMSC community.

EMSC RESEARCH INITIATIVES

NDDP/PECARN Update

The EMSC Network Development Demonstration Projects (NDDP) were awarded in the fall of 2001. In creating the Pediatric Emergency Care Applied Research Network (PECARN), the EMSC Program has realized its goal of creating a network to conduct high priority multi-institutional research into the prevention and management of acute illnesses and injuries in children and youth of all ages, across the continuum of emergency medical health care delivery. This network now provides the leadership and infrastructure needed to promote multi-center studies, support research collaboration among EMSC investigators, and encourage informational exchanges between EMSC investigators and providers.

The four Regional Nodes in this network met as the PECARN Steering Committee and Subcommittee meetings in Washington, DC, in January 2002 in Dallas, Texas in April 2002. These meetings resulted in the election of temporary officers, discussion of the network draft bylaws, workflow and organization, and selection of a mission statement, along with the appointment of subcommittee members and chairpersons and the election of permanent officers. A few months after this meeting, the four NDDP PIs attended an Interagency Committee on EMSC Research meeting to promote recognition of PECARN as a new national resource for pediatric emergency research and to generate interest in supporting network research.

Further progress made includes several proposals in the pipeline for funding submission, consideration of new pre-proposals that address bio-terrorism and other topics, establishment of network-wide workgroups on pediatric mental health issues, emergency department epidemiology, head trauma, and abdominal trauma.

Central Data Management Coordinating Center (CDMCC)

In August 2002 HRSA awarded the University of Utah a three year cooperative agreement to serve as the Central Data Management Coordinating Center for the PECARN Network. The Principal Investigator of the CDMCC, J. Michael Dean, MD, MBA will also serve on the PECARN Steering Committee and Subcommittees, along with several of his senior staff. In this way, the CDMCC will assist the network in carrying out its mission of producing excellent and useful research, while maintaining patient protections and adhering to federal regulations regarding research with human participants.

Interagency Committee on EMSC Research (ICER) Meetings

A milestone was achieved last January 2001 with the release of the EMSC research announcement PA-01-044 in the NIH Guide to Grants and Contracts. The EMSC Program guided eight federal agencies from its Interagency Committee on EMSC Research (ICER). The eight are: Human Resources and Services Administration as the lead agency; Agency for Healthcare Research and Quality (AHRQ), The Center for Disease Control and Prevention's National Institute for Occupational Safety and Health (CDC/NIOSH); the National Heart, Lung and Blood Institute (NHLBI), National Institute for Child Health and Human Development (NICHD), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH) and National Institute for Nursing Research (NINR). ICER continued to meet this fiscal year. The next step is to work toward an extension of this historic interagency achievement, which currently expires in 2004, and to craft a joint request for proposals (RFP) in the area of EMSC research, which would ensure dedicated funding from each participating agency.

National EMS Research Agenda Update

Data Collection -- National EMS Information Systems (NEMSIS)

The National Association of State EMS Directors (NAEMSD) is supported by a joint endeavor of NHTSA and the EMSC Program to study the feasibility of a national EMS database to collect prehospital data to measure outcomes and improve care for both children and adults in the emergency setting. This project proposes steps essential to the establishment of a National EMS Information System. The project has four major objectives:

• Revision of the current NHTSA Uniform Prehospital Data Set to better document and capture important aspects of patient care;
• Development of a plan for data collection and transmission from local, state and national systems;
• Development of a database schema that will promote timely and accurate data submission to state and national systems; and
• A coordinated effort to promote a national standard model for EMS systems, device manufacturers and software vendors to adopt.

The NEMSIS task force met in Arlington, VA in March 2002. Project Director Greg Mears, researchers, federal staff from HRSA, NHTSA, and CDC and representatives from several organizations (e.g., International Association of Fire Fighters, American Ambulance Association, National Academy of Emergency Medical Dispatch, International Association of Fire Chiefs, National Emergency Number Association and more) carefully considered which prehospital data elements would be necessary and which are available for such an information system to feasibly collect real-time data and provide useful outcome data. A NEMSIS fact sheet was produced for dissemination, and in September the Task Force was reconvened to discuss the actual first draft NEMSIS dataset.

EMSC supplement to the National Hospital Ambulatory Medical Care Survey (NHAMCS)

Children's Mental Health Survey for Emergency Departments

NATIONAL PARTNERS

EMS PARTNERSHIP FOR CHLDREN (PFC): Fourteen of the nation's largest and most prestigious organizations involved in pediatric or emergency care have been awarded PFC contracts or Partnership for Information and Communication (also known as "PIC") cooperative agreements to help implement the Emergency Medical Services for Children Five-year Plan 2001 - 2005.

American Academy of Pediatrics Evaluates Guidelines for Emergency Department Pediatric Preparedness. In April 2001, the American Academy of Pediatrics and the American College of Emergency Physicians released "Care of Children in the Emergency Department: Guidelines for Preparedness." These guidelines cover six topics: administration and coordination of the emergency departments; physician and nurse knowledge and training; quality improvement; policies, procedures, and protocols; support services; and equipment, supplies, and medications.

Now that the preparedness guidelines have been issued, the American Academy of Pediatrics and the American College of Emergency Physicians are evaluating the impact that these guidelines have on the pediatric preparedness of emergency departments as well as the reasons some hospitals decide not to implement the guidelines.

Other selected activities to be accomplished by the PFC member organizations are as follows:

• Ambulatory Pediatric Association: Evaluate the results of conference on pediatric emergency medicine outcomes research and organize a consensus meeting to plan a validation study of new outcomes measures that need to be tested and validated.

• American Academy of Pediatrics: Direct and support the process for the development of uniform pediatric first aid, safety, and cardiopulmonary resuscitation training materials for child care providers.

• American Association of Poison Control Centers: Develop continuing education modules and determine whether site visits incorporated into the certification review process of poison control centers add value or change certification outcome.

• American College of Emergency Physicians: Direct and support the process for the development of evidence-based clinical guidelines on pediatric sedation and analgesia in the emergency department.

• American Pediatric Surgical Association: Develop specific national, evidence-based quality measures that are applicable across the continuum of care for certain types of injury common among children.

• American Trauma Society: Direct and support the process for the development and evaluation of a program which is designed to improve the communications and support provided to the family when life-threatening injury or sudden illness strikes.

• Emergency Nurses Association: Direct and support the process for the development and evaluation of a research curriculum for nurses associated with the EMSC Network Development Demonstration Project.

• National Association of Children's Hospitals and Related Institutions: Develop form templates reflecting the recommended components of emergency care plans for children with special health care needs -- prevention and preparation for an emergency situation and identification and initial response to escalating symptoms.

• National Association of EMS Physicians: Direct and support the process for the development and evaluation of a curriculum for a pediatric emergency care research workshop.

• National Association of Emergency Medical Technicians: Direct and support the process for the evaluation of the JumpSTART Pediatric Triage Algorithm.

• National Association of School Nurses: Direct and support the process for the development and evaluation of a disaster preparedness curriculum for school nurses.

• National Association of Social Workers: Direct and support the process for the revision, implementation, and evaluation of the bereavement practice guidelines training program for social workers in the emergency department.

• National Association of State EMS Directors: Build the foundation of a national EMS information system by revising the National Highway Traffic Safety Administration's data set to better document and capture important aspects of patient care, developing plan for data collection and transmission from local, state, and national systems, developing database schema that will promote timely and accurate data submission to state and national systems, and coordinating effort to promote a national standard model for EMS systems, devise manufacturers, and software vendors to adopt.

• National Council of State EMS Training Coordinators: Direct and support the process for the (1) study of essential (of high frequency and/or criticality of use) pediatric skills and knowledge to utilize in pre-hospital care settings; and (2) development of recommendations for refresher training and continuing medical education on such pediatric skills and knowledge.

EMSC PROGRAM LAUDS NATIONAL HEROES

April 2002 marked the fifth presentation of the National Heroes Awards, which honor individuals who have dedicated themselves to improving the way emergency medical care is provided to children throughout the United States. The recognitions, which this year were awarded in Dallas during a dinner gala of the Third National Congress on Childhood Emergencies, celebrate the good work those men and women are doing on behalf of children and their parents across the nation.

This year's recipients include:

Rachel Radcliff-Bostick, age 8, of Indianapolis, IN, won the first-ever Youth Inspiration Award for her heroic response in saving her family from their burning house. In doing so, she applied the lessons learned at her school during an Indiana EMSC-sponsored project at the Peoples Burn Foundation Survive Alive House.

Steven Strawderman, Battalion Chief for Prince William County (VA) Fire & Rescue, and Paul Edward Maxwell, an EMT-Paramedic in San Diego, CA, were named Outstanding EMS Providers of the Year. This award recognizes first responders who consistently provide the highest level of pediatric patient care.

Kathleen Rafe, from Prince William County, VA, was named Parent Volunteer of the Year. This award recognizes a parent who has provided exemplary service that has made a significant positive impact on addressing the emergency medical needs of the children in his or her community.

General Electric and Duke University received the EMSC Community Partnership of Excellence Award for a Color-Coding System for CT Scans. The award recognizes an organization that promotes activities that serve children and adolescents and works closely with the EMSC Program on pediatric emergency issues.

Dr. Walter J. Eppich, a third-year pediatric resident at Duke University Medical Center, received the EMSC Research Young Investigator Award. This award showcases an individual who has conducted and analyzed significant research, and is just beginning a research career in pediatric emergency care issues.

The Special Children's Outreach & Prehospital Education (SCOPE) Program, from Children's National Medical Center, in Washington, DC, received the Innovation in EMSC Product or Program Development Award, which recognizes a product or publication that helps to educate or advance EMS-related issues. It must be unique and cost effective, and be appropriate for use by other EMSC projects. In addition, it must have a significant statewide impact, with a major influence on improving pediatric emergency care.

Project Coordinators D. Breck Rushton, of Utah, and Mary Jean Erschen, of Wisconsin, were named EMSC Project Coordinators of Distinction, which honors a person who has a comprehensive understanding of his or her state's EMSC-related issues, and has successfully integrated EMSC into state EMS programs for the long term.

Tennessee and Florida were both recognized with the EMSC State Achievement Award, which is given to a state grantee of the EMSC Program, with a minimum of four years of EMSC funding. The state must have successfully created a dynamic and creative EMSC team that addresses a wide range of EMSC-related issues. The state must also have established collaborative relationships with other organizations and agencies in the state, had a significant statewide impact, and been a major regional influence on the advancement of pediatric emergency care.

Oregon State Senator Peter Courtney was named EMSC State Legislator of the Year, an honor that recognizes an individual who has been an elected state official within the last five years, and who has advanced legislation mandating EMSC Programs. In addition, the recipient must have a national reputation for safeguarding the health and well-being of children.

Dr. Martin Eichelberger, Director of Children's National Medical Center's (CNMC) Emergency Trauma Services, in Washington, DC, received the EMSC Lifetime Achievement Award, which is given to an individual who is a national advocate for EMSC, and who has devoted a significant part of his or her life to promoting and advancing pediatric emergency care. This individual must have worked to change the manner in which children are cared for throughout the entire continuum of care, serve on numerous committees and boards at the state and national levels, and have EMSC-related works published in journals, textbooks, and/or other publications.

EMSC PRODUCTS

New EMSC Products for 2002

El Juguete Perfecto…Divertido Pero Seguro (The Perfect Toy…Fun But Safe) (#919). This brochure provides guidance for selecting age appropriate toys for children that enhance their cognitive, sensory, and motor skills development.

Helping Children and Adolescents Cope with Violence and Disasters (#943, HTML Document). This online packet of fact sheets discusses the impact of violence and disasters on children and adolescents and suggests steps to minimize long-term emotional harm. Subject areas covered include different emotional reactions based on age group, as well as post-traumatic stress disorder.

Office PERC: Preparedness for Emergency Response to Children (#945, CD-ROM). This tool is designed to prepare the primary care doctor's office to stabilize pediatric emergencies. It provides instruction to train all office personnel to recognize an ill or injured child using the assessment triangle. It describes staff assignments when responding to an emergency. It also includes printable lists of recommended equipment, supplies, and medications for the office, algorithms for treating common pediatric emergencies, and the Emergency Information Form.

On the Same Team: Involving the Family in Prehospital Care (#984, CD-ROM). This interactive CD-ROM is designed to assist prehospital care providers in becoming more proficient in engaging family members in the care of their loved ones. It provides background information on the shift to family-driven services and offers suggestions and examples on how to incorporate family-centered care into an emergency medical services system.

Paramedic TRIPP: Teaching Resource for Instructors in Prehospital Pediatrics (#946, CD-ROM). As a curriculum guide for instructors teaching prehospital pediatric care, this encyclopedic resource expands the scope of prehospital practice from basic to advanced life support procedures. It contains core content sections on patient assessment, as well as respiratory, circulatory and trauma emergencies. It covers neurological and psychological issues and issues related to children with special health care needs.

Pediatric Airway Management (#927, CD-ROM). A tutorial that provides video illustration of the skills necessary for basic and advanced out-of-hospital providers in administering airway management care of critically ill or injured children. Topic areas include differences in the pediatric and adult airway, determination of appropriately sized airway equipment, and management of tracheostomy obstruction in children with special health care needs. Both the basic and advanced provider sections contain tests to measure knowledge gained from the tutorial.

Pediatric Airway Management and Respiratory Distress Self-Study Module (#935). This self-study module, by the Alaska EMSC Project, is designed for emergency medical technicians and paramedics who work in the areas of pediatric airway management and respiratory distress. It includes case studies, post-tests, and reference sources for additional information.

Pediatric Emergency Preparedness in Schools: A Report from the 2001 Southeastern Regional EMSC Annual Meeting (#909, Reprint). This document, by Susan McDaniel Hohenhaus, RN, CEN, of the North Carolina EMSC Project, discusses the challenges that school nurses experience in responding to the need for emergency medical care and the benefits of linking emergency medical services for children with school nurses and school health programs to improve the health and safety of children in schools. Hohenhaus SM. Pediatric emergency preparedness in schools: a report from the 2001 Southeastern Regional EMSC annual meeting. J Emerg Nurs. 2001 Aug;27(4):353-6.

Pediatric Trauma: Self-Study (#936). This self-study module, by the Alaska EMSC Project, is designed for emergency medical technicians and paramedics who work in the area of pediatric trauma. It includes case studies, post-tests, and reference sources for additional information.

Policy Statements: Care of Children in the Emergency Department: Guidelines for Preparedness (#908, Reprint). The American College of Emergency Physicians and the American Academy of Pediatrics present guidelines for the necessary resources to ensure that children receive quality emergency care and transfer to a facility with specialized pediatric services. Guidelines include the qualifications of emergency department personnel, in addition to the qualifications of transport plans to deliver children safely to an appropriate facility. American College of Emergency Physicians and the American Academy of Pediatrics. Care of children in the emergency department: guidelines for preparedness. Ann Emerg Med. 2001 Apr;37(4):423-7.

Recommendations for Emergency Care Plans for Children with Special Health Care Needs (#933). This publication, by the National Association of Children's Hospitals and Related Institutions, presents guidelines and recommendations for administering emergency care for children with chronic health conditions prior to and during an emergency situation. It discusses the importance of the involvement of families and providers across the care continuum; effective content and formats for emergency care plan information; and systems to monitor and evaluate the use and effectiveness of emergency care plans.

Usa el Asiento de Seguridad para Ninos (Use Car Seats for Children) (#920). This colorful fact sheet, by the Puerto Rico EMSC Project, provides guidance to parents and caregivers on the selection and positioning of car seats for children less than twelve years old.

When to Call an Ambulance for a Child (#940). This brochure, by the North Dakota EMSC Project, is a guideline for emergency care. It describes when to call an ambulance for a child, information that one needs to know when calling for help, and what to do until help arrives.

Most Popular Online EMSC Products

1. How to Prevent & Handle Childhood Emergencies: A Handbook for Parents and People Who Care for Children (#576)
2. Resource Manual for the Nurse in the School Setting (#750)
3. NAEMSP Model Pediatric Protocols (#819)

Most Popular Products from the EMSC Clearinghouse

1. Be Prepared Not Scared! EMSC Activity and Coloring Book (#895)
2. EMSC: The Right Care When It Counts! (#781, Brochure)
3. Urgente! (Emergency!) (#846)

NEW MCHB PROGRAMS

Trauma-EMS Program: In 2001 EMSC Grantees, via supplemental grants, assisted the Federal Trauma - EMS Program by gathering a multidisciplinary group of trauma stakeholders to assist in completion of a state Trauma-EMS Survey. Data, from the assessment of State Trauma components, EMS needs, Disaster Readiness and State Strengths, Weaknesses and Opportunities has been collated by NEDARC's Clay Mann. This data has provided a starting point for the enhancement of America's State Trauma Systems. This data, plus revisions in the Model Trauma Plan and NHTSA's Trauma Vision for the Future, are providing guidance for the development of the Federal Trauma - EMS Program. Survey data identified deficits in foundations for Trauma System Development. Under the leadership of Cheryl Anderson, RN, MPH, Federal Project Director, a National Trauma-EMS Stakeholders group has been formed to provide guidance to the program. Fiscal Year 2002 funding focused on developing strong foundations for continued development of State Trauma Systems: a lead agency, a Trauma System Manager, a State Trauma Plan, and a State Trauma Stakeholders group. These State Stakeholders groups are required to include pediatric representation to assure that the unique and special needs of children are addressed and included in State Trauma Plans.

Bioterrorism Hospital Preparedness Program (BHPP)

In response to the real threat of bioterrorism, Congress authorized funding through the Public Health and Social Services Emergency Fund to support activities related to countering potential biological threats to civilian populations. As part of this initiative, the Health Resources and Services Administration (HRSA) made approximately $125 million available in FY 2002 in the form of cooperative agreements with the 50 states, the Commonwealths of Puerto Rico and the Northern Mariana Islands, the territories of American Samoa, Guam, and the U.S. Virgin Islands, and the nation's three largest municipalities (New York City, Chicago, and Los Angeles County). The program grants are administered by state, territorial, or municipal health departments.

The awards provide funding for the development and implementation of regional plans to improve the capacity of hospitals, their emergency departments, outpatient centers, EMS systems, and other collaborating health care entities for responding to incidents requiring mass immunization, treatment, isolation and quarantine in the aftermath of bioterrorism or other outbreaks of infectious disease.

With 2002 EMSC Partnership Grants focusing upon further integration of EMSC into state public health care systems including partnerships and collaboration with state agencies, such as Trauma and EMS and the Bioterrorism Hospital Preparedness Program, opportunities for improving emergency and trauma care for America's children abound