PECCs in EMS Agencies: Measuring the Influence, Magnifying the Impact

EMSC is currently investing in five projects, known as Targeted Issues (TI) grants, which will demonstrate the link between emergency department (ED) and EMS system readiness improvements and improved pediatric clinical care and health outcomes. One of these TI grants is focused on understanding how pediatric emergency care coordinators (PECCs) in EMS agencies influence the quality of care for children in emergency situations. Mark Cicero, MD, FAAP, FAEMS, the grant’s principal investigator and now medical officer/physician for the Health Resources and Services Administration's EMSC Branch, shared the importance of this work.

Tell us about the project.

“Our work aims to establish if there are connections between having a PECC in an EMS agency and both higher quality pediatric care and better outcomes in the prehospital setting. It turns out that Rhode Island, one of the three states represented in our work (along with Colorado and Connecticut) requires every EMS agency to have a PECC. This created a natural laboratory for understanding the study aims.”

How did you decide to work on this project?

“Back in early 2019, EMSC announced the current round of EMSC Targeted Issues Grants and a focus on prehospital PECCs. At the time, our Connecticut EMSC State Partnership Program was involved in the 10-state EMSC PECC Learning Collaborative. That work showed us the value of PECCs in prehospital agencies. We saw an opportunity to build on what we had learned in the collaborative and establish means for determining what having a PECC meant for pediatric patients, for families, and for the agencies themselves.”

How does the program work?

“There are three main efforts for the program.

1. We need to understand what measurable differences there are between EMS agencies with and without PECCs. We have been comparing thousands of prehospital pediatric patient care reports and their corresponding emergency department records, looking for adverse safety events and other gaps in care. Also, our team saw an opportunity to leverage simulation. Knowing that critically ill pediatric patients (thankfully) don’t present to EMS that frequently, we have used prehospital simulation as a way to directly compare the same critical events among EMS teams from agencies with and without PECCs.
2. We look at family satisfaction with the care provided to pediatric patients, and whether the presence of a PECC is associated with improved satisfaction. We have developed the FAMILY evaluation, a tool which empowers families and EMS clinicians to provide feedback about what went well with EMS care for children, and what can be improved.
3. We are working on the implementation of PECCs, from PECC designation to establishing the role of PECC, to supporting existing PECCs, and ensuring sustainability when PECCs move on to the next phase of their careers. My Yale-based colleague Marc Auerbach, who is also part of the EMSC Innovation & Improvement Center, has led the implementation arm of our project. Under his leadership, we have developed a toolkit that includes a PECC activity log, the FAMILY evaluation tool, and workshops for building relationships between EMS PECCs and their community hospital-based counterparts. We also have disseminated the EMS SimBox simulations.”

What is your goal for this grant?

“Briefly, we aim to show whether having a PECC in an EMS agency is associated with higher quality care and better outcomes for children. We suspect the answer to this question will be a hearty ‘YES’, but our work will help EMS agencies, leaders and policymakers understand the value of a PECC, and why the role should be supported in every agency.”

How do you designate a PECC in an EMS agency?

“Often, PECCs are designated by EMS agency leadership. However, this isn’t always the case. When there is a person who already performs some or all of the roles described here that person is a so-called ‘natural’ PECC, the de facto champion for children in the prehospital setting.”

What about smaller rural agencies?

“Currently, rural agencies face a staffing crisis. Many rural agencies are dealing with the absence of advanced life support services and providing care at the basic life support level only. Additionally, some counties in the United States effectively have no emergency medical services at all. Considering these factors, establishing and maintaining the PECC role can be challenging. There are strategies that can ensure PECC involvement, even in rural agencies. First, designating a regional PECC, a go-to pediatric champion who serves the needs of multiple EMS agencies, can bridge the gap, allowing quality and education efforts across a larger expanse. Next, for agencies that have larger pediatric volumes and fewer staffing issues, establishing a dedicated PECC at the agency level is a good step. Finally, for urban, high-volume agencies, designating a PECC for each shift, to serve as the go-to resource for pediatric care, can be a means to ensure 24/7 high-quality pediatric care.”

What is the best way(s) to support EMS PECCs?

“PECCs require resources, support, recognition, and dedicated time. The needs of individual PECCs and agencies are unique. Giving PECCs agency within EMS to advocate for pediatric care will ensure that EMS continues in its mission to deliver timely, high-quality care to all patients.”

Learn more about Targeted Issues Grants here.