Emergency Medical Services for Children (1993) / Chapter Skim
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1 INTRODUCTION
1 INTRODUCTION
Pages 26-37
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From page 26... ...
(ACEP, l990d; American Hospital Association, 19911. Children in certain vulnerable populations, such as those with special health care needs or without adequate primary care, are likely to require emergency services even more than many other children.
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From page 27... ...
Specialized training, which has become available through locally developed programs and nationally recognized courses, has helped emergency care providers acquire the knowledge and skills to improve their care of children. Efforts to improve emergency medical services for children (EMS-C)
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THE INSTITUTE OF MEDICINE STUDY Origins of the Study The efforts of the pediatric community to improve emergency care for children received a substantial boost in 1984 with the passage of federal legislation (Public Law 98-555) authorizing a demonstration grant program on EMS-C.
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From page 29... ...
Six members of the committee have participated in EMS-C demonstration grant projects.) The charge to this committee included the following tasks: · estimate the nature and extent of the problems of mortality, morbidity, disability, and other negative consequences associated with emergency, out-of-hospital pediatric trauma and critical illness; · estimate the adequacy of current efforts to reduce the negative consequences of these emergencies, including attention to the linkages between acute services, prevention, and rehabilitation; · define the desirable characteristics of systems of services that could achieve the above effectively and efficiently, and specify the ways that existing EMS systems must change if the desired pediatric capacity is to be achieved; · develop criteria and data requirements for surveillance of emergencies and their negative outcomes, their determinants and contributing fac
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From page 30... ...
Instead, ensuring high quality care for children should be viewed as a further step in the process that has led EMS systems to develop increasingly sophisticated care for adults suffering heart attacks or injured in automobile crashes. Furthermore, emergency medical care cannot be treated as a process unrelated to a child's routine health care needs.
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From page 31... ...
In the view of this committee, essential elements include community education, prevention programs, a means of requesting assistance (e.g., a 9-1-1 telephone system) , skilled prehospital care, transport for ill and injured children, EDs prepared to offer basic emergency care to children, referral centers able to provide advanced emergency care and timely access to pediatric specialists, PICUs, other inpatient services, and access to further care such as pediatric rehabilitation programs.
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From page 32... ...
EMS-C should also be coordinated with other related programs such as poison control centers and neonatal intensive care units. Just as the impulse to create a freestanding EMS-C system must be overcome, so must reluctance on the part of EMS systems to accept the obligation to prepare adequately for pediatric care (Foltin et al., 1990; Thomas, 1991b)
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From page 33... ...
Involving the medical home in emergency care is especially important for children with special health care needs, whose treatment may differ from what other children might generally receive. GUIDING PRINCIPLES To this vision of EMS-C as a system of care that should operate as an integral element of the broader realms of EMS and child health, the committee added other guiding principles.
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From page 34... ...
It also leads to otherwise unnecessary use of the ED for basic care of minor illnesses and injuries. The continuing loss of health care services in rural areas and the increasingly desperate financial position of many states and localities impose constraints not only on resources available to support emergency care but also on all publicly funded health care programs.
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From page 35... ...
to recognize the need for emergency care, to obtain that care, and to offer basic first aid and resuscitation to children until professional care is available. Chapter 5 turns to those tools that health care providers and that emergency care systems must have to deliver good emergency care to children: appropriate equipment; sound guidelines for pediatric care; pediatric expertise in medical direction for prehospital care and system planning; a clear indication of the pediatric care capabilities of area hospitals; and a regional approach to emergency care to help make efficient and effective use of limited pediatric specialty resources.
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From page 36... ...
are available in identifiable facilities, communication technologies and practices support optimal care, information systems and data are available to contribute to planning and evaluating care, and essential research is undertaken. Among those whom the committee wishes to reach are physicians in pediatrics, family practice, surgery, and emergency medicine; nurses in general and specialty-care settings; emergency medical technicians at all levels; hospital administrators; and medical professionals responsible for organizing and operating EMS systems.
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From page 37... ...
NOTE 1. The six committee members who participated in EMS-C demonstration grant projects are Martin R
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