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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 ers4
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 emsc9
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 emsc11
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 now13
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 now14
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 position16
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 position17
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 position18
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 trauma23
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