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Emergency Care for Children

Emergency Care for Children. Community Pediatrics: Legislative Advocacy May 2008 Emily Greenstein MD Clement Bottino MD. A Public Health Problem. Injury is the #1 cause of death for children in the United States.

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Emergency Care for Children

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  1. Emergency Care for Children Community Pediatrics: Legislative Advocacy May 2008 Emily Greenstein MD Clement Bottino MD

  2. A Public Health Problem • Injury is the #1 cause of death for children in the United States. • In 2004, injury accounted for 60% of all deaths in children younger than 18 years. • Each year, 1 in 4 children sustain an unintentional injury that requires medical care.

  3. Kids In Adult ERs • Most hospitals do not have a separate pediatric facilities (PICU) • 10% of hospitals without a PICU admit critically injured children to their ADULT ICUs • Few hospitals have protocols for obtaining pediatric consultation on pediatric emergencies.

  4. Kids In Adult ERs Evidence basis: • Athey, J., et al. “Ability of hospitals to care for pediatric emergency patients.” Pediatric Emergency Care. 17(3):170-174, June 2001 • “Appropriately sized equipment for successful care of infants and children in an emergency situation was more likely to be missing than adult-sized equipment” • Many hospitals did not have adequate equipment to care for newborn emergencies

  5. History • 1970s - initial legislative advocacy: • Calvin Sia, M.D., president of the Hawaii Medical Association • Urged AAP to develop EMS programs that would decrease illness and death in children • Worked with Hawaii state legislature to accomplish this

  6. History • 1984: • Senators Orrin Hatch (R-UT) and Lowell Weicker (R-CT) joined Senator Inouye (D-HI) in sponsoring the first EMSC legislation • C. Everett Koop, M.D. and the AAP strongly supported this measure • Under Section 1910 of the Public Health Service Act, the U.S. Congress enacted legislation authorizing the development of the Emergency Medical Services for Children (EMSC) Program

  7. History • 1986: • Alabama, California, New York, and Oregon became the first recipients of Federal grant money specifically earmarked to improve pediatric emergency medical services This is the Emergency Medical Services for Children (EMSC) Program!

  8. So what is EMSC? “Mission Statement”: • To ensure that all ill and injured children and adolescents receive state-of-the-art emergency care • This includes: • primary prevention • Pre-hospital care • Emergency care • Acute care • Rehabilitation

  9. So what is EMSC? Administered by: • The U.S. Department of Health and Human Services' Health Resources and Services Administration • in collaboration with – • The U.S. Department of Transportation's National Highway Traffic Safety Administration

  10. So What is the EMSC? What does it do exactly? • The EMSC Program provides grants to States and U.S. territories to improve existing emergency medical services (EMS) systems • and - • To develop and evaluate improved procedures and protocols for treating children

  11. So What is the EMSC? • The EMSC Program is the only Federal program that focuses specifically on improving the quality of children's emergency care • Since its establishment, the EMSC Program has allocated $138 million to fund 851 grant awards and…  child injury death rates have dropped by 40 percent!

  12. Where Are We Now? April 8, 2008: • The House of Representatives approved HR 2464, the Wakefield Act, by a vote of 390-1

  13. Where Are We Now? The Wakefield Act: • This bill reauthorizes the EMSC Program for five years! • 2009: $25,000,000 • 2010: $26,250,000 • 2011: $27,562,500 • 2012: $28,940,625 • 2013: $30,387,656

  14. Where Are We Now? But To Become Law: • Both the House and the Senate must vote on, and pass, their respective versions of the bill!! • To date, no action has occurred on S 60, the Senate version of the Wakefield Act

  15. What is the AAP’s Position? AAP Position #1 - Congress’ Role: • Congress must invest in: • creating effective local, state and federal disaster response systems • a healthy, adequately funded, well-coordinated and functional emergency medical services system

  16. What is the AAP’s Position? AAP Position #2 - The MD’s Role: • Disaster Planning: • “Primary care pediatricians and pediatric medical and surgical subspecialists should be included in emergency and disaster planning” • “This should occur at every organizational level, at all levels of government, and in all types of planning”

  17. What is the AAP’s Position? AAP Position #3 - Pediatric Casualties: “Federal, state and local disaster plans should include specific protocols for the management of pediatric casualties, including strategies to: • Minimize parent-child separation and implement systems for the timely and reliable reunification of families • Improve the level of pediatric expertise on disaster response teams • Address the care requirements of children with special health care needs • Ensure the inclusion of pediatric mass casualty incident drills in both federal and state planning

  18. What is the AAP’s Position? AAP Position #4 - Funding: • “The Emergency Medical Services for Children (EMSC) program should be reauthorized • Ultimately funded at the level of $37.5 million per year • As recommended by the Institute of Medicine report, to support the continued improvement in pediatric emergency and disaster preparedness”

  19. How does this affect you? • Case Examples from the ED: • School bus accident • The Black-Out • September 11

  20. Write a Letter! The EMSC Program • Support HR 2464, the Wakefield Act, and advocate for your pediatric patients! • May 21 is “EMSC Day 2008”

  21. Or an Email! • http://clinton.senate.gov/contact/webform.cfm?subj=issue • Dear Senator Clinton: • I am a Resident in Pediatrics at a children’s hospital in New York City. I am writing to ask that you support HR 2464 / S 60, the Wakefield Act, which will reauthorize funding for the Emergency Medical Services for Children (EMSC) Program • Congress must invest in creating effective state disaster response systems and an emergency medical services system that is healthy, adequately funded and well coordinated – and one that can meet the specific needs of New York’s children. • I think that this is an important bill because I believe in the importance of the health and safety of our children. • Thank you for your support.

  22. International Pediatric Trauma • Myanmar: • May 3 cyclone kills 62,000 - 100,000 people • 1.5 million survivors

  23. International Pediatric Trauma • China: • May 12 earthquake kills at least 10,000 people

  24. Pediatric Rescue/Relief • UNICEF: www.unisefusa.org • Save the Children: www.savethechildren.org

  25. References • Emergency Medical Services for Children National Resource Center • http://bolivia.hrsa.gov/emsc/index.aspx • Press Statement on Legislation to Reauthorize Emergency Medical Services for Kids • http://www.aap.org/advocacy/washing/05-23-07-emsc-statement.pdf • Images • www.nytimes.com

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