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OCR for page 379
INDEX
OCR for page 380
OCR for page 381
A
Access to care, 5, 33-34
federal EMS-C center and, 287-288
health care system and, 326
in medical home concept, 32-33
primary care services, 288, 331
reimbursement issues in, 288
state EMS-C agencies and, 303
Access to emergency services, 84
9-1-1 systems and, 12-13, 188-189,
195
for physicians, 131, 148 n.9
for prehospital providers, 126-127
Activities of daily living assessment,
244, 263 n.9
Acuity. See Assessment/diagnosis;
Illness~es); Injuries
Adolescents
emotional and behavioral
development, 42
mental health emergencies, 55
poisoning mortality, 49
public education in, 111-112 Advanced Pediatric Life Support
Accreditation Council for Graduate (APLS), 9, 81, 119, 134, 141, 159
Medical Education, 9, 94, 131, 148 Advanced Trauma Life Support, 81,
n.9
Accreditation of facilities
in categorization, 172
data collection and, 233, 239
See also Categorization of hospital
capabilities; Joint Commission on
Accreditation of Healthcare
Organizations
Accreditation of training programs, 9
for nurses, 130
in pediatric emergency care, 80-81,
93-94, 130
134
Advisory Councils, 18- 19, 324
national EMS-C, 17, 283, 297-298,
319 n.ll
recommendations for, 17, 283, 284
state EMS-C, 17, 306-308
Advocacy, 310-311
Agency for Health Care Policy and
Research, 254, 286, 291
Alcohol use, 49
Ambulatory Pediatric Association, 80,
219, 283
381
OCR for page 382
382
American Academy of Orthopaedic
Surgeons, 70, 115, 219
American Academy of Pediatrics, 32,
39, 70, 80-81, 92, 94, 109-110,
113, 119, 153, 178, 219, 283
American Association of Critical Care
Nurses, 129'219
American Association of Poison
Control Centers, 13, 198, 236
American Board of Emergency
Medicine, 81, 131
American Board of Pediatrics, 80-81,
131
American College of Emergency
Physicians, 70, 74, 80-81, 94, 115,
119, 153, 167, 200, 211, 219, 262
n.3, 283
American College of Surgeons, 70, 74,
78, 81, 172, 219, 283
American Heart Association, 74, 75, 81,
94, 111, 114, 119, 120
American Hospital Association, 46, 75,
81, 90, 94
American Medical Association, 70, 94,
153, 172, 185-186 n.6
American Nurses Association, 94, 130
American Pediatric Surgical
Association, 138
American Public Health Association,
241
INDEX
mortality predictors, 270
9- 1 - 1 systems in, 188
of outcomes, 244-245
pediatric-specific scales for, 234,
267-268, 269, 271-272
protocols for prehospital care, 159-
160
by public, of emergencies, 7, 46, 109
reliability and validity of, 242-243
research topics in, 257
training in, for health care providers,
120, 121-122, 135
triage, 158, 160-162, 163-165, 268-
269
Associated Public-Safety
Communications Officers (APC())
189, 219
Association of Air Medical Services,
219
Asthma
-,,
National Asthma Education Program,
117
research topics in, 256-257
See also Chronic illnessfes);
Respiratory illness
B
Backboards, 154
Bag-valve-mask devices, 151
American Red Cross, 94, 111, 114, 115 Basic life support, 40
American Society for Testing and equipment costs, 155
Materials, 94, 189-190, 238
American Trauma Society, 70, 219
Americans with Disabilities Act, 191
Anaphylaxis, 117, 147 n.4
Anatomy, of children vs. adults, 41, 151
Antishock garments, 154, 256
Arkansas, 57, 152, 174, 237
As se s sment/diagnosis
activities of daily living measure in,
244, 263 n.9
of children, 41-44
of emergencies, 46-47, 51
illness severity measures, 270-273
injury severity measures, 265-270
for medication dosages, 151
medical control in, 167- 168
skills training for prehospital
providers, 121, 122, 133
Behavioral development, 42
Bicycle helmets, 110, 113, 116, 147 n.3
Birth-related conditions, 45, 51
long-term effects of premature birth,
53
Broselow Tape, 151
Burns. See Fire-related injuries
C
California, 6, 27, s7' 79, 89, 116, 173,
174, 207-208, 210, 246, 299
OCR for page 383
INDEX
Cardiac arrest
in children vs. adults, 43
treatment of, 68
Cardiopulmonary resuscitation, 7, 43,
69, 133
protocols, 165
public education in, ~ ~ I' ~ 14
recommendations for training, 8, 9,
118, 127, 128
required training, 116
research topics in, 256
retention of skills, 142-143
telephone instruction in, 159, 185 n.3
Categorization of hospital capabilities
case example, 173- 174
definition, 11, 150
elements of, 170-171
government involvement in, 184-185
for pediatric emergency care, 172
173, 185 n.6
processes for, 171 -172
recommendation for, 11- 12, 182
in rural areas, 182
Centers for Disease Control and
Prevention, 78, 219, 231
Cervical collars, 151
Child abuse/neglect
in emergency department protocols,
165
model organizations in, 295-296
prevalence, 56
reported mortality in, 48-49, 64 n.3
Children
anatomy of, 41
assessment of, 43-44
behavioral development, 42
definition of, 3, 39-40
emotional development, 42
mortality/morbidity patterns in, 43
physiology of, 41-42
treatment of, 3-4, 44-45
Children Can't Fly, 218, 323
Children's EMS Alliance, 219
Children's National Medical Center,
119, 134, 135, 295
Chronic illnessfes), 4, 51
emergency care for children with, 45,
53-55, 117
383
preventive care, 110-111
Clinical practice guidelines, 137, 157
See also Protocols
Committee on Allied Health Education
and Accreditation, 94, 127
Communication
with colleagues, 217, 219-221
within EMS systems, 12- 13, 216-217
facsimile (FAX), 208
with managed care providers, 212-213
with medical specialists, 205-208
on-line medical control, 203-205
in patient transfer, 209-211
in prehospital care, 200-205
with primary care providers, 206,
211-212
radio frequency availability and, 201-
202, 223 n.4
role of, 187-188
state regulation of, 87-88
technologies, 201-203, 208
See also 9-1-1 systems
Confidentiality. See Privacy and
confidentiality issues
Congenital anomalies, 51
Consolidated Omnibus Budget
Reconciliation Act (COBRA) of
1985, 78, 164-165, 223 n.6, 330
Consultation
guidelines for, 207-208
local, 206-207
with national specialists, 207-208
with referral centers, 175, 207-208
telephone hot lines for, 208
Consumer Product Safety Commission,
77, 236, 287
Continuing education. See Professional
training
Continuity of care, 32-33, 211-216
Coordinating Council on Juvenile
Justice and Delinquency
Prevention, 296-297
Costs
asthma care, 5, 62
data needs, 225, 227, 290-291
EMS-C system, 313, 324-325
of equipment, 155- 156
OCR for page 384
384
federal EMS-C center in tracking,
290
of health care, 326
for illness-related emergencies, 62
for injuries, 61-62
nonmonetary, 62-63
research topics in, 257
trauma component, 62
uncompensated care, 78, 177, 328-329
CPR. See Cardiopulmonary
resuscitation
Critical care. See Intensive care;
Pediatric intensive care units
D
Data collection and analysis
claims records, 234-235, 262 n.5
costs in, 241, 251-252
data needs for EMS-C systems, 14
16, 225-227
death records, 235-236
defining data elements, 238-239, 247
248, 250
diagnostic data, 15, 46, 64 n.l, 232,
242
emergency department data, 231-232,
240-241, 275
by EMS-C demonstration projects,
237
for EMS system planning, 14- 16,
228, 250, 262 n.2
for evaluation, 228-229, 250-251,
262 n.2
goals for, 85, 234, 252-254, 260
hospital data, 231-233
hospital discharge records, 232, 240
241
implementation, 251-252
linking data, 235, 239, 240, 246, 262
n.5
motor vehicle crash data, 236-237
National Electronic Injury
Surveillance System, 236
national uniform data set for EMS-C,
246-251, 274-279
obstacles to, 251 -252, 319 n. l 3
INDEX
for outcomes assessment, 15, 244
245, 263 n.8
in patient transfer, 209
pediatric-specific injury scales, 234
performance indicators, 233
personal identifiers, 239-240
poison Castro! centers, 236
prehospital services, 122, 230-231,
238, 275
privacy and confidentiality issues,
240, 245-146, 263-264 n.ll
recommendations, 15, 16, 241, 246,
250
reliability and validity of data, 241
243, 262 n.6, 263 n.7
for research, 229-230, 252-254
role of federal EMS-C center, 287,
289-290
shortcomings in, 224-225, 226, 237
239
by state agencies, 302-303, 319 n.l3
technical assistance for, 250, 292-293
trauma registries, 233-234, 262 n.4
UB-92, 232, 241
uniformity of data elements in, 238
239
violent crime, 237
vital statistics, 235-236
See also Medical records; Privacy
and confidentiality issues
Dental education, 147 n.6
Department of Agriculture, 287
Department of Commerce. See
Consumer Product Safety
Commission
Department of Defense, 93, 287, 317
n.2
Department of Education, 287
Department of Health and Human
Services, 2, 5, 17, 18, 28, 78, 115,
231, 254, 283-284, 286
federal EMS-C center prototypes in,
294-295
Department of Justice, 18, 296
Department of Transportation. See
National Highway Traffic Safety
Administration
OCR for page 385
INDEX
Developmental stages, 42
prevention and, 111
Diagnosis. See Assessment/diagnosis
Diagnostic coding
for emergencies, 15, 46
for emergency department visits, 4
64 n.l, 240~-~41
for illness-related emergencies, 46,
242
for injuries, 46, 232
limitations of, 242-243
for mechanism of injury, 240-241
N-codes, 242, 278
recommendation for, 15, 241
value for injury prevention, 323
See also E-codes
Disaster preparedness, 165
Discharge data, 46, 232, 240-241
Dispatchers, EMS
in 9-1-1 systems, 193-194
protocols for, 158-159, 185 n.2, 194
telephone instructions from, 158-159,
185 n.3
training for, 122- 123
See also Prehospital care
District of Columbia, 49, 166, 215, 332
Drownings, 48, 49, 53, 61, 117
Drug abuse, 49
Drug Abuse Warning Network, 231
E
E-codes, 15, 64 n.l, 232, 240-241, 242,
278
recommendation for use, 15, 241
Education. See Professional training;
Public education
Emergency care
for children with chronic illnesses, 45
cost of, 61-62
demand for, 53-55, 55-56, 328-329
in emergency departments, 58-59, 90-
91
follow-up care, 214-215
inpatient care, 59-61, 90-91
managed care organizations in, 195-
196, 212-213
385
for mental health problems, 55
nonmonetary costs of, 62-63
in office-based settings, 56-57
parents in, 45, 84, 108-109
patient compliance after, 214
in prehospital settings, 57-58, 89-90
by primary cam provoke, 92
quality assurance in, 262 n.3
related to violence, 55-56
research topics in, 256-257
role of, 1, 27
shortcomings in, 1-2, 27-28
staff shortages, 287-288, 329
training for, 118- 119
triage protocols, 163- 165
in urgent care clinics, 91-92
Emergency department approved for
pediatrics (EDAP), 27, 75, 79,
173-174
Emergency departments, 74, 75, 85, 90-
91, 332-334
communication with medical
specialists, 205-208
data collection from, 231-232, 248,
275, 278-279
as health care gateway, 332-333
managed care providers and, 212-213
primary care in, 34, 212, 288, 332-
333
recommendation for equipment, 10,
154
role in medical control, 162-163
telephone advice from, 199-200
training needs, 123-124
triage, 163- 165
use of, 58-59
waiting times, 163, 164
See also Emergency care
Emergency Medical Services for
Children Program, 2, 82, 219-220,
315
grants awarded, 103-107
Emergency Medical Services Systems
Act of 1973, 5, 6, 71, 76, 83
Emergency medical technicians
(EMTs), 69, 73, 81, 86, 90, 123
authorized procedures, 154, 159
OCR for page 386
386
recommendation for training, 9, 127
training for, 1 19, 121, 126-127
See also Prehospital care
Emergency Nurses Association, 70, 80,
81, 94, 1 19, 128, 129, 135, 200,
219, 283
Emotional development, 42
EMS agencies, 86-87
data collection by, 230-231
definition of, 40
local-level, 89-90
origins of, 71
role of, in EMS-C, 284
state-level, 86-87
EMS-C
benefits, 322-324
challenges to, 21-22, 27-28
cost-benefit analysis of, 20, 290, 313
314
cost of, 321-322, 324-325
data collection and analysis, 14-16,
224-227, 246-252
definition of, 40
demonstration projects, 2, 6, 28, 82,
103-107, 117-118, 135, 157, 208,
220, 237, 282, 320 n.l7
early developments in, 2, 5-6, 27, 28,
69, 74-75, 79-83, 93-94
EMS and, 3, 32, 84-85, 283
equipment needs in, 150-155
essential services, 6, 84
evaluation of, 224-229
federal center for, 16, 17, 18, 19,
252-253, 283-285
health care reform and, 20-21, 325
328, 334 n.1
medical home and, 32-33, 84, 206,
212
national uniform data set for, 238
239, 246-251, 289-290
population to be served by, 3, 30-31
primary care providers in, 33, 56-57,
92, 166, 206, 331-332
protocols for, 10-1 1, 156-157
public education on use of, 111
112
research agenda, 252-254
INDEX
role of, 1-2, 3, 6, 30-31, 33-34, 36
37, 84-85, 322-324
system linkages, 3, 12-14, 30, 31-33,
36-37, 283, 324-325
EMS-C agencies, state, 17, 298-300,
305, 319 n l2
access to care and, 303
accountability in, 304-305
data collection and analysis role of,
302-303, 319 n.l3
definition of, 319 n.l2
in education and training, 301
EMS-C guideline development, 302
in interstate coordination, 303-304
medical control and, 302
models for, 305, 308
obstacles to, 308-310
in planning state programs, 300
recommendation for, 17, 284
value of, 310-313
EMS-C center, federal, 284-285
advisory council for, 17-19, 297-298,
319 n.ll
alternatives to, 317-318 n.3
clearinghouse services, 220, 287,
289
in coordinating federal efforts, 286
287
data collection and analysis role, 16,
289-290
funding, 1 9, 314-31 6
in improving access to care, 287-288
models for, 293-297, 318 n.9
need for, 283-284
in professional education, 288-289
in promoting interstate coordination,
293
recommendations, 16, 17, 19, 250,
283
research role, 288, 290-291
responsibilities of, 18, 284-293
state activities and, 291-293
technical assistance from, 292-293
value of, 310-31 1
EMS-C National Resource Center, 220,
295
EMS-C Resource Network, 295
OCR for page 387
INDEX
EMS systems
advocacy groups, role of in
developing, 94-95
block grant funding, 76-77, 96, 99
n.4, 318 n.7
definition of, 40
development of, S-6, 27
dispatcher protocols in, 158- 159
EMS-C and, 3, 32, 74-75, 79-83
functions of, 6, 71, 83
funding for, 95-96
historical development, 5-6, 27, 66,
74-75, 83, 97-98
hospitals in, 90-91
local and regional activities in, 89-93
need for protocols in, 157
organizational structure, 85-86
primary care providers in, 92
private enterprise in, 89
range of services in, 40-41
regionalization of, 71, 73
state-level activities, 86-89
trauma care in, 78-79
urgent care clinics in, 91-92
See also EMS-C
Endotracheal tubes, 154
Epidemiology
of childhood emergencies, 45-47, 63-
64
of illness, 51-55
of injury, 47-51
research topics in, 259
Equipment. See Medical equipment/
supplies
External cause-of-injury codes. See E-
codes
F
Facsimile (FAX) communication, 208
Federal Communications Commission,
202, 223 n.4, 287
Federal efforts
"anti-dumping" regulations, 21, 78,
164-165, 223 n.6, 329-330
in categorization/regionalization,
184-185
387
coordination of, for EMS-C, 286-287
in development of EMS-C, 28-29,
81-82, 282-283
in development of EMS systems, 5
6,70-73, 76-77, 96, 282-283
EMS-C demonstration projects, 2, 6,
28, 82' IO3~07, 117~-18, 135,
157, 208, 220, 237, 282, 320 n.l7
in injury prevention, 70, 77-78, 115,
218-219
models for federal EMS-C center,
294-297
in 9- 1 - 1 systems, 197
in public education, 111, 112, 115, 117
recommendations for, 17-18, 19, 250,
283, 314
state efforts and, 311-313, 319-320
n.l6
See also EMS-C center, federal
Federal Emergency Management
Agency, 287
Fire departments, 89
Fire-related injuries, 48, 49, 62, 117,
215, 223 n.7
First responders, 86, 121, 122, 126, 247
See also Prehospital care
Florida, 119, 134-135, 189, 208
Funding, 19, 312
cost-benefit analysis and, 20, 313-314
for data collection, 252
of Emergency Medical Services for
Children Program, 82, 103, 315,
320 n.l7
EMS-C, 321-322, 324-325
in federal efforts, 71, 76-77, 79
federal EMS-C center in tracking,
290-292
Preventive Health and Health
Services Block Grant, 76, 99 n.4
for professional information
exchange, 220
for professional training, 144
recommendation for, 19, 314
Robert Wood Johnson Foundation, 73
in state efforts, 72, 95-96, 99 n.5,
309-310
state EMS-C agencies and, 305-306
OCR for page 388
388
G
Glasgow Coma Scale, 271, 275
H
Hawaii, 55, 95, 208
Head injury
in children vs. adults, 41, 43
long-term effects, 50, 51
mortality, 50 prevalence, 43
research topics in, 256
sources of, 50, 116
Health Care Financing Administration,
· 263 n.10, 287, 320 n.l6
Health care professionals
communications among, 219-220
in delivery of emergency services, 86
in EMS-C systems, 36
pediatric emergency care training for,
8-9, 128
prehospital providers, 121
professional organizations for, 219
recommendations for training, 9, 127,
128, 130, 131
specialist consultations, 205-208
See also Emergency medical
technicians; Nurses; Paramedics;
Primary care providers
Health care reform, 20-21, 325-328,
334 n.l, 334-335 n.3
Health maintenance organizations
(HMOs), 152, 195-196, 212-213,
223 n.3
See also Managed care organizations
Health Resources and Services
Administration (HRSA), 2, 6, 28,
103, 117, 218, 254, 282-283
Health Services, Preventive Health
Services, and Home and
Community Based Services Act of
1984, 82
Highway Safety Act of 1966, 69
Home care, 5, 55
Homicide, 48, 49
as child abuse, 64 n.3
firearms in, 5, 55-56
statistics, 55-56
INDEX
Hospitalizations, 26, 59-60
community-specific factors in, 55, 60
for head injury, 43, 59
for illness, 51-53, 59-61
for injury, 4, 49, 55, 59-61
intensive care, 60-61
pregnancy-related, 55
for respiratory illness, 4, 51-53
See also Transferring patients;
Triage
Hospitals
categorization of capabilities, 171
174
communication in, 13, 205-207, 208,
216-217
data collection in, 46, 231-234, 274
275
in EMS system, 27, 31, 90-91
inpatient staff protocols, 165- 166
minimum levels of care in, 21
outpatient staff protocols, 166
patient transfers and, 21, 164- 165,
165-166, 176, 209-211
regional coordination of services, 91,
175-182
in rural areas, 91, 182
trauma centers in, 78-79, 90, 176-177
See also Emergency departments;
Pediatric intensive care units;
Pediatric trauma centers
1
ICD-9-CM. See International
Classification of Diseases
Idaho, 88, 139, 202, 299
Illness(es)
assessing in children, 43-44
bringing attention to, 288
chronic, 51, 53-55
cost of emergency care for, 62
emergency care in office settings, 56
57
emergency department visits, 58-59
epidemiology, 4, 51-55
hospitalizations for, 53-55, 60
mortality, 1, 51
OCR for page 389
INDEX
prehospital care for, 57
prevention of, 110-111
respiratory, 4, 26, 41-42, 51-53, 59,
117, 151
severity measures, 161, 243, 257,
270-273, 288
500~ographic patches, 327
triage protocols for, 161, 163
Immunization, 110
Indian Health Service, 93, 254, 286
Infants, assessment of, 44
Injuries
assessing in children, 43-44
cost of emergency care for, 61-62
definition, 47
emergency department visits for, 49-
50, 58, 59
epidemiology, 4, 47-51, 64 n.2
field triage protocols, 161 - 162, 163,
fire-related, 48, 49, 62, 215, 223 n.7
head, 41, 43, 50, 51
hospitalizations for, 26, 49-50, 59
intentional vs. unintentional, 47-49
long-term effects, 50-51, 64 n.5
mortality, 1, 26, 38, 47-48, 49-50
motor-vehicle related, 47-48, 49
prevention programs, 110-111, 112-
116, 218-219, 258-259
severity measures, 265-270
triage protocols for, 161-162, 163-
164
Injury Prevention Program, The (TIPP),
113, 115
Institute of Medicine, 2, 28-29, 263-264
n.ll, 303, 319 n.l3, 319 n.l6, 334-
335 n.3
Intensive care, 176-177, 207-208, 334
n.4
See also Pediatric intensive care
units; Pediatric trauma centers
International Association of Fire Chiefs,
219
International Classification of Diseases
(ICD-9-CM), 15, 46, 232, 240-241,
242, 260
shortcomings in, 242
International concerns, 293
389
Intraosseous needles, 154
IV equipment, 151
J
Joint Commission on Accreditation of
Healthc~are Organizations, 39, 93
94, 233, 239, 262 n.3
K
Kempe National Center for Prevention
and Treatment of Child Abuse and
Neglect, 295-296
L
Legal issues
in interstate regionalization, 180- 181
in 9-1-1 systems, 196-197
in patient transfer, 21, 164-165, 223
n.6, 329-330
privacy and confidentiality, 245-246
telephone advice, 199
M
Maine, 138, 152, 173, 237
Major Trauma Outcome Study, 43, 233,
238
Managed care organizations
emergency department
communication with, 212-213
9-1-1 systems and, 195-196, 223 n.3
Maryland, 6, 27, 75, 78, 83, 88, 271,
299
Massachusetts, 49, 50
Maternal and Child Health Block Grant,
96, 320 n.17
Maternal and Child Health Bureau, 115,
147 n.l, 218, 223 n.5, 282, 286,
295, 320 n.l7
See also Health Resources and
Services Administration
Medicaid, 78, 95, 96, 181 - 182, 213,
235, 241, 287, 288, 293, 303-304,
305, 319 n.l5, 324, 328-329, 332
OCR for page 390
390
Medical care
specialized, 4-5, 45, 60-61, 130, 131,
147-148 n.8, 177-178
See also Assessment/diagnosis;
Emergency care
Medical control, 184
definition 150
emergency department protocols'
162-163
mobile intensive care nurses, 129,
203-204
need for pediatric expertise in, 169
170
off-line, 11, 167, 169- 170
on-line, 11, 13, 167, 168-169, 203
205
role of, 167-168
state EMS-C agencies and, 302
Medical equipment/supplies, 150- 151
cost considerations, 155- 156
guidelines for, 153- 154
items needed, 149, 152-154
medication needs, 151, 152- 153
in office settings, 152, 185 n.1
in prehospital care, 151 - 152
recommendations for, 1 O. 154- 155
Medical home concept, 3, 32-33, 84,
110, 179, 206, 212
Medical records
computerization of, 232, 237, 238,
239-240, 251, 289, 303, 319 n.l2
emergency department, 231-232
privacy and confidentiality issues,
245-246, 263-264 n.l 1
trauma registries, 233-234
UB-92 billing record, 232, 241
Medications, 151, 152- 153
Mental health care, 55-56, 59
Military medicine, 67-68, 317 n.2
Minnesota, 96
Monitoring equipment, 155
Mortality
from child abuse/neglect, 48-49, 64
n.3
children vs. adults, 43
death records, 235-236
effect of 9-1-1 systems on, 194
INDEX
from head injury, 50
hospital data on, 232-233
from illness, 51-53
from injuries, 1, 4, 26, 38, 47-50, 55
56, 110-111
in outcomes research, 244
from poisoning, 49
predictive measures, 270
preventable deaths, 108, 109, 270
regionalization of services and, 178
179
state-specific data, 49, 50, 64 n.2
from violence, 55-56
Motor vehicle crashes, 4, 47-48, 49,
110-111, 147 n.2
cost of care for, 61
data collection on, 236-237
in development of EMS systems, 67,
68, 69
N
National Academy of Sciences, 29, 67,
73
National Association of Children's
Hospitals and Related Institutions,
80, 90
National Association of Emergency
Medical Technicians, 70, 81, 94,
134, 219
National Association of EMS
Physicians, 80, 167, 219
National Association of State EMS
Directors, 86
National Center for Health Statistics,
46, 231, 232, 261 n.1
National Center for Injury Prevention
and Control, 78, 115, 147 n.l, 219,
286
National Center on Child Abuse and
Neglect, 286, 296
National Child Abuse and Neglect Data
System, 56
National Committee for Injury
Prevention and Control, 47, 236
National Committee on Vital and
Health Statistics, 241
OCR for page 391
INDEX
National Electronic Injury Surveillance
System, 231, 236
National Emergency Medical Services
Week, 114, 218
National Emergency Number
Association (NENA), 189, 219
National EMS-C Resource Alliance,
135, 141, 220, 295
National Health Interview Survey, 46
National Highway Traffic Safety
Administration, 5, 69, 70, 76, 111,
112, 127, 236, 238, 282, 286, 292-
293
standard prehospital training
curricula, 126- 127
state EMS system assessment
program, 262 n.3, 292-293
National Hospital Ambulatory Medical
Care Survey, 231
National Hospital Discharge Survey,
49, 64 n.4, 232
National Institute of Child Health and
Human Development, 238, 286
National Institutes of Health, 117, 254,
286
National League for Nursing, 94
National Pediatric Trauma Registry, 43,
61, 234, 237
National Research Council, 67
National SAFE KIDS Campaign, 94,
114-115, 218
National Safety Council, 94, 114
National uniform data set for EMS-C,
16, 246-251, 274-279
New Jersey, 83, 299, 305
New York, 49, 57-58, 159, 208, 218
Neonatal care, 3, 41, 69, 185 n.5
9- 1 - 1 systems
access to emergency services and,
188-189, 195
cost considerations, 193
development of, 72-73, 189
dispatch services, 193- 194
enhanced, 12, 191-192
extent of, 189- 190
inappropriate use of, 195
installation, 192- 193
391
interjurisdictional issues, 193
managed care guidelines for use of,
195- 196, 223 n.3
operation of, 193- 194
outcomes research, need for, 194
poison control centers and, 198- 199
privacy and confidentiality issues Ins
196-197
public use of, 112, 117, 195
recommendation for, 12, 197
as response, vs. emergency, number,
222-223 n.1
standard capabilities of, 190- 191
North Carolina, 49, 193, 194
Nurses
mobile intensive care nurses, 129,
203, 204
recommendation for training, 9, 130
staff shortages, 21, 329
training for, 9, 129-130, 134-135
training needs, 119, 128
o
Office of Disease Prevention and
Health Promotion, 286, 294
Office of Juvenile Justice and
Delinquency Prevention, 296-297,
318 n.l0
Office of Minority Health, 294-295
Office-based care
emergency care, 56-57, 92
emergency equipment needs for 152,
185 n.1
emergency transport from, 166
protocols for, 166
telephone advice, 199-200
Omnibus Budget Reconciliation Act
(OBRA)
of 1981, 76-77
of 1989, 78, 223 n.6, 319 n.l5, 330
of 1990, 315, 319 n.l5
Organizational structure, 35-36
bottom up approach in, 37, 93
communication links in, 216-217,
239-240
current EMS-C system, 281-283
OCR for page 392
392
data needs concerning, 225
of EMS systems, 85-86, 97-98
in local-level emergency care, 89
for on-line medical control, 204-205
recommendations for, 17- 19, 283-284
research topics on, 258
of state advisory councils, 306-308
of state EMS-C agencies, 299-300
of state EMS management, 86-89
top down approach in, 36-37, 93
See also EMS-C center; EMS
systems
Outcomes research, 15, 263 n.8, 288
claims data in, 234-235
on EMS-C system performance, 226-
227, 322-324
expected, vs. observed cases,
assessment in, 244, 263 n.l0
methodological issues, 244-245
need for, 257, 228-229
on 9-1-1 systems, 194
on regionalization of care, 178-179
p
Paramedics, 121-122, 126-127, 159-162
See also Emergency medical
technicians; Prehospital care
Parents
education of, 7-8, 108- 109
role in emergency care, 7, 92-93
Pediatric Advanced Life Support
(PALS), 81, 119, 133-134, 140
141, 159
Pediatric critical care centers, 27, 75,
79, 173-174, 176
Pediatric EMS Training Program
(PEMSTP), 81, 119, 134
Pediatric Intensive Care Network of
Northern and Central California,
60, 207, 210
Pediatric intensive care units (PICUs),
26, 60-61, 335 n.4
availability of beds, 176, 335 n.4
development of, 69, 75
equipment in, 153, 156
evaluation of, 263 n.3
INDEX
in regionalization of services, 176
transfer agreements, 176
Pediatric trauma centers, 60-61, 75,
172-173, 176-177, 178-179
Physiology, of children vs. adults, 41-
42
Poison control centers, 12~ 13, 49-, 55,
70, 198-199, 207, 236
Poison Prevention Packaging Act, 77,
116
Poisoning, 49, 55
Prehospital care
assessment in, 121-122, 159-160
authorized procedures, 123, 154
for children, 5, 31, 57-58, 84
communications systems in, 200-203,
221
data collection in, 46, 230-231, 238,
274-277
development of pediatric care in, 75,
80-81
dispatch protocols, 158- 159, 185 n.2
epidemiology, 46, 57-58
equipment needs in, 151 -152, 155
field triage protocols, 160- 162
historical developments in, 67-68, 69
local-level activities in, 89-90
in national uniform data set, 248, 275
recommendations, 9, 127, 154-155
research topics in, 259
training in, 9, 121-123, 126-127, 135
transport decisions, 159- 160
triage assessment instruments, 268
269
See also Medical control
Prehospital Trauma Life Support
(PHTLS), 81, 134
Preventive Health and Health Services
Block Grant, 76, 99 n.4
Prevention, 94-95
benefits of, 85, 323
in development of EMS, 70
educating public in, 7-8, 110- 111,
114-115, 218-219
government efforts in, 70, 77-78,
115, 116, 218
in medical home concept, 32-33
OCR for page 393
INDEX
research topics on, 258-259
Primary care providers
access to, 331-332
authorizing emergency care, 195- 196,
212-213
in EMS and EMS-C systems, 33, 92,
206
in Medicaid program, 212-213, 332
in public education effort, 112-113
training for emergency care, 124-125,
129, 130-132
Privacy and confidentiality issues, 263
264 n.ll
in data collection, 245-246
in linking patient records, 240
in 9- 1 - 1 systems, 196- 197
Private sector
advisory council participation, 297,
324
in EMS, 89
Professional training, 35
access to, 9, 138-141
accrediting organizations in, 9, 127,
131
basic skills, 44-45, 120-121
clearinghouse for training materials,
141, 220
computer-based, 139, 142-143
continuing education, 119, 125, 132
138, 141
curriculum change, 125- 126, 132,
136
for data collection and analysis, 251
Department of Transportation
standard curricula, 126-127
development of, 6, 27, 74, 80-81
for dispatchers, 122- 123, 194
for emergency department staff, 123
124
in EMS structure, 124
for EMTs, 9, 121, 125-126
evaluating programs for, 141 -142
federal EMS-C center in, 288-289
funding for, 144
graduate level, 128
for hospital staff, 124
incentives for, 143-144
393
interactive videodisc systems, 139
for nurses, 129-130, 134-135
obstacles to, 137-138
for paramedics, 127
pediatric assessment in, 120, 121 -122
for physicians, 130-132, 148-149 n.8,
149 n.~O
for prehospital providers, 9, 121 - 123,
126-127
for primary care staff, 124- 125
psychosocial skills, 120-121
recommendations for, 9, 127, 128,
130, 131
research topics in, 258
retention of skills, 142-143
settings for, 138-140
shortcomings in, 118- 119, 136- 137
state EMS offices in, 87, 301
in stress management, 121
in undergraduate medical curricula,
128
Protocols
for child abuse/neglect cases, 165
clinical practice guidelines and, 150
definition, 149-150
for dispatchers, 158-159, 185 n.2,
194
emergency department triage, 163
165
for inpatient staff, 165- 166
medical control, 162- 163, 168
need for 27, 75, 157
in outpatient settings, 166
for prehospital personnel, 159-162
prehospital triage, 160- 162
regionalization efforts and, 179-180
role of, 10-11, 156-157, 183-184
transport, 159- 160
Public education, 35, 217-219
in basic first aid, 111
in cardiopulmonary resuscitation, 7,
111, 114
for children and adolescents, 109-110
content of, 110-112
goals for, 108-109, 145
local context for, 116- 118
for parents and other adults, 108- 109
OCR for page 394
394
in prevention, 110- 111
in public schools, 109, 117
for recognizing emergencies, 7, 109,
111
recommendations for, 7-8, 118
research topics in, 258
settings for' 7-8~ 112~15
state EMS-C agencies in, 301
on use of emergency services, 7, 8,
13, 111-112, 195
Q
Quality assurance, 227, 251, 262 n.3
in emergency care, 262 n.3
Quality of care, EMS-C, 228-229
R
Recommendations, summarized, 23-25
categorization of hospital
capabilities, 184
data collection and analysis, 261
EMS-C agencies and advisory
councils, 317
EMS-C research agenda, 261
federal funding, 317
medical equipment, 184
9- 1 - 1 systems, 221
professional training, 146
public education, 146
regionalization of services, 184
Referral centers, 175- 176, 207-208, 209
See also Pediatric intensive care
units; Pediatric trauma centers
Regionalization of services
consultation with specialists, 207-208
continuity of care and, 179
definition, 10, 150
in development of EMS systems, 71,
73
federal EMS-C center in, 293
government role in, 184- 185
interjurisdictional coordination in,
180-182, 186 n.7
medical outcomes and, 178- 179
off-line medical control and, 170
INDEX
on-line medical control and, 204-205
patient transfers and, 175, 210-211
pediatric intensive care units in, 176
recommendation for, 11 - 12, 182- 183
referral centers in, 175- 176
reimbursement issues in, 181 - 182
resistance to, 179
role of, 91, 171, 175
in rural areas, 182
scarcity of pediatric resources, 180
specialized transport services in, 177-
178
state EMS-C agencies in, 303-304
trauma care, 176-177
triage protocols and, 179- 180
Rehabilitation, 61
planning for, 207, 215-216
research topics in, 259
training for pediatric care, 129, 130
types of services, 216
Reimbursement issues, 95
access to care and, 288, 331-332
in interstate regionalization, 181 - 182
in managed care organizations, 213
Medicaid, 288, 324, 332
uncompensated care, 78, 177, 328-
329
Research priorities, 16, 252-259
clinical care, 256-257
costs, 257
epidemiology, 259
federal EMS-C center in, 288, 290-
291
prehospital care, 259
prevention, 258-259
professional training, 258
public education efforts, 258
recommendations for, 16, 253-254
rehabilitation, 259
severity and acuity measures for
illness and injury, 257
system organization and operation,
258
See also Outcomes research
Respiratory illness
in children, 41-42
emergency department visits for, 59
OCR for page 395
INDEX
hospitalizations for, 4, 51-53
special equipment needs for, 151
See also Asthma; Cardiopulmonary
resuscitation
Robert Wood Johnson Foundation, 5,
73, 201, 303, 334 n.2
Rural areas, 2l, 3-4, 89-90, 318 n.S
farm injuries, 117
hospitals in, 78, 91, 173-174, 287-
288, 328
medical control in, 92, 204
9-1 -1 systems in, 192-195
prehospital care in, 58, 86, 122
professional training in, 9, 81, 88,
139, 144
protocol design for, 159
regionalization of care and, 182
system communications in, 13, 202-
203
S
SAVE A CHILD triage, 272
School programs, 113-115, 117
Severity measures. See Assessment/
diagnosis; Illnessfes); Injuries
Social security number, 240
Society for Academic Emergency
Medicine, 131
Society of Critical Care Medicine, 80,
153
Society of Pediatric Emergency
Medicine, 80
Society of Pediatric Nurses, 80, 219
Sociocultural factors
in health care reform, 326-327
in patient compliance, 214, 215
in public education programs, 117
State efforts
advisory councils, 306-308, 309-310
block grant funding and, 76-77, 99
n.4
in categorization/regionalization, 11
12, 184-185
in coordinating EMS-C system, 282
in data collection, 15- 16, 230-231,
246
395
in development of EMS systems, 71
in EMS systems management, 86-89
federal assistance for, 292-293
federal efforts and, 311 -313, 319-320
n.16
in funding, 19, 95-96, 99 n.5, 291-
292, 3149 318 n.8
in implementing 9-1 -1 systems, 197
interstate coordination, 293, 303-304
obstacles to, 308-310
in prevention, 116
in public education, 115
recommendations for, 8, 10, 11 - 12,
15, 16, 17, 118, 154, 182, 197,
241, 246, 284
See also EMS agencies; specific state
Sudden infant death syndrome, 4, 51-53
definition of, 64-65 n.6
Suicide, 48, 49
emergency department visits related
to, 55
firearms in, 5, 55, 56
T
Telephone advice
from emergency departments, 199
200
need for training and oversight, 200
from primary care providers, 198
199
See also Consultation; 9- 1 - 1 systems;
Poison control centers
Texas, 83
TIPP. See Injury Prevention Program,
The
Transferring patients
communications between institutions
in, 209, 210-211
evaluating systems for, 211
legal issues, 21, 164-165, 223 n.6,
329-330
medical control in, 203
to regional referral centers, 175
specialized transport for, 177-178
written agreements for, 175-176, 209-
210
OCR for page 396
396
Trauma care, 91
assessment instruments, 233, 265-270
categorization of capabilities in, 172
173
costs, 62
development of, 78-79
in EMS~C systems, 31
field triage, 160-161
outcomes research, 323
regionalization of services for, 176
177
systems, 75, 78-79, 91, 173, 176-177,
283
Trauma Care Systems Planning and
Development Act, 79, 283, 319
n.14
Trauma registries, 233-234, 262 n.4
Triage
assessment scales for, 161 - 162, 267- 301
269
emergency department protocols,
163-165
prehospital protocols for, 158, 160
162
priorities for care, 185 n.4
telephone-based, 200
U
Uniform Crime Report, 237
Uniform Hospital Discharge Data Set,
240, 241
Urban areas, 57-58, 89
communications in, 195, 202
INDEX
demand for emergency care, 21, 34,
55-56, 328-329
hospitals in, 163, 288, 328-329
injury risks, 34' 55-56, 113, 117
interstate cooperation, 303-304
uncompensated care, 78, 177
Urgent care clinics, 91-92, 152
V
Violence, 4-5, 34, 55-56, 237
cost of care for injuries from, 61
firearms in, 5, 55-56, 117
See also Child abuse/neglect;
Homicide; Suicide
Virginia, 78, 95, 96, 116
Volunteers
impact of training costs on, 138, 144,
as prehospital providers, 83, 86, 90,
329
value of services, 96, 290
W
Washington state, 49, 135, 157, 173,
308
Wisconsin, 202
Workgroup on Electronic Data
Interchange, 240
y
Year of the Child in EMS, 219
Representative terms from entire chapter:
emergency department
