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Emergency Care for Children. Community Pediatrics: Legislative Advocacy May 2008 Emily Greenstein MD Clement Bottino MD. A Public Health Problem. Injury is the #1 cause of death for children in the United States.

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Emergency care for children

Emergency Care for Children

Community Pediatrics:

Legislative Advocacy

May 2008

Emily Greenstein MD

Clement Bottino MD

A public health problem
A Public Health Problem

  • Injury is the #1 cause of death for children in the United States.

    • In 2004, injury accounted for 60% of all deaths in children younger than 18 years.

  • Each year, 1 in 4 children sustain an unintentional injury that requires medical care.

Kids in adult ers
Kids In Adult ERs

  • Most hospitals do not have a separate pediatric facilities (PICU)

  • 10% of hospitals without a PICU admit critically injured children to their ADULT ICUs

  • Few hospitals have protocols for obtaining pediatric consultation on pediatric emergencies.

Kids in adult ers1
Kids In Adult ERs

Evidence basis:

  • Athey, J., et al. “Ability of hospitals to care for pediatric emergency patients.” Pediatric Emergency Care. 17(3):170-174, June 2001

    • “Appropriately sized equipment for successful care of infants and children in an emergency situation was more likely to be missing than adult-sized equipment”

    • Many hospitals did not have adequate equipment to care for newborn emergencies


  • 1970s - initial legislative advocacy:

    • Calvin Sia, M.D., president of the Hawaii Medical Association

    • Urged AAP to develop EMS programs that would decrease illness and death in children

    • Worked with Hawaii state legislature to accomplish this


  • 1984:

    • Senators Orrin Hatch (R-UT) and Lowell Weicker (R-CT) joined Senator Inouye (D-HI) in sponsoring the first EMSC legislation

    • C. Everett Koop, M.D. and the AAP strongly supported this measure

  • Under Section 1910 of the Public Health Service Act, the U.S. Congress enacted legislation authorizing the development of the Emergency Medical Services for Children (EMSC) Program


  • 1986:

    • Alabama, California, New York, and Oregon became the first recipients of Federal grant money specifically earmarked to improve pediatric emergency medical services

      This is the Emergency Medical Services for Children (EMSC) Program!

So what is emsc
So what is EMSC?

“Mission Statement”:

  • To ensure that all ill and injured children and adolescents receive state-of-the-art emergency care

  • This includes:

    • primary prevention

    • Pre-hospital care

    • Emergency care

    • Acute care

    • Rehabilitation

So what is emsc1
So what is EMSC?

Administered by:

  • The U.S. Department of Health and Human Services' Health Resources and Services Administration

    • in collaboration with –

  • The U.S. Department of Transportation's National Highway Traffic Safety Administration

So what is the emsc
So What is the EMSC?

What does it do exactly?

  • The EMSC Program provides grants to States and U.S. territories to improve existing emergency medical services (EMS) systems

    • and -

  • To develop and evaluate improved procedures and protocols for treating children

So what is the emsc1
So What is the EMSC?

  • The EMSC Program is the only Federal program that focuses specifically on improving the quality of children's emergency care

  • Since its establishment, the EMSC Program has allocated $138 million to fund 851 grant awards and…

     child injury death rates have dropped by 40 percent!

Where are we now
Where Are We Now?

April 8, 2008:

  • The House of Representatives approved HR 2464, the Wakefield Act, by a vote of 390-1

Where are we now1
Where Are We Now?

The Wakefield Act:

  • This bill reauthorizes the EMSC Program for five years!

    • 2009: $25,000,000

    • 2010: $26,250,000

    • 2011: $27,562,500

    • 2012: $28,940,625

    • 2013: $30,387,656

Where are we now2
Where Are We Now?

But To Become Law:

  • Both the House and the Senate must vote on, and pass, their respective versions of the bill!!

  • To date, no action has occurred on S 60, the Senate version of the Wakefield Act

What is the aap s position
What is the AAP’s Position?

AAP Position #1 - Congress’ Role:

  • Congress must invest in:

    • creating effective local, state and federal disaster response systems

    • a healthy, adequately funded, well-coordinated and functional emergency medical services system

What is the aap s position1
What is the AAP’s Position?

AAP Position #2 - The MD’s Role:

  • Disaster Planning:

    • “Primary care pediatricians and pediatric medical and surgical subspecialists should be included in emergency and disaster planning”

    • “This should occur at every organizational level, at all levels of government, and in all types of planning”

What is the aap s position2
What is the AAP’s Position?

AAP Position #3 - Pediatric Casualties:

“Federal, state and local disaster plans should include specific protocols for the management of pediatric casualties, including strategies to:

  • Minimize parent-child separation and implement systems for the timely and reliable reunification of families

  • Improve the level of pediatric expertise on disaster response teams

  • Address the care requirements of children with special health care needs

  • Ensure the inclusion of pediatric mass casualty incident drills in both federal and state planning

What is the aap s position3
What is the AAP’s Position?

AAP Position #4 - Funding:

  • “The Emergency Medical Services for Children (EMSC) program should be reauthorized

    • Ultimately funded at the level of $37.5 million per year

    • As recommended by the Institute of Medicine report, to support the continued improvement in pediatric emergency and disaster preparedness”

How does this affect you
How does this affect you?

  • Case Examples from the ED:

    • School bus accident

    • The Black-Out

    • September 11

Write a letter
Write a Letter!

The EMSC Program

  • Support HR 2464, the Wakefield Act, and advocate for your pediatric patients!

  • May 21 is “EMSC Day 2008”

Or an email
Or an Email!

  • http://clinton.senate.gov/contact/webform.cfm?subj=issue

  • Dear Senator Clinton:

    • I am a Resident in Pediatrics at a children’s hospital in New York City. I am writing to ask that you support HR 2464 / S 60, the Wakefield Act, which will reauthorize funding for the Emergency Medical Services for Children (EMSC) Program

    • Congress must invest in creating effective state disaster response systems and an emergency medical services system that is healthy, adequately funded and well coordinated – and one that can meet the specific needs of New York’s children.

    • I think that this is an important bill because I believe in the importance of the health and safety of our children.

    • Thank you for your support.

International pediatric trauma
International Pediatric Trauma

  • Myanmar:

    • May 3 cyclone kills 62,000 - 100,000 people

    • 1.5 million survivors

International pediatric trauma1
International Pediatric Trauma

  • China:

    • May 12 earthquake kills at least 10,000 people

Pediatric rescue relief
Pediatric Rescue/Relief

  • UNICEF: www.unisefusa.org

  • Save the Children: www.savethechildren.org


  • Emergency Medical Services for Children National Resource Center

    • http://bolivia.hrsa.gov/emsc/index.aspx

  • Press Statement on Legislation to Reauthorize Emergency Medical Services for Kids

    • http://www.aap.org/advocacy/washing/05-23-07-emsc-statement.pdf

  • Images

    • www.nytimes.com