Emergency Medical Services for Children (1993) / Chapter Skim
Currently Skimming:
3 EMERGENCY MEDICAL SERVICES SYSTEMS: ORIGINS AND OPERATIONS
3 EMERGENCY MEDICAL SERVICES SYSTEMS: ORIGINS AND OPERATIONS
Pages 66-107
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 66... ...
. In the 1960s, emergency care in most communities and hospitals was little more than first aid.
|
From page 67... ...
First, surgeons with military experience in Korea and Vietnam recognized that trauma care available to wounded soldiers was substantially better than the care available to civilians (Boyd, 1983~. The need for rapid response to serious injury had long been recognized on the battlefield, and the medical services of the U.S.
|
From page 68... ...
In Europe these units were staffed by physicians, but in the United States this care was delegated to public safety personnel already available in community fire departments. This choice led to the development of specially trained personnel paramedicsto provide this prehospital care.
|
From page 69... ...
. Drawing on the new developments and recommendations, individual communities across the country began to enhance their capabilities for emergency care through greater attention to resources, training, and coordination of services, particularly for treating cardiac cases.
|
From page 70... ...
As interest and activities in EMS grew, strong recommendations were being made for the highest levels of the executive branch of the federal government to lead nationwide efforts to improve the delivery of emergency services. The ACS and the AAOS addressed this issue in the proceedings of a joint conference, Emergency Medical Services.
|
From page 71... ...
93-1544. The EMS S Act created a new categorical grant program in the Division of Emergency Medical Services of DHEW.
|
From page 72... ...
and provide direct communication links among personnel and facilities throughout the system and with other EMS systems Transportation: adequate numbers of vehicles (ground, air, or water) appropriate for the region, which meet standards for design, performance, and equipment and whose operators have necessary training and experience Medical facilities: adequate numbers of accessible emergency care facilities collectively providing continuous services, with appropriate categorization of capabilities and coordination with other system facilities Critical care units: access (including transportation)
|
From page 73... ...
It demonstrated that the various players in emergency care-including health professionals, local and regional governments, and concerned private organizations-could cooperate effectively (NAS/NRC, 1978b)
|
From page 74... ...
Most, however, devoted relatively little time to pediatric emergency care compared to the volume of pediatric patients seen in the emergency room. Children and EMS Although the EMSS Act was encouraging the development of EMS systems, children were not a target population, and only limited expertise in pediatric emergency medicine existed in 1973 (Foltin and Fuchs, 1991~.
|
From page 75... ...
This service operated through the Maryland Institute for Emergency Medical Services Systems, a well-known model for a fully integrated EMS and trauma system (Foltin and Fuchs, 1991~. Still, in the vast majority of regions developing EMS systems, the special emergency care needs of children remained unrecognized through the 1970s.
|
From page 76... ...
(OTA, 1 989; Public Health Foundation, 199 1~. In addition, the block grant program eliminated most EMS and emergency medicine activities within DHEW (renamed the Department of Health and Human Services [DHHS]
|
From page 77... ...
In other states, however, the state EMS office retained only limited authority. The block grant program carried no requirement for states to adhere to the 15-component EMS system model that was central to the EMSS Act, but it allowed states to continue funding for EMS regions that were not eligible for additional categorical grants.
|
From page 78... ...
For EDs, uncompensated care and inadequate reimbursement for emergency care of Medicaid patients created problems. Some urban trauma centers found it difficult to remain within the trauma system because of the financial burden of caring for large numbers of seriously injured but uninsured patients.
|
From page 79... ...
Greater Attention to EMS-C Local efforts in various places across the country were attracting greater attention to the need for EMS-C and producing some visible changes. For example, the Los Angeles EDAP-PCCC program described above became firmly established; a network of PICUs in northern and central California coordinated services for the region; and pediatric trauma centers were established in several cities (Seidel and Henderson, 1991~.
|
From page 80... ...
Together AAP and ACEP formed a Joint Task Force on Pediatric Emergency Medicine in 1984 to facilitate communication and coordination between the two groups in their activities to improve emergency care for children. The Society of Critical Care Medicine established a pediatric section in 1982; in 1984, in a nice piece of symmetry, AAP created a section on critical care medicine (Downes, 1992~.
|
From page 81... ...
Children's National Medical Center in Washington, D.C., developed its Pediatric Emergency Medical Services Training Program (PEMSTP) specifically to prepare EMT instructors to teach pediatric aspects of emergency care (Eichelberger, 1989~.
|
From page 82... ...
expand and improve State and local capability for reducing pediatric emergencies and their consequences in the State and (ultimately, collectively, throughout the Nation) , paying special attention to handicapped and minority populations, including Native Americans; (2)
|
From page 83... ...
Steps such as these must continue and the need for them must be widely recognized if children are to benefit from the full capabilities of modern emergency services. PROVIDING EMERGENCY MEDICAL SERVICES EMS systems must to be able to perform certain basic functions in order to deliver timely and appropriate care, but they must have both a narrow and a broad view of their responsibilities.
|
From page 84... ...
Essential Services for Emergency Care of Children EMS-C should be able to provide a continuum of care frown initial problem identification through a broad spectrum of services that include prehospital care; hospital-based emergency, inpatient, and critical care; and rehabilitative services appropriate for children. An EMS-C system should ensure links with children's primary care providers and should apply its experience with illness and injury to prevention priorities.
|
From page 85... ...
In general, the EMS agencies providing prehospital care are the part of the system most closely controlled by state and local governments, being
|
From page 86... ...
are more likely to be privately owned and operated than are EMS agencies providing prehospital care. The medical community itself plays a large role in hospital oversight and regulation and in defining the practice of emergency medicine.
|
From page 87... ...
Public Health and Health Care State health agencies other than the EMS office typically have responsibility for or authority over important pieces of EMS systems. State regulations governing licensing for hospitals and for physicians and nurses can influence the availability of services, and the standards applied can affect capabilities for providing emergency care.
|
From page 88... ...
Two Examples of Unusual State-Level Efforts Maryland Maryland has established a unique private, nonprofit organization with responsibility for coordinating EMS across the state-the Maryland Institute for Emergency Medical Services Systems (MIEMSS) (Ramzy, 1990~.
|
From page 89... ...
Prehospital Services Communities have taken many different approaches to organizing prehospital services. In 50 percent of the 200 most populous cities in the nation, EMS services are provided by the fire department, alone or in conjunction with a private provider (Cady, 1992~.
|
From page 90... ...
Of these, 37 have an ED and 22 are state-certified trauma centers; 5 of the other acute-care children's hospitals provide emergency care through arrangements with other hospitals. Another 105 children's hospitals provide specialty care such as orthopedics, rehabilitation, or psychiatric services.
|
From page 91... ...
Moreover, many of the nurses who provide the principal staffing for these EDs have additional responsibilities in other areas of the hospital; they also report a need for better pediatric training (OTA, 1989; Henderson and Avery, 1992~. Major referral centers with specialized pediatric and surgical services are able to provide more extensive care, including highly skilled pediatric intensive care, for the most seriously ill and injured children.
|
From page 92... ...
The AAP's (1992e) recently published manual, Emergency Medical Services for Children: The Role of the Primary Care Provider, provides valuable guidance for all of these roles.
|
From page 93... ...
Planning in these medical systems needs to address guidelines for pediatric emergency care that are appropriate for the settings in which their service providers operate. In addition, it should address coordination with surrounding communities in order to facilitate access to appropriate levels of care.
|
From page 94... ...
Similarly, EMS-C advocates will need to work with organizations that oversee professional standards and that represent the interests of their m:embers. A long list of organizations could begin with groups such as the AAP, ACEP, ENA, and NAEMT, whose members deliver emergency care to children, the American Hospital Association, the American Medical Association, and the American Nurses Association, which have broad interests in health care services; and the Accreditation Council on Graduate Medical Education, the National League for Nursing, and the Committee on Allied Health Education and Accreditation, which have a role in the accreditation of training programs.
|
From page 95... ...
In many states, EMS activities at the state and local levels are funded, at least in part, by state appropriations of general funds. The amount of such appropriations varies quite widely from none in Virginia to about $28 million in Hawaii (NASEMSD, 1991; Emergency Medical Services, 1992~.
|
From page 96... ...
In 1991, Minnesota adopted a $25.00 fine (increased from $10.00) [~r seatbelt violations, 90 percent c>f the fines collected are d~str~uted to the status eight regional EMS systems (Emergency Medical Services, 19921.
|
From page 97... ...
Over time, however, some states and communities increased their own funding for EMS. By the late 1970s, pediatricians and pediatric surgeons had begun to recognize that children's emergency care needs had not received adequate attention.
|
From page 98... ...
EDs and hospital inpatient services are also subject to governmental regulation but are more likely than EMS agencies to be privately owned and operated. (community hospitals provide emergency care for many children while major referral centers, with highly skilled pediatric specialists and pediatric intensive care facilities, are prepared to care for more seriously ill or injured children.
|
From page 99... ...
4. States could elect to use preventive health block grant monies to finance programs in the following areas: EMS, comprehensive public health services, rodent control, fluoridation, hypertension control, health education and risk reduction programs, and establishment of home health agencies (OTA, 1989)
|
From page 100... ...
· Preparation of nationally acceptable texts, training aids, and courses of instruction for rescue squad personnel, policemen, firemen, and ambulance attendants. Ambulance Services · Implementation of recent traffic safety legislation to ensure completely adequate standards for ambulance design and construction, for ambulance equipment and supplies, and for the qualifications and supervision of ambulance personnel.
|
From page 101... ...
Emergency Departments · Initiation of surveys and pilot programs to establish patterns of and the numbers and types of emergency departments necessary for optimal care of emergency surgical and medical casualties in a selected number of cities, groups of small communities, and sparsely populated areas. · Development of a mechanism for inspection, categorization, and accreditation of emergency rooms on a continuing basis.
|
From page 102... ...
AUTOPSY OF THE VICTIM victims. · Routine performance and analysis of complete autopsies of accident CARE OF CASUALTIES UNDER CONDITIONS OF NATURAL DISASTER · Development of a center to document and analyze types and numbers of casualties in disasters, to identify by on-site medical observation problems encountered in caring for disaster victims, and to serve as a national educational and advisory body to the public and the medical profession in the orderly expansion of day-to-day emergency services to meet the needs imposed by disaster or national emergency.
|
From page 103... ...
The program is designed to develop knowledge that can be applied to improving the pediatric care capabilities of existing emergency medical services (EMS) systems around the country.
|
From page 104... ...
Department of Health District of Emergency Medical Services Children's National October 1987 to Columbia for Children-Focus on the Medical Center, George September 1991 Neurologically Impaired Washington University Child Florida Emergency Medical Services University Medical Center, October 1987 to Grant for Children University of Florida June 1991 Health Science Center, Jacksonville Hawaii Emergency Medical Services Emergency Medical October 1987 to for Children Services Systems Branch, September 1991 Hawaii Department of Health Idaho Idaho Statewide EMSC EMS Bureau, Health October 1989 to Project Division, Idaho September 1992 Department of Health and Welfare
|
From page 105... ...
Maryland Institute for EMS Systems, University of Maryland at Baltimore October 1987 to September 1991 Massachusetts Department October 1992b of Health Michigan Department of October l991b Health Missouri Department of October l991b Health Nevada Division of October l991b Health Trustees of Dartmouth October l 991 b College New Jersey Pediatric EMS System New Jersey Department October l991b Development for New of Health Jersey (I) New Emergency Medical Services Division of Emergency October 1990b Mexico for Children Medicine, University of New Mexico School of Medicine New York New York State EMS for New York State Health February 1986 to Children and Health Research, Inc.
|
From page 106... ...
Utah Utah Emergency Medical Services for Children Bureau of Emergency October 1990b Medical Services, Utah Department of Health Vermont EMS for Children: EMS Division, Vermont October 1989 to Improvement of the Department of Health September 1992 Pediatric Component of a Rural EMS System West Tri-State Appalachian Virginia Alliance for EMSC (I) Department of Pediatrics, October 1992b West Virginia University Washington Emergency Medical Services Washington EMSC, October 1987 to for Children Children's Hospital September 1991 and Medical Center and Washington Department of Health Wisconsin Improving Emergency Services for Children in Wisconsin California Development of EMS for Children Subsystems in California Emergency Medical October 1987 to Services Section, Division September 1991 of Health, Wisconsin Department of Health and Social Services Targeted Issues Grants EMS Authority, State of October l991b California
|
From page 107... ...
SOURCE: NCEMCH (1992) ; Peter Conway, Maternal and Child Health Bureau, personal communication, November 1992.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.