Emergency Medical Services for Children

Administered by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), the Emergency Medical Services for Children (EMSC) Program is a national initiative designed to reduce child and youth disability and death due to severe illness or injury.

Program was established in 1984 with purpose of raising awareness about the importance of providing emergency medical care to children that corresponds to their physiological and psychological development. The Program targets primary and acute healthcare professionals, emergency medical services (EMS) and trauma system providers and planners, and the general public.

Background

Although the EMSC Program began almost 30 years ago, the larger emergency care system of which it is a part dates back to the Korean and Vietnam Wars. Medical experiences in both conflicts demonstrated that survival rates improve dramatically when patients are stabilized in the field and transported immediately to a well-equipped emergency facility. During the 1960s, civilian medical and surgical communities began to recognize the possibilities in applying these experiences within an organized EMS system.

Support for EMSC

In 1973, Congress passed the Emergency Medical Services Systems Act of 1973, establishing a program managed by HRSA to provide additional resources to state and local governments for implementing comprehensive EMS systems. Between 1975 and 1979, state EMS systems dramatically improved the outcomes for adults, however pediatric surgeons, pediatricians, and other concerned groups began to recognize that children’s outcomes did not keep pace.

In 1979, Calvin C.J. Sia, MD, then-president of the Hawaii Medical Association, requested the members of the American Academy of Pediatrics (AAP) to develop multifaceted EMS programs designed to decrease disability and death in children. Soon after, Senator Daniel Inouye (D-HI) joined Dr. Sia’s crusade after the daughter of his staff assistant Patrick DeLeon was hospitalized with meningitis. Her treatment demonstrated the shortcomings of average emergency department in treating a child in crisis.

Senators Orrin Hatch (R-UT) and Lowell Weicker (R-CT), backed by other staff members with similar disturbing experiences, joined Sen. Inouye in sponsoring legislation to create the EMSC Program.

In 1984, the U.S. Congress enacted legislation (Public Law 98-555) authorizing the use of federal funds for EMSC. Administered by MCHB, the EMSC Program provides states grant money to help develop and “institutionalize” emergency medical services for critically ill and injured children. The Program does not promote the development of a separate EMS system for children, but rather seeks to enhance the pediatric capability of existing EMS systems.

One year later, Congress appropriated initial funds for EMSC and the first program grant announcements were published. In 1986, EMSC awarded the first federal grants specifically earmarked to improve pediatric emergency medical services to Alabama, California, New York, and Oregon.

Federal EMSC Program

The federal EMSC Program is designed to ensure that all children and adolescents, no matter where they live, study, or travel, must receive appropriate care in a health emergency. Since its establishment, the EMSC Program has provided grant funding to all 50 states, including the District of Columbia, five U.S. territories, and three Freely Associated States. Additional EMSC Program funding has been used to establish national resource centers and to support the infrastructure for a pediatric emergency care research network. Grants and cooperative agreements funded by the program are outlined in the below table:

Grants and Cooperative Agreements Funded by EMSC	Description
State Partnership (SP) Grants	State Partnership grants fund activities to improve and integrate pediatric emergency care in a state EMS System. The typical applicant is a state government unless the State decides to delegate responsibility to an accredited school of medicine. Every grantee is required to collect and report data on program-defined performance measures.
Targeted Issue (TI) Grants	Targeted issue grants are intended to address specific needs, concerns, or topics in pediatric emergency care that transcend state boundaries. Grantees are typically schools of medicine looking to find new approaches to providing the best possible emergency care for children across the nation. Typically, the projects result in new products or resources, or demonstrate the effectiveness of model system component(s) or service(s) of value.
State Partnership Regionalization of Care (SPROC) Grants	The purpose of the SPROC grants is two-fold: (1) to continue its work with state governments and/or accredited schools of medicine to develop regionalized systems that encompass the sharing of resources and improve access to pediatric health care services for children and families in tribal, territorial, insular, and rural ares of the United States and (2) to develop "Models of Inclusive Care" that may be replicated in other regions where access to specialized pediatric medical treatment is limited due to geographical distances or jurisdictional borders.
Network Development Demonstration Project (NDDP) Cooperative Agreements	NDDP cooperative agreements demonstrate the value of an infrastructure or network that conducts multi-center investigations on the efficacy of treatment, transport, and care responses for children, including those preceding the arrival of children to hospital emergency departments. These cooperative agreements form the Pediatric Emergency Care Applied Research Network (PECARN). PECARN currently consists of six Research Node Centers that work collaboratively with Hospital Emergency Department Affiliates to develop and submit nodal research proposals and conduct PECARN-approved research at their respective institutions. In 2013, PECARN added an EMS demonstration node.
EMSC Data Coordinating Center (DCC)	Following the inception of PECARN, a cooperative agreement was awarded to the University of Utah to serve as a central repository for data generated by each of the PECARN research nodes and their hospital affiliates. The DCC also works with PECARN principal investigators to implement PECARN-wide standards for data collection and analysis in order to ensure uniformity and quality of the data and to monitor the safety and timely progress of PECARN studies.
National EMSC Data Analysis Resource Center (NEDARC)	Funded through a cooperative agreement, NEDARC provides technical assistance to EMSC grantees and state EMS offices in the areas of data collection, data analysis, data communication, quality improvement, grant writing, and research design.
EMSC National Resource Center (EMSC NRC)	Also funded through a cooperative agreement, the EMSC NRC focuses on dissemination and transfer of best practices in pediatric emergency care. This is accomplished by the following: identification of resources and model programs; development of interfacilty transfer guidelines/agreements and facility recognition; development of legislation and regulations; and dissemination and implementation of EMSC best practices.

EMSC Program Accountability

To measure the effectiveness of federal grant programs, HRSA requires grantees to report on specific performance measures related to their grant funded activities. The measures are part of the Government Performance Results Act (GPRA). In order to receive or continue to receive Program funds, all EMSC grantees must measure:

• Performance Measure 71: The percent of prehospital 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 72: The percent of prehospital provider agencies in the state/territory that have off-line pediatric medical direction available from dispatch through patient transport to a definitive care facility.

• Performance Measure 73: The percent of patient care units in the state/territory that have essential pediatric equipment and supplies as outlined in national guidelines.

• Performance Measure 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.

• Performance Measure 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.

• Performance Measure 76: The percentage of hospitals in the state/territory that have written interfacility transfer guidelines that cover pediatric patients and that include pre-defined components of transfer.

• Performance Measure 77: The percent of hospitals in the state/territory that have written interfacility transfer agreements that cover pediatric patients.

• Performance Measure 78: The adoption of requirements by the state/territory for pediatric emergency education for license/certification renewal of BLS/ALS providers.

• Performance Measure 79: The degree to which state/territories have established permanence of EMSC in the state/territory EMS system by establishing an EMSC Advisory Committee, incorporating pediatric representation on the EMS Board, and hiring a full-time EMSC manager.

• Performance Measure 80: The degree to which state/territories have established permanence of EMSC in the state/territory EMS system by integrating EMSC priorities into statutes/regulations.

Partnership Opportunities

Maintaining Partnerships with National and Professional Organizations. The Program works with a variety of national and professional organizations to identify and address the key issues affecting EMS, including but not limited to: managed care, disaster preparedness, children with special healthcare needs, mental health, family-centered care, and cultural diversity. The Program develops national task forces and publishes comprehensive reports drawing attention to many of these critical issues. Past examples of such collaborative work include the following:

1. In 2012, the American Academy of Pediatrics, the American College of Emergency Physicians, the Emergency Nurses Association, and the EMSC Program began an ongoing quality improvement project designed to promote the optimal care of children in all emergency departments (ED). In 2013, emergency departments (ED) across the nation voluntarily participated in an assessment of their department's readiness based on the 2009 Guidelines for the Treatment of Children in the Emergency Department (or National Guidelines). The assessment was conducted over a seven-month period and offered to every ED that treats children (approximately 5,000 nationwide). Immediately upon completing the assessment, facilities were given a pediatric readiness score and a gap analysis. The score represents the essential components needed to establish a foundation for pediatric readiness and is based on the six topic areas within the National Guidelines. The project’s assessment phase was completed in August 2013. More than 4,000 EDs participated, yielding a response rate of more than 80% (see http://www.PediatricReadiness.org/ for in-depth information about Peds Ready national results).
3. The American College of Surgeons Committee on Trauma, the National Association of EMS Physicians, the American College of Emergency Physicians (ACEP), and the EMSC Partnership for Children Stakeholder Group collaborated to revise the recommended equipment list for ambulances in the United States. This revised document will be used to evaluate the availability of pediatric equipment and supplies for Basic Life Support and Advanced Life Support patient care units.
5. Duke University and the AAP convened a multidisciplinary panel of experts to discuss recommendations to improve pediatric medication safety in the emergency department.
7. In partnership with the The George Washington University School of Public Health and Health Services Department of Health Policy, the NRC published the issue brief “The Application of the Emergency Medical Treatment and Labor Act (EMTALA) to Hospital Inpatients". The issue brief provides a brief overview of the Emergency Medical Treat¬ment and Labor Act (EMTALA) and focuses on its application to hospital inpatients.
9. In collaboration with the Federal Interagency Committee on EMS, the EMSC NRC conducted a Gap Analysis of EMS Related Research. This project, which involved a review of more than 270 articles, mapped existing literature to priorities described in national research agendas as a mechanism for assisting with the process of making informed decisions regarding policy and funding priorities.

Collaborating with Federal Organizations. The Program works with numerous federal agencies to improve the quality and quantity of EMSC research, to foster interagency collaboration in highlighting EMSC research topics within research agendas, and to reduce barriers impeding the production of high-quality EMSC research. The Center also collaborates with the Pediatric Emergency Care Applied Research Network (PECARN), the first federally funded pediatric emergency medicine research network.

Working with Healthcare Providers: Training and Education. The Program addresses contemporary pediatric emergency care issues such as family presence in the emergency department and pediatric disaster planning and preparedness from healthcare providers' perspective through the development of online training programs.

External links

• EMSC National Resource Center, a department within Children’s National Medical Center, Washington, DC.
• The National EMSC Data Analysis Resource Center, Salt Lake City, UT.
• Pediatric Emergency Care Applied Research Network, the first federally funded pediatric emergency medicine research network in the United States.