Emergency Medical Services for Children

1. Emergency Medical Services for Children

2. EMSC Program Background Mission 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

3. HRSA / MCHB / EMSC

4. 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.

5. EMSC FY 09 Funding State Partnership Grants 54 continuation 9 in last year at $115,000 45 in second year at $130,000 Targeted Issues Grants 13 continuing projects funded at $200,000-$250,000 per year Network Development Demonstration Project 4 new in 2008 $890, 000 per year Central Data Management Coordinating Center 1 continuing $1,110,000 per year

6. 2006 IOM Report on EMSC “Children who are injured or ill havedifferent 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 needequipment that is smaller than what is used for adults, and they require medication in muchmore carefully calculated doses. They have specialemotional 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 equippedto handle these patients.” Emergency Care for Children: Growing Pains IOM Report 2006

7. 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

8. 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.

9. EMSC Performance Measures The process to develop included: 6 months of extensive research on all EMSC issues. Development of 71 draft measures that was narrowed down to ten final measures. (Note – measures have been renumbered from prior versions) A two-day consensus conference with numerous federal agencies, national organizations. resource center staff, and grantees. Beta testing of the measures in 3 states. Sign-off of the measures by HRSA.

10. EMSC Performance Measures 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

11. EMSCNational Resource Center A program of

12. 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).

13. 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

14. 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

15. 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

19. 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

20. EMSC National Resource Center Contact: Tasmeen Weik, DrPH, NREMT-P Executive Director 202-476-4927, tsingh@cnmc.org State Partnership Technical Assistance Team: Diana Fendya, dfendya@cnmc.org Jocelyn Hulbert, jhulbert@cnmc.org Theresa Morrison-Quinata, tmquinat@cnmc.org Website: www.childrensnational.org/emsc

21. Who is NEDARC…? www.nedarc.org

22. …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

23. 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

24. 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

25. Development of National “Customizable” Performance Measure Fact Sheets

26. 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.

27. www.nedarc.org

28. NEDARC Faculty & Staff • 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

29. Why is data collection important?

30. 1993 IOM Report on EMSC “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.”

31. 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…) Improvereimbursement Obtain grant funding

32. NEDARC’s Goal: Data Collection 80% Response Required Using Data to HelpInitiate System Change Data Analysis Communicating the Data (Reports / Fact Sheets)

33. A Perfect Example Utah EMSC Aware of Equipment Performance Measure (XX) Disseminated a “Needs Assessment” with NEDARC’s help (Data Collection) Identified equipment that Providers were lacking such as – “Pediatric Backboards & Broselow Tape” 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

34. A Perfect Example 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 Pediatric Backboards and Broselow Tape distributed to all agencies in the State of Utah (System Change)

35. 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.

36. Introducing the EMSC Performance Measures

37. Performance Measures 71and 72 (formerly 66a)Medical Direction

38. 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.

39. 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.

40. Performance Measure 71 By 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.

41. 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.

42. 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. Performance Measure 72(Formerly 66a (part ii)

43. Performance Measure 72 By 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.

44. 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.

45. 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

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

47. Reporting DataPM 72 BLS Off-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 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-hospital provider agencies are included with BLS pre-hospital provider agencies AND NOT with ALS pre-hospital provider agencies. • 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.

48. National Analysis – Online Medical Direction 1114 2496

49. National Analysis – Offline Medical Direction 929 2852

50. 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.