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The Emergency Medical Services for Children (EMSC) program is a national initiative designed to reduce morbidity and mortality in children due to life-threatening illness and injuries. In 1984, Senator Daniel Inouye and Senator Orrin Hatch developed initial legislation to support the EMSC program. In 1984 this federal legislation (Public Law 98.555) was enacted to fund EMSC programs in the states to address the emergency care of children. The Health Resources and Services Administration (HRSA) provides EMSC grant funding to help states develop existing hospital and Emergency Medical Services (EMS) systems so as to be better able to provide excellent care for critically ill and injured children. This is the only federal program that focuses specifically on the quality of children’s emergency care.
Approximately 30 million children are evaluated in Emergency Departments (ED’s) each year in the United States, of whom an estimated 1.5 to 3 million (5% - 10%) arrive by ambulances. Children account for approximately 10% of all Emergency Medical Services transports. Because the needs of children treated in the prehospital setting are different from those of adults, prehospital care providers must have appropriate equipment and training, along with safe and effective protocols to treat children. (Foltin et al. and the Prehospital Working Group of the Pediatric Emergency Care Applied Research Network, Priorities for Pediatric Prehospital Research, Pediatric Emergency Care, Volume 26, Number 10, October 2010 page 773, pec-online.com). According to the self-reported 2013 National Pediatric Readiness Project survey, in 2012 Delaware had a total of 452,061 Emergency Department visits, of which 89,388, or 19.8%, were pediatric patients.
Delaware was awarded its first EMSC grant through HRSA’s Maternal and Child Health Bureau in 1997. The Delaware EMSC program has been administered through the State Office of EMS via a contract with the Nemours Foundation /Alfred I. duPont Hospital for Children (N/AIDHC). The Delaware EMSC program works to maintain a high quality emergency care system that provides optimal care for ill and injured children. It assesses EMSC Performance Measures as directed by the federal program. Funds are used to provide staff to oversee and implement the program’s goals and objectives.
The Delaware EMSC Advisory Committee meets quarterly and is chaired by a pediatrician who also represents the EMSC program on the Delaware Emergency Medical Services Oversight Council (DEMSOC). Title 16, Chapter 97 of the Delaware Code was revised in 2012 to officially establish the Emergency Medical Services for Children (EMSC) Program within the Office of Emergency Medical Services, EMS and Preparedness Section, Division of Public Health. The EMSC Act of 2012 also defines the membership of the EMSC Advisory Committee and enables development of a Pediatric System Quality Program.
Delaware EMSC Program Accomplishments
Delaware’s Inclusive STATEWIDE PEDIATRIC SYSTEM Becomes a Reality
The initial phase of development of Delaware’s Statewide Pediatric System through recognition of Delaware’s hospitals as Pediatric Emergency Care Facilities was completed with a public ceremony held in February 2012. Every Delaware acute care hospital that treats children voluntarily chose to participate in this new program, which required them to meet state standards, submit a lengthy application, and be visited by a review team. Since 2007, the Division of Public Health’s (DPH) Emergency Medical Services for Children (EMSC) Standards Committee, a group of 19 Delaware clinical emergency care experts, worked to develop the statewide Pediatric Emergency Care Facility Recognition Program with the goal of standardizing and streamlining emergency medical care for children in the state. Development of such a program is a Performance Measure of the Health Resources and Services Administration (HRSA) national EMSC grant program. Delaware’s Standards Committee relied upon documents and regulations adopted in other states such as California, Illinois and Tennessee as models for the Delaware program. The purpose of having statewide pediatric standards for the emergency departments is to develop an organized system of emergency care for children.
“We are proud that every Delaware hospital has chosen to be part of this emergency care system for children,” said Dr. Karyl Rattay, DPH director. “This is an opportunity to recognize their commitment to excellence in pediatric care. Having an inclusive statewide pediatric system means that every child will receive the benefit of an entire system of specialized pediatric care if they should need it.”
The following hospitals were recognized as Delaware Pediatric Emergency Care Facilities:
The Level 1 facility is capable of providing comprehensive specialized pediatric medical and surgical care to all acutely ill and injured children. This facility serves as a regional referral center for the specialized care of pediatric patients.
The Level 2 facility is capable of identifying and stabilizing pediatric patients who are critically ill or injured and providing ongoing inpatient care or appropriate timely transfer to a Level 1 facility.
A Level 3 facility is capable of identifying and stabilizing those pediatric patients who are critically ill or injured and providing appropriate timely transfer to a higher level of care. Level 3 facilities have capabilities for the management of minor pediatric inpatient problems.
Like the Delaware Trauma System, the role of Delaware’s Pediatric System of care is to organize resources and assure their immediate availability to the target population at all times and in all geographic areas of the system. Studies have shown that the coordination of these resources which takes place as a system of care is developed can result in dramatic improvements in patient outcome.
According to the EMSC National Resource Center, Delaware is only the 5th state in the nation to successfully implement the Pediatric Emergency Care Facility Recognition Program, and the 3rd state to have all acute care facilities that treat children participating.
Since the first phase of the program, hospitals have developed and submitted written Pediatric Plans and are preparing for their second site visit. Recognition periods are for three years. The EMSC Quality Program has also begun to be developed through quarterly meetings, educational presentations, and data sharing.
All Delaware hospitals participated in the EMSC Targeted Issue Grant Project: “Evaluation of a Pediatric Emergency Care Facility Recognition Program on the Care of Injured Children”. The project was based at Wake Forest University School of Medicine, Winston-Salem, North Carolina, in partnership with the American College of Surgeons Committee on Trauma and Delaware and North Carolina EMSC Programs. The purpose of the project was to analyze and report on the care of injured children in states with and without a Pediatric Emergency Care Facility Recognition Program (PECF).
Although initially only six hospitals were needed, all the Delaware hospitals wanted to participate so the project was opened to all eight Delaware PECF hospitals. The project required three separate data collection periods - before, immediately after, and a year after PECF recognition. The project examined care of children with the most common injuries, looking at documentation of weight and vital signs, pain assessment and management, use of sedation, physical abuse screening, imaging, procedures and treatments, and utilization of consultants. Data analysis was provided to the individual hospitals for use in developing future performance improvement projects.
It is expected that the positive impact of PECF on the emergency care of children in Delaware will grow even more over time. Research articles are being readied for submission to several journals on various aspects of the project. Delaware’s 100% hospital participation is worthy of recognition, as is this opportunity for national attention on the success of Delaware’s Pediatric Emergency Care Facility Recognition Program and Statewide Pediatric System.
National Pediatric Readiness Project (NPRP) 2013 – 100% participation
Delaware’s eight acute care hospitals and two freestanding Emergency Departments (ED’s) participated in this assessment between May and July 2013. Participating hospitals and ED’s received immediate feedback to the online survey, a pediatric readiness score, and a gap analysis based on nationally recommended guidelines. The gap analysis covers administration/ coordination, staffing, quality/performance improvement, patient safety, policies and procedures, and equipment/supplies. Delaware’s median hospital pediatric readiness score out of 100 was 86 while the national median score of participating hospitals (4,143) was 69. Delaware’s excellent survey performance is at least partly due to Delaware’s PECF Recognition Program.
Nationwide EMS for Children Assessment 2013 – 100% participation
The Delaware EMSC Program completed an EMS needs assessment with technical assistance provided by the National EMSC Data Analysis Resource Center (NEDARC). The online EMS needs assessment was conducted between August and October 2013. 64 Delaware Basic Life Support (BLS) agencies that are licensed to respond to 911 calls and are patient ground transport units were asked to participate in the online survey. The survey involved assessment of the availability of the essential pediatric equipment on ambulances throughout Delaware, as recommended by five national organizations in the publication “Equipment for Ambulances” Pediatrics 2009; 124; e166. The assessment response rate was a success with 100% participation. All of Delaware’s 64 BLS EMS agencies (16 in Kent County, 24 in New Castle County and 24 in Sussex County) completed the assessment. It provides accurate counts of the total number of transporting ground vehicles (BLS) and each piece of nationally-recommended pediatric equipment that they carry.
Delaware’s 100% response rate on both surveys exceeded the federal EMSC program’s minimum required response rate of 80%.
The Delaware EMSC Program partnered with Safe Kids Delaware to provide this educational day on June 25, 2014 in Dover. Over 125 attendees participated as well as vendors from a variety of injury prevention agencies. This year’s conference presentations were “Caring for Children in a Disaster”, “Generation Rx” (Prescription Drug Safety), “Sudden Cardiac Arrest and Automated External Defibrillator Awareness”, and “How to Identify and Report Child Abuse and Neglect in Delaware”. The conference is designed to educate nurses, childcare providers, teachers, Emergency Medical Technicians, and other related professionals in topics related to the overall Safe Kids Delaware and EMSC goal of reducing preventable childhood injuries in our state.
For more information, please contact the program office.
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