Barriers and Enablers to Recruiting for the PECC Role in EMS Agencies

More than 80% of EMS agencies see fewer than eight children per month. As a result, many EMS professionals may have limited pediatric-focused education opportunities and infrequent encounters with children. In 2007, the Institute of Medicine recommended that EMS agencies designate a pediatric emergency champion, or pediatric emergency care coordinator (PECC), to support the care of children. The PECC can oversee pediatric quality improvement initiatives, provide skills-based pediatric training to agency staff, and ensure that pediatric medications, equipment, and supplies are available.

To identify best practices to increase the percentage of EMS agencies with PECCs – which is a performance measure for the EMSC Program’s 58 State Partnership grantees – the EMSC Innovation and Improvement Center hosted a six-month PECC Learning Collaborative (PECCLC). Findings from the PECCLC were published last month in the journal Prehospital Emergency Care.

The PECCLC engaged nine states (Connecticut, Kentucky, Montana, New Mexico, New York, Ohio, Pennsylvania, Rhode Island, Wisconsin). State representatives participated in virtual monthly learning sessions with subject matter experts and support staff as well as a two-day in-person meeting.

PECCLC Outcomes

Outcomes of the PECCLC showed that during the six-month collaborative, state representatives recruited 341 PECCs (92% of predetermined recruitment goals). During the five months after the collaborative, 184 more PECCs were recruited for a total of 525 PECCs (142% of goal). State representatives and PECCs reported that the biggest barriers to PECC recruitment were:

• competition from other EMS responsibilities,
• budgetary constraints,
• lack of incentive for agencies to create the position, and
• lack of requirement for establishing the role.

On the other hand, the biggest enablers were:

• having an EMS agency recognition program that includes the PECC role,
• train-the-trainer programs, and
• inclusion of the PECC role in agency licensure requirements.

Interviews with PECCs identified that the most common activity associated with their role was pediatric-specific education and the most important need for PECC success was agency-level support.

“Long-term PECC recruitment and retention may be possible through local and national EMS agency support, and the continued development of and outreach to interested individuals in prehospital pediatric care,” says Hoi See Tsao, MD, MPH, an Assistant Professor of Pediatric Emergency Medicine at UT Southwestern Medical Center who serves as the Prehospital Domain EMSC Fellow and is the publication’s lead author. “Future work includes investigating other methods and outreach efforts to further increase the number of PECCs in addition to the use of learning collaboratives. This may provide insight into additional effective ways to increase the number of PECCs and best practices, and ultimately improve the prehospital care of children.”

EMSC-funded studies—including Targeted Issues grant projects in North Carolina, Connecticut, Rhode Island, Colorado, and Louisiana— are evaluating the effects of EMS agency PECCs on patient care. The National Prehospital Pediatric Readiness Project is supporting EMS agency pediatric readiness efforts with a publicly available toolkit containing over 100 resources, including resources developed by the PECC-focused Targeted Issues grant in Connecticut, which is led by Mark X. Cicero, MD.