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INDEX

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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