Emergency Medical Services for Children

Emergency Medical Services for Children

EMSC Program BackgroundMission of the Emergency Medical Services for Children

Program:

– to ensure state-of-the-art emergency medical care for ill or injured children and adolescents;

– to ensure pediatric services are well integrated into state emergency medical services (EMS) system and backed by optimal resources;

– to 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 as well as adults

Program of HHS/HRSA/MCHB

HRSA / MCHB / EMSC

MARY WAKEFIELD, PhD, RNHRSA Administrator

PETER VAN DYCK, MDAssociate Administrator

Maternal and Child Health BureauDAVID HEPPEL, MDChief

Division of Child, Adolescent & Family Health

PETER CONWAYDeputy

Division of Child, Adolescent & Family Health

DAN KAVANAUGH, MSW, LSCW-CSenior Program Manager, EMSC Program

TINA TURGEL, BSN, RN, BCNurse Consultant, EMSC Program

FY 2010 Appropriations & Authorization

Appropriations: – FY 2009:

• President: $0• Final appropriations bill: $20 million

– FY 2010 • Presidents Budget released 5/7/09,

recommending $20 million for the program for fiscal year 2010 (Oct. 09-Sept. 2010.)

Authorization Proposals– HR 2464: Wakefield Act

• Approved by House of Representatives– Senate 408

• No action since introduction.

EMSC FY 09 FundingState Partnership Grants

54 continuation9 in last year at $115,000

45 in second year at $130,000

Targeted Issues Grants13 continuing projects funded at $200,000-

$250,000 per yearNetwork Development Demonstration Project

4 new in 2008 $890, 000 per yearCentral Data Management Coordinating Center

1 continuing $1,110,000 per year

2006 IOM Report on EMSC

“Children who are injured or ill have different medical needs than adults with the same problems. They have different heart rates, blood pressures, and respiratory rates, and these change as they grow. They often need equipment that is smaller than what is used for adults, and they require medication in much more carefully calculated doses. They have special emotional needs as well, often reacting very differently to an injury or illness than adults do. Unfortunately, although children make up 27 percent of all visits to the ED, many hospitals and EMS agencies are not well equipped to handle these patients.”

Emergency Care for Children: Growing PainsIOM Report 2006

http://www.nap.edu/catalog/11655.html

Future of Emergency Care in theUnited States Health System

Emergency Care for Children, Growing Pains

Key Recommendations

Coordination of Care

Regionalization of Specialty Pediatric

Accountability

Arming the Emergency Care Workforce with Pediatric Knowledge and Skills

Patient Safety and Advancements in Technology and Information Systems

Improve Emergency Preparedness for Children Involved in Disasters

Build the Evidence Base for Pediatric Emergency Care

EMSC Performance Measures

The EMSC Performance Measures were developed

in 2005 to demonstrate national outcomes for the

EMSC Program and to improve the delivery of

emergency care for pediatric patients at the

local level.


The process to develop included:

1. 6 months of extensive research on all EMSC issues.

2. Development of 71 draft measures that was narrowed down to ten final measures. (Note – measures have been renumbered from prior versions)

3. A two-day consensus conference with numerous federal agencies, national organizations. resource center staff, and grantees.

4. Beta testing of the measures in 3 states.

5. Sign-off of the measures by HRSA.


The EMSC Performance Measures represent the best thinking of EMSC experts throughout the country on

how to improve the care for children through the EMSC State Partnership

grants!

Priorities for 2009-2010:

•Review collected data

•Strategic planning to affect system change

EMSCNational

Resource Center

A program of

EMSC National Resource Center

• The NRC was established in 1991 to assist the federal EMSC program in helping states reduce child and youth disability due to severe illness and injury.

• The NRC supports the federal EMSC Program (Administered by the U.S. Department of Health and Human Services, Health Resources and Services Administration with collaboration from the U.S. Department of Transportation, National Highway Traffic Safety Administration).

Role of the National Resource Center

• Provide technical assistance to EMSC Program grantees

• Work with national organizations (AAP, ACEP ACS, etc)

• Collaborate with federal agencies (NHTSA, CDC, NIH)

• Provide resources to grantees, national organizations and federal agencies.

• Provide support to the federal program staff

State Technical Assistance

• Assist grantees with grants management

• Assist with performance measure implementation

• Provide resources– Website– Quick news listserv– Fact sheets and

resources– Support FAN network

Resources for Grantee Development

• Products and resources database– Special topic resources such as CSHCN,

disaster preparedness etc.– Webcasts – interfacility transfer– Tool boxes

• Annual Program meeting• Town Hall Communication Opportunities• Share and Learn Conference Calls – Peer

to peer learning opportunities• Mentoring Matches• Website— www.childrensnational.org/emsc

http://www.childrensnational.org/emsc

Policy and Partnerships

• Work with national organizations for document and policy review

• Serve as liaisons to several national committees

• Host and facilitate consensus building meetings


Contact:

Tasmeen Weik, DrPH, NREMT-PExecutive Director202-476-4927, [email protected]

State Partnership Technical Assistance Team:Diana Fendya, [email protected] Hulbert, [email protected] Morrison-Quinata, [email protected]

Website: www.childrensnational.org/emsc

mailto:[email protected]





Who is NEDARC…?

www.nedarc.org

• …National EMSC Data Analysis Resource Center (1995, U. of Utah)

• Sister resource center with the NRC for EMSC grantees

• NEDARC provides assistance in data collection, data analysis, data utilization and other technical areas

Assistance NEDARC Provides:• EMS data system development• State Visits

– Evaluate data system capacity– NEMSIS migration efforts

• Data Workshops– Increase capabilities in data collection,

analysis, reporting, etc.– Data dissemination– Quality improvement– Etc, etc

Assistance NEDARC Provides: • EMSC Performance Measures

– Electronic surveys for collection and evaluation of data• On/off line medical direction• Pediatric equipment on ambulances• Hospital transfer agreements/guidelines

– Sample design– Data cleaning and analysis– Data dissemination

• Fact sheets

Development of National “Customizable” Performance Measure Fact Sheets

Once you gather your data, you’ll be able to communicate it to the key audiences… helping to boost your credibility and clearly explain your needs.

www.nedarc.org

• J. Michael Dean, MD, MBA– Principal

Investigator

• Michael Ely, MHRM– NEDARC Director

• Lenora Olson, PhD, MA– Co-Investigator

• Don Vernon, MD– Co-Investigator

• Clay Mann, PhD, MS– Co-Investigator

• Patty Schmuhl, BA– Communication

Specialist

• Andrea L. Genovesi, MA– Education Coordinator

• Craig Hemingway, EMT-I– EMS Specialist

• Kent Page, MStat– Statistician

• Angie Marchant, MS– Statistician

NEDARC Faculty & Staff

Why is data collection

important?

“Without a broad and reliable base of information, it is hard for

anyone—emergency care providers, administrators, parents, policymakers—to determine in any

systematic way how successful EMSC systems are in providing

appropriate, timely care or what they ought to do to improve

performance and patient outcomes.”

1993 IOM Report on EMSC

Why Bother to Collect Data?

• Improve patient care

• Systematically evaluate the responsiveness and effectiveness of EMS

• Identify weaknesses AND strengths

• Conduct research/QI

• Decision-making and resource allocation based on evidence (not isolated occurrence, assumption, emotion, politics…)

• Improve reimbursement

• Obtain grant funding

NEDARC’s Goal:

Data Collection 80% Response

Required

Data Analysis

Communicating the Data

(Reports / Fact Sheets)

Using Data to HelpInitiate System

Change

A Perfect Example Utah EMSC

1. Aware of Equipment Performance Measure (XX)

2. Disseminated a “Needs Assessment” with NEDARC’s help (Data Collection)

• Identified equipment that Providers were lacking such as – “Pediatric Backboards & Broselow Tape”

3. Looked at existing data sources and discovered the lack of these items at the state level : (Data Collection & Analysis)

• Utah equipment requirements

• Utah Inspection Forms

A Perfect Example

4. Approached the Bio-Terrorism group (Communicating Data)

• Here is the data, “Would you be willing to give us money?”

• Bio-Terrorism group included the request into their grant - $240,000

5. Pediatric Backboards and Broselow Tape distributed to all agencies in the State of Utah (System Change)

Conclusions . . .

Data will help you describeand improve your state EMSC system.

Data will help us describe and improve the

EMSC system in the entire United States.

Data will give EMSC a National Profile.

Introducing the EMSC Performance Measures

Performance Measures 71

and 72 (formerly 66a)

Medical Direction

Why is this important?

Children are not just little adults. Without appropriate pediatric medical direction, whether direct communication or via defined documented protocols, a pre-hospital provider could underestimate a pediatric patient in critical condition, make a medication dosing error, or be unable to effectively triage multiple pediatric patients.

Performance Measure 71

(Formerly 66a (part i)

The percent of pre-hospital provider agencies in the State/Territory that have on-line pediatric medical direction available from dispatch through patient transport to a definitive care facility.

Performance Measure 71By 2011:• 90% of basic life support (BLS) pre-hospital provider

agencies in the State/Territory have on-line pediatric medical direction available from dispatch through patient transport to a definitive care facility.

• 90% of advanced life support (ALS) pre-hospital provider agencies in the State/Territory have on-line pediatric medical direction available from dispatch through patient transport to a definitive care facility.

71 Online Medical Direction

On-line pediatric medical direction: An individual

is available 24/7 to EMS providers who need

medical advice when providing care to a pediatric

patient. This person must be a medical

professional (e.g., nurse, physician, physician

assistant [PA], nurse practitioner or EMT-P) and

must have a higher level of pediatric

training/expertise than the EMS provider to

whom he/she is providing medical advice.

72. The percent of pre-hospital provider agencies in the State/Territory that have pediatric off-line medical direction available from dispatch through patient transport to a definitive care facility.


(Formerly 66a (part ii)

Performance Measure 72By 2011:• 90% of basic life support (BLS) pre-hospital provider

agencies in the State/Territory have off-line pediatric medical direction available from dispatch through patient transport to a definitive care facility.

• 90% of advanced life support (ALS) pre-hospital provider agencies in the State/Territory have off-line pediatric medical direction available from dispatch through patient transport to a definitive care facility.

72 Offline Medical Direction

Treatment guidelines and protocols used by

EMS providers to ensure the provision of

appropriate pediatric patient care, available

in written or electronic (e.g., laptop/tablet

computer) form in the unit or with a

provider. Protocols must be available from

the time of dispatch through patient

transport to a definitive care facility.

Data Collection for 71 and 72

Acceptable data collection methods for these measures include:– Inspection reports: Grantees may be able to use

such for gathering data for this measure. An inspection process could be used to determine whether pediatric protocols are physically carried on ambulances. It is less likely that an inspection process could be used to determine online medical direction. Grantees are expected to contact NEDARC if an inspection process is to be utilized.

– Surveys to an appropriate target population : • Additional requirements to ensure data quality• All data collection surveys are to be coordinated

with NEDARC• Must use NEDARC templates or have proposed

final tool approved by NEDARC before sending out

Reporting DataPM 71

BLS On-line Medical Direction:You will be asked to enter a numerator and a denominator. NOTE: ILS pre-

hospital provider agencies are included with BLS pre-hospital provider agencies AND NOT with ALS pre-hospital provider agencies.

• NUMERATOR (BLS provider agencies): __________________– Number of BLS/ILS pre-hospital provider agencies that have on-line pediatric

medical direction according to the data collected.• DENOMINATOR (BLS provider agencies): __________________

– Total number of BLS/ILS pre-hospital provider agencies that provided data.

ALS On-line Medical Direction:You will be asked to enter a numerator and a denominator. NOTE: ILS pre-


• NUMERATOR (ALS provider agencies): __________________– Number of ALS pre-hospital provider agencies that have on-line pediatric

medical direction according to the data collected.• DENOMINATOR (ALS provider agencies): __________________

– Total number of ALS pre-hospital provider agencies that provided data.

Reporting DataPM 72

BLS Off-line Medical Direction:You will be asked to enter a numerator and a denominator. NOTE: ILS pre-


• NUMERATOR (BLS provider agencies): __________________– Number of BLS/ILS pre-hospital provider agencies that have off-line pediatric

medical direction according to the data collected.• DENOMINATOR (BLS provider agencies): __________________

– Total number of BLS/ILS pre-hospital provider agencies that provided data.

ALS Off-line Medical Direction:You will be asked to enter a numerator and a denominator. NOTE: ILS pre-


• NUMERATOR (ALS provider agencies): __________________– Number of ALS pre-hospital provider agencies that have off-line pediatric

medical direction according to the data collected.• DENOMINATOR (ALS provider agencies): __________________

– Total number of ALS pre-hospital provider agencies that provided data.

1114

2496

National Analysis – Online Medical Direction

929 2852

National Analysis – Offline Medical Direction

Guidelines for Annual Targets of Performance Measures 71 and 72

Year Target

• 2006 30%

• 2007 40%• 2008 50%• 2009 65%• 2010 80%

•2011 90%

Targets are universal for all grantees and do not take into account lack of funding situations and inability to progress in achievement.

Planning Considerations for Performance Measures 71 and 72

• Are there anticipated barriers to collecting data related to this measure? – Note: Response Rate

• Do you know who provides on-line medical direction and knowledge of pediatrics in your state?

• Do statewide off line protocols exist for EMS providers?

• Is there a subset of pediatric specific off line protocols available?

• Do formal agreements exist between the EMS agency and the hospital to provide on-line medical direction?


(Formerly 66b

The percent of patient care units in the State/Territory that have the essential pediatric equipment and supplies as outlined in national guidelines.


Without the right sized pediatric equipment, a pediatric airway cannot be managed, an IV cannot be established, a c-spine cannot be immobilized, and appropriate medication doses cannot bedelivered.


By 2011:•90% of basic life support (BLS) patient care units in the State/Territory have the essential pediatric equipment and supplies, as outlined in national guidelines for pediatric equipment and supplies for basic life support ambulances.

•90% of advanced life support (ALS) patient care units in the State/Territory have the essential pediatric equipment and supplies, as outlined in national guidelines for pediatric equipment and supplies for advanced life support ambulances.

Definition: Patient Care Unit? A patient care unit is defined as a

vehicle staffed with EMS providers (BLS and/or ALS) dispatched in response to a 911 or similar emergency call AND responsible for transporting a patient to the hospital. Examples include an ambulance, or other type of transporting unit. This definition excludes non-transport vehicles (such as chase cars) to provide additional personnel resources, air ambulances, exclusively defined specialty care units, and water ambulances/units.

Data Collection for 73 Implementation manual requires data collection

through:

– Ambulance inspection reports• List of the data elements available in the dataset

and a data dictionary;• Copy of the inspection report indicating a 1:1 match

with the National Guideline required pediatric equipment list; and

• Copy of tabulations from data collected.

– Surveys to an appropriate target population• Additional requirements to ensure quality of data• Have to use NEDARC templates and have final

approved by NEDARC before sending out

Reporting DataPM 73

BLS Patient Care Units:You will be asked to enter a numerator and a denominator. NOTE: ILS

patient care units are included with BLS patient care units AND NOT with ALS patient care units.

• NUMERATOR (BLS patient care units): __________________– Number of BLS/ILS patient care units that have the essential pediatric

equipment and supplies according to the data collected.• DENOMINATOR (BLS patient care units): __________________

– Total number of BLS/ILS patient care units for which data was provided.

ALS Patient Care Units:You will be asked to enter a numerator and a denominator. NOTE: ILS

patient care units are included with BLS patient care units AND NOT with ALS patient care units.

• NUMERATOR (ALS patient care units): __________________– Number of ALS patient care units that have the essential pediatric

equipment and supplies according to the data collected.• DENOMINATOR (ALS patient care units): __________________

– Total number of ALS patient care units for which data was collected.

National Guidelines for Required Pediatric Equipment

PM 73 – Pediatric Equipment National Findings

• EMSC Program Targets:– 2007 Target: 50% of units– 2011 Target: 90% of units

• Percentage of PCUs Nationwide that Meet the EMSC Program 2011 Target:– BLS units: 16%– ALS units: 18%

New Equipment Checklist for Pediatrics

1081 2163

% of BLS & ALS PCUs that Carry ALL Pediatric Equipment

16% 18%

90%

0%

20%

40%

60%

80%

100%

BLS(6590 total PCUs)

ALS (ILS & ALS)(12183 total PCUs)

National Target2011

1081 2163

National Analysis – Equipment on Patient Care Units*

Guidelines for Annual Targets of

Performance Measure 73 Year Target

• 2006 40%

•2007 50%• 2008 60%

• 2009 70%

• 2010 80%

•2011 90%


Planning Considerations for Performance Measure 73

• What were some of the barriers experienced when collecting data related to this measure? – Note: Response Rate %

• What are some of the reasons specific pieces of equipment are missing?

• Are missing pieces of equipment out of provider’s scope of practice or is it related to lack of funding?

• What can be done to obtain the missing pieces of equipment?

• Are there potential partners available to assist in securing equipment?


and 75 (formerly 66c)

Hospital Recognition

System


Without a pediatric emergency facility designation process, access to appropriate critical care, trauma care, or burn care could be delayed. Delays can result in very negative patient outcomes.


74. The percent of hospitals recognized through a statewide, territorial or regional standardized system that are able to stabilize and/or manage pediatric medical emergencies.

By 2017:25% of hospitals are recognized as part of a statewide, territorial, or regional standardized system that are able to stabilize and/or manage pediatric medical emergencies.


75. The percent of hospitals recognized through a statewide, territorial or regional standardized system that are able to stabilize and/or manage pediatric traumatic emergencies.

By 2017:50% of hospitals are recognized as part of a statewide, territorial, or regional standardized system that recognizes hospitals that are able to stabilize and/or manage pediatric trauma.


74. The percentage of hospitals recognized as a pediatric medical facility is now an optional measure for states to work on with the new revisions.

75. The percentage of hospitals recognized as a pediatric trauma facility is a measure grantees are to continue to work on.

Data will be entered for medical and trauma categorization separately in the EHB each year for both 74 and 75.

Supporting Documentation

• Measure does not require specific data collection

• Target date for achieving is 2017• Supporting documentation includes:

– Facility recognition application packet;– Criteria that facilities must meet in order to

receive recognition as a facility able to stabilize and/or manage pediatric medical emergencies/trauma; and

– List of hospitals participating in the pediatric medical emergency/trauma facility recognition program and their corresponding designation/recognition level.

Reporting PM 74 & 75

Hospitals recognized for Pediatric Medical Emergencies:You will be asked to enter a numerator and a denominator. NOTE: This measure only applies to

hospitals with an Emergency Department (ED).• NUMERATOR: __________________

– Number of hospitals with an ED that are recognized through a statewide, territorial or regional standardized system that are able to stabilize and/or manage pediatric medical emergencies.

• DENOMINATOR: __________________– Total number of hospitals with an ED in the State/Territory.

Hospitals recognized for Pediatric Traumatic Emergencies:You will be asked to enter a numerator and a denominator. NOTE: This measure only applies to

hospitals with an Emergency Department (ED).• NUMERATOR: __________________

– Number of hospitals with an ED that are recognized through a statewide, territorial or regional standardized system that are able to stabilize and/or manage pediatric traumatic emergencies.

• DENOMINATOR: __________________– Total number of hospitals with an ED in the State/Territory.

Scoring Scale:Data entry will require scoring of the progress made towards meeting both of these performance

measures. You will be asked to enter a number (from 0-5) based on the scale located in the table below. Note: included in the table below are examples of supporting documentation that your State/Territory may be asked to submit to HRSA.

• Indicate the degree to which a standardized system for pediatric medical emergencies exists: _________________ (0-5)

• Indicate the degree to which a standardized system for pediatric traumatic emergencies exists: _________________ (0-5)

ReportingPM 74 & 75

Scoring ScalePoint on Scale Supporting Documentation

0 = No progress has been made towards developing a statewide, territorial, or regional system that recognizes hospitals that are able to stabilize and/or manage pediatric medical emergencies and/or trauma.

No supporting documentation is necessary

1 = Research has been conducted on the effectiveness of a pediatric medical and/or trauma facility recognition program (i.e., improved pediatric outcomes)

And/or

Developing a pediatric medical and/or trauma facility recognition program has been discussed by the EMSC Advisory Committee and members are working on the issue.

Reports or presentations that include research findings (e.g., white paper on recognition programs including an assessment of the State/Territory’s status on components and gaps)

Copy of the EMSC Advisory Committee agenda and meeting minutes reflecting discussion of pediatric facility recognition program.

2 = Criteria that facilities must meet in order to receive recognition as a pediatric medical and/or trauma facility have been developed.

Copy of criteria that facilities must meet in order to receive recognition as a pediatric medical and/or trauma facility

3 = An implementation process/plan for the pediatric medical and/or trauma facility recognition program has been developed.

Copy of implementation process or plan

4 = The implementation process/plan for the pediatric medical and/or trauma facility recognition program has been piloted.

Any piloting materials, such as: 1) instructions for facilities participating in the pilot process; 2) marketing materials developed to motivate facilities to participate in the pilot; 3) list of facilities participating in the pilot; 4) results of pilot process

5 = At least one facility has been formally recognized through the pediatric medical and trauma facility recognition program

Facility recognition application packet; formal evaluation/assessment results; the name of the facility(s) formally participating in the program(s) and corresponding recognition level

National Analysis – Hospital Recognition

Examplehttp://www.luhs.org/depts/emsc/facility.htm

http://www.luhs.org/depts/emsc/facility.htm


and 77 (formerly 66d

and 66e)

Interfacility Transfer

Why is this Important?• Evidence has shown that the best outcomes for

critically ill and injured children are achieved when treated at facilities most prepared to address their needs.

• Hospitals should have Inter-facility Transfer Agreements (written formalized arrangements between health care facilities) that specify alternate care sites capable of meeting the clinical needs of critically ill and injured pediatric patients.

• Hospitals should also have interfacility transfer guidelines that assist hospitals in considering the management of patients needing transport and identify processes needed to expeditiously transfer patients.

Performance Measure76

76. The percentage of hospitals in the State/Territory that have written inter-facility transfer guidelines that cover pediatric patients and that include the following components of transfer:

•Defined process for initiation of transfer, including the roles and responsibilities of the referring facility and referral center (including responsibilities for requesting transfer and communication).

•Process for selecting the appropriate care facility.•Process for selecting the appropriately staffed transport service to match the patient’s acuity level (level of care required by patient, equipment needed in transport, etc.).•Process for patient transfer (including obtaining informed consent).•Plan for transfer of patient information that includes:

* medical record * signed transport consent

*personal belongings of the patient * provision of directions and referral institution information to family


By 2011:90% of hospitals in the State/Territory have written inter-facility transfer guidelines that cover pediatric patients and that include specific components of transfer.

Data ReportingPM 76

Hospitals with Inter-facility Transfer Guidelines that Cover Pediatric Patients:

You will be asked to enter a numerator and a denominator. NOTE: This measure only applies to hospitals with an Emergency Department (ED).

• NUMERATOR: __________________– Number of hospitals with an ED that have written inter-facility

transfer guidelines that cover pediatric patients and that include specific components of transfer according to the data collected.

• DENOMINATOR: __________________– Total number of hospitals with an ED that provided data.


76. The percentage of hospitals in the State/Territory that have written inter-facility transfer agreements that cover pediatric patients.

By 2011:90% of hospitals in the State/Territory have written inter-facility transfer agreements that cover pediatric patients.

Data ReportingPM 77

Hospitals with Inter-facility Transfer Agreements that Cover Pediatric Patients:

• You will be asked to enter a numerator and a denominator. NOTE: This measure only applies to hospitals with an Emergency Department (ED).

• NUMERATOR: __________________– Number of hospitals with an ED that have written

inter-facility transfer agreements that cover pediatric patients according to the data collected.

• DENOMINATOR: __________________– Total number of hospitals with an ED that provided

data.

Supporting Documentation

• Surveys:– Copies of hospitals’ transfer

guidelines/agreements– Copy of state transfer

guidelines/agreements utilized by all hospitals in the state

– Copy of survey results from NEDARC or raw data

• Other state data:– Consult NEDARC

• Exemption from data collection collection:– Approval letter from EMSC Project Officers

PM 66d/e – Inter-facility Transfer Guidelines/Agreements National Findings• EMSC Program Targets:

– 2007 Target: 25% of hospitals– 2011 Target: 90% of hospitals

• Percentage of Hospitals Nationwide that Meet the EMSC Program 2011 Target:– Guidelines: 14%– Agreements: 38%

234

Data Collection for 76 and 77

Implementation manual requires data collection through:– Surveys

•Additional requirements to ensure data quality

•Have to use NEDARC templates and have final approved by NEDARC before sending out

– Other State/Territory Data

Guidelines for annual targets for measures 76 and 77

Year Target

• 2007 25%• 2008 40%• 2009 45%• 2010 50%

•2011 90%


Planning Considerations for 76 and 77

• What were some of the barriers experienced when collecting data related to this measure? – Note: Response Rate %– What are some recommendations to

overcome those barriers?• Which hospitals have inter-facility

transfer agreements or guidelines? • Are the agreements and guidelines

pediatric-specific?


(formerly PM 68a-c)

The adoption of requirements by the State/Territory for pediatric emergency education for the license/certification renewal of basic life support (BLS) and advanced life support (ALS) providers.

By 2011, the State/Territory will have adopted requirements for pediatric emergency education for the recertification of BLS and ALS providers.


Studies have documented that retention of pediatric emergency skills quickly deteriorate without pediatric continuing education.

An Example of One State’s Current Requirements

A state rule currently requires 50 hours of continuing education for paramedic recertification, of which, 8 hours must be dedicated to pediatrics or obstetrics. Modification of this rule requires approval by the Board of Health. The rules regarding recertification were last modified in 2006.

Current plans are to revisit these rules in

2010. Need to double check on EMT recertification plans

Annual Targets for 78

Reporting PM 78

Pediatric Education for BLS Providers:Has your State/Territory adopted requirements for pediatric education for the license/certification renewal

of BLS providers?• YES NO NOT APPLICABLE

If “Yes,” please provide the following information: • Total number of hours required for BLS license/certification renewal: _________• Of the total number of hours required for BLS license/certification renewal, indicate the number of

hours that need to be dedicated to pediatrics: _________

• Comments:_________________________________________________________________________________

• If “No,” please indicate the reasons why your State/Territory has not adopted requirements for pediatric education for the license/certification of BLS providers. Please also indicate what steps you have taken towards adopting requirements, highlighting any major barriers towards adoption.

_________________________________________________________________________________

• If “Not Applicable,” please provide reasons why the measure is not applicable to your State/Territory (e.g., State/Territory does not have BLS providers).______________________________________________________________________________

Reporting PM 78

Pediatric Education for ALS Providers:

Has your State/Territory adopted requirements for pediatric education for the license/certification renewal of ALS providers?

• YES NO NOT APPLICABLE

If “Yes,” please provide the following information:• Total number of hours required for ALS license/certification renewal: _________• Of the total number of hours required for ALS license/certification renewal, indicate the number of

hours that need to be dedicated to pediatrics: __________Comments:• _________________________________________________________________________

If “No,” please indicate the reasons why your State/Territory has not adopted requirements for pediatric education for the license/certification of ALS providers. Please also indicate what steps you have taken towards adopting requirements, highlighting any major barriers towards adoption.

• _______________________________________________________

If “Not Applicable,” please provide reasons why the measure is not applicable to your State/Territory (e.g., State/Territory does not have ALS providers).

• ____________________________________________________________________________________________________

National Analysis – Recertification Requirements


•The degree to which States/Territories have established permanence of EMSC in the State/Territory EMS system.

•Goal: To increase the number of State/Territories that has established permanence of EMSC in the State/Territory EMS system..


Permanence of EMSC in a State/Territory EMS system is defined as:

a. The EMSC Advisory Committee has the required members as per the implementation manual.

b. The EMSC Advisory Committee meets at least four times a year.

c. By 2011, pediatric representation will have been incorporated on the State/Territory EMS Board.

d. By 2011, the State/Territory will mandate requiring pediatric representation on the EMS Board.

e. By 2011, one full time EMSC Manager that is dedicated solely to the EMSC Program will have been established.


A stable EMSC program within your State that includes a dynamic advisory committee, pediatric representation on your state EMS board, and a full-time EMSC program manager, will lead to successful EMS improvements for pediatric patients even if the EMSC grant program ends.

By integrating pediatric priorities into existing EMS rules and regulations, your EMS system changes will become permanent.

Supporting Documentation for Performance Measure 79

• Measure does not require specific data collection

• Example supporting documentation:– Copies of advisory committee minutes

and agenda– Copy of the state mandate describing

requirements for a formal, designated voting pediatric representative on the state EMS Board


EMSC Advisory Committee1. Nurse with emergency pediatric experience

2. Physician with pediatric training (e.g., pediatrician or pediatric surgeon)

3. Emergency physician (a physician who primarily practices in the emergency department; does not have to be a board-certified emergency physician)

4. Emergency medical technician (EMT)/Paramedic who is currently a practicing, ground level pre-hospital provider (i.e., must be currently licensed and riding in a patient care unit such as an ambulance or fire truck)

5. EMS State agency representative (e.g., EMS medical director, EMS administrator)

6. EMSC principal investigator

7. EMSC grant manager

8. Family representative

Reporting PM 79

Five Components to Promote Permanence of EMSC:

• The EMSC Advisory Committee has the required members as per the implementation manual: ______________

• The EMSC Advisory Committee has met four or more times during the grant year: ______________

Reporting PM 79

Components to Promote Permanence of EMSC:

• The EMSC Advisory Committee has the required members as per the implementation manual: ______________

• The EMSC Advisory Committee has met four or more times during the grant year: ______________

• There is pediatric representation on the EMS Board: ______________ (Yes/No)

• There is a State/Territory mandate requiring pediatric representation on the EMS Board: ______________ (Yes/No)

• There is one full-time EMSC Manager that is dedicated solely to the EMSC Program: ______________ (Yes/No)

Possible Score 0-5

National Analysis – EMSC Advisory Committee

National Analysis – EMS Board Representation

National Analysis – Full Time EMSC Manager


The degree to which the State/Territory has established permanence of EMSC in the State/Territory EMS system by integrating EMSC priorities into statutes/regulations. \

By 2011, EMSC priorities will have been integrated into existing EMS or hospital/healthcare facility statutes/regulations.


Priorities: The priorities of the EMSC Program include the following six areas:

• BLS and ALS pre-hospital provider agencies in the State/Territory have on-line and off-line pediatric medical direction available from dispatch through patient transport to a definitive care facility.

• BLS and ALS patient care units in the State/Territory have the essential pediatric equipment and supplies, as outlined in the nationally recognized and endorsed guidelines.

• The existence of a statewide, territorial, or regional standardized system that recognizes hospitals that are able to stabilize and/or manage• pediatric medical emergencies • trauma

• Hospitals in the State/Territory have written inter-facility transfer guidelines that cover pediatric patients and that include the following components of transfer:

• Defined process for initiation of transfer, including the roles and responsibilities of the referring facility and referral center (including responsibilities for requesting transfer and communication).

• Process for selecting the appropriate care facility.• Process for selecting the appropriately staffed transport service to match the patient’s acuity level (level of care required by

patient, equipment needed in transport, etc.).• Process for patient transfer (including obtaining

informed consent).• Plan for transfer of patient medical record • Plan for transfer of copy of signed transport consent• Plan for transfer of personal belongings of the patient• Plan for provision of directions and referral institution information to family

• Hospitals in the State/Territory have written inter-facility transfer agreements that cover pediatric patients.

• The adoption of requirements by the State/Territory for pediatric emergency education for the license/certification renewal of BLS and ALS providers.

Reporting PM 80

There is a statute/regulation for pediatric on-line medical direction for ALS and BLS providers: ______________ (Yes/No)

There is a statute/regulation for pediatric off-line medical direction for ALS and BLS providers: ______________ (Yes/No)

There is a statute/regulation for pediatric equipment for BLS and ALS patient care: ______________ (Yes/No)

There is a statute/regulation for a hospital recognition system for identifying hospitals capable of dealing with pediatric medical emergencies: ______________ (Yes/No)

There is a statute/regulation for a hospital recognition system for identifying hospitals capable of dealing with pediatric traumatic emergencies: ______________ (Yes/No)

There is a statute/regulation for written transfer guidelines that include components for pediatric inter-facility transfer within hospitals: ______________ (Yes/No)

There is a statute/regulation for written transfer agreements that include components for pediatric inter-facility transfer within hospitals: ______________ (Yes/No)

There is a statute/regulation for the adoption of requirements for continuing pediatric education during recertification of BLS and ALS providers: ______________ (Yes/No)


Helpful Resources:

EMSC webcasts at www.mchcom.com

Performance Measures Implementation Manual and FAQs available at www.mchb.hrsa.gov/emsc


National EMSC Data Analysis Resource Center

http://www.mchcom.com/

http://www.mchb.hrsa.gov/emsc

EMSC Program Contacts• Dan Kavanaugh, MSW, LCSW-C

CAPT. USPHSSenior Program Manager (301) 443-1321 or [email protected]

• Christina Turgel, BSN, RN, BCNurse Consultant (301) 443-5599 or [email protected]

http://mchb.hrsa.gov/emsc



http://mchb.hrsa.gov/emsc

EMSC Resource Center Contacts

• EMSC National Resource Center (NRC) Tasmeen Singh Weik, DrPH , NREMT-P Executive Director 202-476-6866 or [email protected]/emsc

• National EMSC Data Analysis Resource Center (NEDARC),

Michael Ely, MHRM Director, 801-585-9761

[email protected] www.nedarc.org




http://www.nedarc.org/

EMSC NRC & NEDARCContacts

Jocelyn HulbertState Partnership Outreach Coordinator

EMSC-NRC(202) 476-6880

[email protected]

Andrea Genovesi Education Coordinator

NEDARC(801) 581-7280

[email protected]



Documents

Emergency Medical Services for Children