Emergency Medical Services for Children (1993) / Chapter Skim
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SUMMARY
SUMMARY
Pages 1-25
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When prevention fails, families should have access to timely care by trained personnel within a well-organized emergency medical services (EMS) system.
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undertake a study of pediatric emergency medical services to look at the issues more broadly than individual demonstration projects could. The IOM study was guided by a 19-member com mittee with expertise in pediatrics, emergency medicine, trauma, nursing, prehospital emergency services, injury prevention, hospital administration, public policy, and local government (see roster)
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Second, EMS-C must be integrated into the larger EMS system. Third, EMS-C must develop strong ties to the broader elements of child health care.
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With no commonly accepted set of diagnoses defining illnessrelated emergencies, however, determining specific numbers of cases from available mortality and hospitalization data is difficult. Some deaths attributed to sudden infant death syndrome, the second leading cause of death among infants, may be due to child abuse or inadvertent suffocation.
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Federal funding was first made available to support development of EMS systems through the National Highway Traffic Safety Administration of the Department of Transportation and through the Department of Health, Education, and Welfare (now DHHS) under the 1973 Emergency Medical Services Systems (EMSS)
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Training in pediatric emergency care became available through locally developed programs and nationally recognized courses (e.g., Pediatric Emergency Medical Services Training Program, Pediatric Advanced Life Support [PALS] , and Advanced Pediatric Life Support [APLS]
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Opportunities for training include health care visits, schools, day care, recreation, and community programs. A child's primary care provider should
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To address these issues, the committee recommends that: ~ states and localities develop and sustain programs to provide to the general public of all ages adequate and age-appropriate levels of education and training in safety and prevention, in first aid and cardiopulmonary resuscitation, and in when and how to use the emergency medical services system appropriately for children. It recommends further that: the content of such programs reflect the particular needs of each community; -the content of such programs reflect the special medical, developmental, and social needs of children; parents and other adults who are responsible for the care and education of children (e.g., day-care workers, teachers, coaches)
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· accreditation organizations require that curricula for EMT-Paramedic programs include training in advanced life support for children. · appropriate accrediting organizations require that the primary curricula for all health care professionals include training in basic resuscitation skills and the use of the emergency medical services system.
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The committee calls for each health care provider or agency to define the emergencies that occur in the patient populations that they serve and to ensure that the necessary and proper equipment is available to treat critically ill and injured neonates, infants, children, and adolescents. To this end, the committee recommends that all state regulatory agencies with jurisdiction over hospitals and emergency medical services systems require that hospital emergency departments and emergency response and transport vehicles have available and maintain equipment and supplies appropriate for the emergency care of children.
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On-line medical control implies real-time direction by designated medical personnel of prehospital care for seriously injured or ill children; services may include authorization for advanced life support procedures, triage and destination assignment, and management of patients who refuse care. Off-line medical control operates through policymaking activities, training programs, quality assurance efforts, and the like.
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The 9-1-1 system must be universally accessible and effectively linked to the emergency medical services system. Communities with 9-1-1 systems in place should move toward enhanced 9-1-1 capabilities.
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. When EMS systems develop on-line medical control, they must consider factors such as the availability and cost of base-hospital staff, the level of care that prehospital providers are authorized to deliver, and the perceived need for direct medical oversight of prehospital care.
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Public educat~n should be ax integral part of these systems; injury prevention is an especially high priority. Opportunities for valuable communication among providers exist through various professional activities, including those related to the EMS-C demonstration grant program.
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This information is valuable in identifying specific risk factors, setting targets for injury prevention programs, monitoring the effectiveness of prevention efforts, and assessing the cost of care for specific kinds of injuries. These points were regarded as sufficiently persuasive that the committee recommends that states and other relevant bodies adopt requirements that ICD-9-CM E-codes be reported for all injury diagnoses reported for hospital and ED discharges.
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Finally, the committee advises that EMS-C agencies in federal and state government (proposed below) assume responsibility for determining how these activities should be organized and supported; at the federal level, the committee recommends that the federal center responsible for EMS-C develop guidelines for a national uniform data set on emergency medical services for children.
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Specifically, the committee recommends that: Congress direct the Secretary of DHHS to establish a federal center or office to conduct, oversee, and coordinate activities related to planning and evaluation, research, and technical assistance in EMS-C; · Congress direct the Secretary to establish a national advisory council for this center; members should include representatives of relevant federal agencies, state and local governments, the health care community, and the public at large; · states establish a lead agency to identify specific needs in emergency medical services for children and to address the mechanisms appropriate to meeting those needs; and · state advisory councils be established for these agencies; members should include representatives of relevant state and local agencies, the health care community, and the public at large. The committee argues the case for these federal and state centers and advisory councils for EMS-C on six key grounds: (1)
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From page 18... ...
covers 11 elements that were judged to be critical to progress in this field: developing a national strategy for EMSC, coordinating efforts throughout the federal government, disseminating information and providing for a clearinghouse function, improving access to care, underscoring medical illness as a special concern in EMS-C, assisting education and training efforts, collecting and analyzing data, supporting enhanced research efforts, creating incentives for state action, providing technical assistance, and encouraging regional coordination. The first eight elements presuppose a national perspective; the last three aim to foster state and local efforts.
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The agenda for the advisory councils should include immediate concerns such as funding priorities as well as longer-term issues such as health care reform. Public accountability is essential and can be encouraged by requirements such as publication of annual reports that are widely disseminated.
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The committee believes that national and state advisory councils may well want to place cost issues high on their respective agendas-especially because reallocations of health sector dollars among competing needs may be likely in the near term. A Changing Health Care Environment The health care system within which EMS-C exists faces significant questions regarding its future shape and structure.
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proposals attend to broader issues of health care for children must be of special concern for those interested in EMS-C. Special Challenges to EMS and EMS-C Regardless of the outcome of the health care reform process, EMS-C must contend with more immediate challenges that arise out of problems facing EMS and the larger health care community.
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FINAL THOUGHTS Attempts to ensure that children receive adequate emergency medical care are a recent development in the field of EMS. This committee has adopted the position that EMS-C efforts in the future must consider all the elements that constitute good emergency care and good health care generally, working through channels in both the public and private sector.
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