Improving Pre-Hospital Care and Transport for Children with Special Health Care Needs

1. Improving Pre-Hospital Care and Transport for Children with Special Health Care Needs Justine Ropp RRT PPC Capstone January 25, 2011

2. Why this topic? • Identify family knowledge of EMS • Identify EMS knowledge for transporting children with special health care needs • Identify outside facilities knowledge of activating CHETA • Goal 4: Provide regional and national continuing education…based on identified needs

3. Process • Develop Questionnaire/Needs assessment • EMS • Families • Contact surrounding EMS to distribute questionnaires • Contact Families • Parent member of PPC Family involvement • Face to Face interview

4. EMT Levels • EMT-Basic • EMT -Paramedic

5. EMT- Basic (EMT-B) • Represents the first level of the EMS System • Receive 120-150 hours of training • Basic Life Support (BLS) skills • Assess a patients condition and manage respiratory, cardiac, and trauma situations • Usually restricted to using oxygen, glucose, inhalers, small volume nebulizers, and auto injectors

6. EMT-Paramedic • Receive 1,200-1,800 hours of training • Advanced Life Support (ALS) skills • All skills in EMT-Basic • Provide the most extensive pre-hospital care • administer drugs orally or intravenously • interpret EKG • perform endotracheal intubations • use complex equipment

7. EMT/Paramedic Questionnaire • Madison Fire Department • Rockford Fire Department • Waunakee • Deer Grove • Did not hear back from: • Green Bay • Racine • Middleton • Merrimac

8. EMT/Paramedic Response • 88% of responses were EMT-Paramedics • 18% of responses were EMT-Basics

9. EMT/Paramedic Age Comfort

10. Pediatric Experience

11. EMS Response-Family • Family/child visit station or obtain information prior to initiating call • Knowledgeable care provider able to ride in ambulance to assist with care/questions • Written instructions and medical information

12. EMS Response-PPC • Education • Seminars • In-services • Case Studies • Lectures from experts • Organize a peds bag • BiPAP training • Information on specialized equipment

13. EMS Response-Limitations • Lack of equipment options • BiPAP unavailable on ambulance • Cough machine • Lack or Pure Sine Wave Inverter to power Cough machine and BiPAP

14. FamilyQuestionnaire • Local families of SMA website • 0 response • Interviewed families in clinic and inpatient setting • 12 responses

15. Family Questionnaire-Response • 33% use EMS to transport to local hospital • 100% used own equipment • 66% feel they can transport faster and safer • 33% notified EMS of their child’s needs and residence • 25% notified EMS of their child’s equipment • EMS unable to support technology on rig

16. Family Questionnaire-Response • 50% of families are willing to provide in-services • 100% of families would like to be transferred to AFCH • 66% of families have heard of CHETA • 33% Feel they would be comfortable advising the outside facility how to activate CHETA • 16.7% of family believe their outside facility has knowledge of CHETA

17. Family Response-EMS • Things families feel EMS should be knowledgeable on • Cough machine • Suction • BiPAP • Bag mask ventilation • Willingness to take advice from families

18. Families perception of EMS weakness • No Knowledge of child's disease process • EMT’s afraid to touch and handle children • The ones that did, didn’t realize the lack of muscle strength

19. Recommendations for MovingForward

20. Moving Forward-PPC • PPC Provide education for local EMS • In-services and other forms of education opportunities for local EMS providers • Collaborate with other resources such as CHETA and MATC to provide simulation with scenarios and equipment • Provide Case Studies • Encourage EMS on Equipment recommendations • Pure Sine Wave inverter

21. Moving Forward-PPC Update discharge process to include contacting patients local EMS providers with pertinent information standardize form Meet with access center to understand each others needs in the process of transporting to AFCH patients diagnosis safest way to transport initiate CHETA at point of transporting to local hospital

22. Moving Forward-Families • Encourage families to: • Educate local community providers • Local care providers • Schools • Make contacts with their local EMS • Identify child’s needs • Review equipment

23. Outside Facilities • CHETA- outreach for medical training and technical assistance • Target regions with high census of children with special health care needs • Create a quick reference for families to give to outside facilities for initiating a transport. • Initiating CHETA at point of transport to local hospital

25. CHETA: Children’s Hospital Emergency Transport Ambulance • A critical care team with life support skills to bridge care between health care facilities • A vehicle equipped with state of the art technology and equipment designed specifically for pediatric patients • Transport services available 24/7 • 24/7Consultation with: • Pediatric critical care physician • Pediatric pulmonologist • How to activate CHETA: • To arrange transport or to speak to a pediatric critical care physician, call the Access Center at • 1-800-472-0111. • Bringing pediatric critical care to the bedside of children in a community or a referring hospital

26. Why Wait How can we relay importance of a specialized Pediatric Critical Care team (CHETA) to outside facilities • Pediatric Nurse • Pediatric Respiratory Therapist • CHETA RTs know neuromuscular protocol and how to care for these children

27. Moving Forward-CHETA • PPC Collaborate with CHETA to identify areas of improvement • CHETA makes connections with patients and families when they are in clinic or inpatient • CHETA reviews process for implementing with family • CHETA provides follow up with local hospital/EMT after transport

28. Questions