About Emergency Medical Services for Children

NATIONAL GOAL: By 2021, 80% of EMS agencies in the state submit NEMSIS version 3x-compliant patient care data to the State EMS Office for all 911-initiated EMS activations

Access to quality data and effective data management plays an important role in improving the performance of an organization’s health care systems. Collecting, analyzing, interpreting, and acting on data for specific performance measures allows health care professionals to identify where systems are falling short, make corrective adjustments, and track outcomes. Uniform data collection is needed to evaluate systems consistently and develop Quality Improvement (QI) programs.

NATIONAL GOAL: By 2020, 30% of EMS agencies in the state have a designated individual who coordinates pediatric emergency care.

The Institute of Medicine (IOM) report “Emergency Care for Children: Growing Pains” (2007) recommends that EMS agencies and emergency departments designate a pediatric emergency care coordinator (PECC) to provide pediatric leadership for the organization. This individual need not be dedicated solely to this role and could be personnel already in place with a special interest in the care of children who assumes this role as part of their existing duties.

Studies have found that EDs with a designated PECC are more prepared to care for children during times of emergent need and are more likely to report having important pediatric policies in place and a quality improvement plan than EDs that reported not having a PECC.

Within an EMS agency, the PECC should be a member familiar with the day-to-day operations and needs of the agency; however, there are a variety of models states can use to ensure that pediatric care is coordinated. If there is a designated individual who coordinates pediatric education and care for a region or county, that person could serve as the PECC for multiple agencies.

NATIONAL GOAL: By 2020, 30% of EMS agencies will have a process that requires providers to physically demonstrate the correct use of pediatric-specific equipment.

The Institute of Medicine (IOM) report “Emergency Care for Children: Growing Pains” (2007) reports that because EMS providers rarely treat seriously ill or injured pediatric patients, providers may be unable to maintain the necessary skill level to care for these patients. For a small rural state such as Vermont, those encounters can be even fewer and farther between; for example, in 2016, roughly 5% of all of Vermont’s 911-initiated calls were for pediatric patients (ages 0 days – 18 years old).

As a result of this low volume, learned skills may deteriorate over time, even back to baseline levels as early as six months after a specialized pediatric education course (Su, 2000). Continuing education – PALS, PEPP, APLS, etc. – is vitally important for maintaining skills and is considered an effective remedy for skill atrophy. Still, these courses are typically only required every two years. More frequent and varied practice methods are necessary for EMS providers to ensure readiness to care for pediatric patients when faced with these infrequent encounters.

NATIONAL GOAL: By 2022, 25% of hospitals are recognized as part of a statewide, territorial, or regional standardized program that can stabilize and/or manage pediatric medical emergencies.

The recognition program need not be mandated; voluntary recognition programs are acceptable.

Performance Measure 04:

1. Emphasizes the importance of the existence of a standardized statewide, territorial, or regional system of care for children that includes a recognition program for hospitals capable of stabilizing and/or managing pediatric medical emergencies.

2. Helps to ensure essential resources and protocols are available in facilities where children receive care for medical and trauma emergencies and can facilitate EMS transfer of children to appropriate levels of resources

3. Can include verification processes to identify facilities meeting specific criteria, which has been shown to increase the degree to which EDs are compliant with published pediatric readiness guidelines and improve pediatric readiness statewide.

NATIONAL GOAL: By 2022, 50% of hospitals statewide are recognized as part of a statewide, territorial or regional standardized system that recognizes hospitals that are able to stabilize and/or manage pediatric trauma emergencies.

The recognition program need not be mandated (though it is preferred the state has a trauma program or registry); voluntary recognition programs are acceptable.

Like EMSC Performance Measure 04, this performance measure is intended to emphasize the importance of a standardized, statewide system of care for the unique needs of pediatric patients in times of a trauma emergency. Considering trauma emergencies are a majority of the reason 911 calls are initiated for children, disparities in equipment, supplies, and training are of concern.

The EMSC Program continues to champion efforts to ensure that the ability to stabilize and/or manage pediatric trauma is fully integrated into all trauma systems statewide.

NATIONAL GOAL: By 2021, 90% of hospitals in the state have written interfacility transfer guidelines and agreements that cover pediatric patients and that include specific components of transfer.

Ensuring that children receive optimal care, and timely transfer to a specialty care center is essential. Such transfers are better coordinated through the presence of interfacility transfer agreements and guidelines (IFT A/G). Timely access to pediatric specialty services for a child in the acute stages of illness or injury is critical to reducing morbidity and mortality.

Most children are treated first in a local community hospital, which may not have all the processes, staff, and equipment needed to provide specialty pediatric care. When this is the case, a critically ill or injured child will need to be transferred rapidly from the referring facility to a more specialized receiving facility. IFT A/G in place facilitates the patient transfer process through written steps and procedures among hospitals and facilitates cooperation between hospitals across the state, as well as in cases of surge capacity in the event of a disaster or mass casualty event.

NATIONAL GOAL: To establish permanence for the EMSC Program in the state by establishing 1) A state EMSC Advisory Committee that meets regularly, 2) a pediatric representative on the state EMS Board, and 3) a full-time EMSC program manager for the state.

Establishing the long-term success of the EMSC program in the state EMS system is important for building the infrastructure of the EMSC Program. An EMSC Advisory Committee (comprised of eight core members representing prehospital and pediatric care in many forms) is crucial in steering decisions and implementing plans that ensure that EMSC priorities are addressed.

NATIONAL GOAL: EMSC priorities will be integrated into existing EMS or hospital and healthcare facility statutes or regulations.

For the EMSC program to be sustained in the long term and reach permanence, it is important for the program’s priorities to be integrated into existing state mandates. Integration of the ESMC priorities into mandates will help ensure pediatric emergency care issues and/or opportunities are addressed statewide for the long term.