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Ensuring Excellence in EMS Care for Kansas Children. Jeffrey Colvin, M.D., J.D., FAAP Kansas Chapter American Academy of Pediatrics. Summary. Children can not be treated as “little adults” when providing medical care.

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Ensuring Excellence in EMS Care for Kansas Children

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Ensuring Excellence in EMS Care for Kansas Children

Jeffrey Colvin, M.D., J.D., FAAP

Kansas Chapter

American Academy of Pediatrics


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Summary

  • Children can not be treated as “little adults” when providing medical care.

  • Experts in pediatrics and emergency medicine have established pediatric-specific national guidelines to ensure that children receive the same quality of EMS and emergency medical care as adults.

  • The guidelines address pediatric EMS education, equipment, medical direction, representation on state EMS boards, and other essential issues.

  • Kansas Emergency Medical Services for Children (KEMSC) is attempting to implement these guidelines to improve the quality of emergency medical care for children.

  • Governor Sebelius and the Child Health Advisory Board are essential partners with KEMSC and the American Academy of Pediatrics (Kansas Chapter) in ensuring excellence in EMS care for Kansas children.


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Definitions

  • Pre-Hospital Care: the care given to a sick or injured patient until they are given definitive care (i.e.,9-1-1 system, EMS care.)

  • Emergency Medical Services: pre-hospital care, medical treatment in an emergency room, and care during transport to another hospital.

  • Emergency Medical Services for Children (EMSC): the federal program designed to improve pediatric emergency care.

  • EMS Agency: a company or government division that employs EMTs and paramedics and provides ambulance services.

  • Off-Line Medical Direction: printed pediatric treatment protocols.

  • On-Line Medical Direction: real-time, live pediatric medical advice by phone from a provider with pediatric expertise.

  • Paramedics & EMTs: pre-hospital care providers (with varying degrees of skills and training.)


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The “Discovery” of Children in the Emergency Medical System

  • Children aren’t “little adults.”

  • Differences between Children and Adults:

    • Physical

    • Emotional

    • Psychological

    • Different Diseases & Injuries

    • Different Treatments


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EMSC is Created

  • Emergency Medical Services for Children (EMSC)

    • Created by Federal Statute in 1984 (Preventative Health Amendments, P.L. 98-555)

    • A program of the Health Resources and Service Administration’s Maternal and Child Health Bureau

    • The only federal program focusing on improving emergency care for children

    • www.mchb.hrsa.gov/emsc


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DISPARITIES GAIN NATIONAL ATTENTION

January 27, 1992


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Institute of Medicine (1993):“Emergency Medical Services for Children”

  • “Emergency Medical Services for Children”

    • Pediatric Education & Training

    • Pediatric Equipment

    • Protocols for Pediatric Care

    • Real-Time On-Line Medical Direction

    • Hospital Categorization


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Current State of Pediatric Emergency Care

“If there is one word to describe pediatric emergency care in 2006, it is uneven.”

IOM, Emergency Care for Children: Growing Pains (2007)


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EMS Care in Kansas

  • 174 EMS Agencies in Kansas

    • 443 BLS Ambulances

    • 202 BLS Ambulances with ALS Capabilities

    • 178 ALS Ambulances

  • 3861 Certified EMTs/Paramedics in KS

    • Range 2-400 EMTs/Agency (Median 22)


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Pediatric EMS Care in Kansas

  • At least 208,00 calls for EMS services in 2006

    • At least 10% of calls were Pediatric (20,500)


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ER Care in Kansas

  • 125 Hospitals in Kansas with ERs

  • 855,818 Kansas ER Visits in 2006


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ER Care in Kansas


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Improving Emergency Medical Care for Kansas Children

  • KDHE began receiving funding from the federal EMSC in 2003 for a Kansas EMSC (KEMSC).

  • KEMSC is directed by KDHE’s Office of Injury and Disability Programs.

  • KEMSC is advised by a Steering Committee, composed of a broad coalition of stakeholders.


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KANSAS EMSC

The Mission of Kansas EMSC:

  • To ensure state-of-the-art emergency medical care for ill and injured children and adolescents.

  • To ensure that pediatric services are well integrated into the emergency medical services (EMS) system and backed by optimal resources.

  • To ensure that the entire spectrum of emergency services--including primary prevention of illness and injury, acute care, and rehabilitation--is provided to infants, children, adolescents and young adults.


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Specific KEMSC Goals

1. Enhance the Operational Capacity of Kansas to Provide Pediatric Emergency Care.

2. Achieve Adoption of State Requirements for Pediatric Emergency Education for the Recertification of Paramedics.

3. Obtain Permanence of EMSC into Kansas’s EMS System to Ensure a Continued Pediatric Voice in EMS Decision-making.


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Specific KEMSC Goals

1. Improve Kansas’s Operational Capacity to Provide Pediatric Emergency Care.

  • Off-Line Medical Direction: established pediatric treatment protocols

  • On-Line Medical Direction: access to real-time live pediatric medical advice

  • Essential Pediatric Equipment

  • Hospital Recognition System: designated hospitals capable of higher levels of pediatric care

  • Inter-Facility Transfer Guidelines & Agreements for Pediatric Patients


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EMSC Recommended Equipment


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Specific EMSC Goals

2. Adoption of State Requirements for Pediatric Emergency Education for the Recertification of Paramedics & EMTs.

- National Average: 14% Continuing Education Time is Required to be Pediatric-Specific


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Specific EMSC Goals

3. Permanence of EMSC into Kansas’s EMS System to Ensure a Continued Pediatric Voice in EMS Decision-Making.

  • Pediatric representation on the EMS Board (KBEMS)

  • Integration of EMSC priorities into statutes, rules, and regulations.


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Ensuring Excellence in EMS Care for KS Children


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KS EMS Survey


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KS EMS Survey


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KS EMS Survey


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Micro level

Hospitals

EMS systems

Professionals

Macro level

Regulatory

Legislative

Stakeholder Organizations

Implementation Strategies


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EMS Problems in Kansas

“From a public perspective there is no assurance these agencies who are answering calls for emergency medical assistance meet any standard for training, equipment, operations, quality assurance and quality improvement, medical oversight, communications or other essential capabilities to provide safe and effective care.”


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How the Kansas Child Health Advisory Committee Can Help

1. Recommend that the National EMSC Guidelines are Adopted by KBEMS

  • Essential Pediatric Equipment

  • Pediatric Continuing Education for Recertification of Paramedics & EMTs: 15%

  • “Offline” Pediatric Medical Direction

  • “Online” Pediatric Medical Direction


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How the Kansas Child Health Advisory Committee Can Help

2. Recommend that the Following EMSC Goals are Supported by KBEMS:

a. Inter-Facility Transfer Agreements and Protocols for all Kansas Hospitals.

b. State-Wide Hospital Recognition System Delineating Kansas (or Neighboring State) Hospitals Capable of Caring of More Severely Injured or Ill Children.


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How the Kansas Child Health Advisory Committee Can Help

3. Recommend Pediatric Representation on the Kansas Board of EMS

a. Appointment of a board member with pediatric expertise, and also

b. Change of the statute mandating a pediatric representative on the Board of EMS


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Thank you.


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