Three Targeted Issue grants focus on prehospital space

In 2019, Emergency Medical Services for Children (EMSC) funded five Targeted Issues (TI) grants to address current gaps in pediatric emergency care and enhance existing programs that promote pediatric readiness in emergency care settings.

Below, in honor of National Emergency Medical Services (EMS) Week, principal investigators share updates on three grants related to prehospital care.

CONNECTICUT – Yale University. Pediatric Emergency Care Coordination in EMS Agencies: Measuring the Influence, Magnifying the Improvement (Principal Investigator: Mark X. Cicero, MD).

The work of this team includes a comparison of EMS agencies with Pediatric Emergency Care Coordinators (PECCs) to those without a designated PECC. It also includes evaluation of the quality of care provided to pediatric patients, their outcomes in the prehospital setting, and in the emergency department, and family satisfaction with that care. To augment the investigation of actual patient outcomes, simulations are used to determine if there is a difference in how PECC and non-PECC agencies care for children.

To date, the team has published an article describing the development and implementation of the Family Assessment of Medical Interventions and Liaisons with the Young (FAMILY) Satisfaction tool and presented their work at the National Association of EMS Physicians annual meeting. A series of formative simulations have been conducted at each agency, and this spring, evaluation simulations will allow interim comparison among agencies. The team continues to work on a PECC implementation toolkit, that includes the PECC EMS Evaluation Tool (PEET). Finally, the team is engaged in qualitative research, to determine barriers and facilitators of establishing and maintaining the PECC role in EMS agencies.

NORTH CAROLINA – University of North Carolina at Chapel Hill. System Readiness Improvements through the EMS Pediatric Emergency Care Coordinators Program (Principal Investigator: Jane Brice, MD, MPH).

The Pediatric Emergency Care Coordinator Plus (PECC+) program, formally titled “System Readiness Improvements through the EMS Pediatric Emergency Care Coordinators Program,” provides access to online educational content, individualized performance adherence reports, and an alert system for EMS clinician-related pediatric care. Each element will be housed within a centralized PECC Hub for 10 participating rural North Carolina EMS agencies.

To date, agencies have been identified using an application system supported by the North Carolina Office of EMS and North Carolina EMSC, and a selection process between the research team and these two partners. The team is currently working with ESO and the North Carolina Area Health Education Centers Program to outfit the PECC Hub with the aforementioned features to support PECCs in their roles. In addition, the project is planning its first PECC Summit, to be held in July 2021, at which PECCs will learn about their roles, engage in expert-led lectures, and experience simulation-based education. Being dedicated to advancing research experience and knowledge in the next generations, the project also will engage high school interns from its Internship in Science and Health Training and Research program in summit planning and execution. In addition, data collected from the summit will be utilized by masters-level public health students in the next year to develop patient-provider communication tools.

LOUISIANA – Louisiana Department of Health, Office of Public Health. Pediatric Care Coordination in EMS Agencies – Improving Child Health Outcomes in Louisiana (Principal Investigators: Toni Gross, MD, MPH, and Gail Gibson, RN, MSN, FABC).

Louisiana had a high child fatality rate noted from 2014-2016, and the mission of this project is to reduce childhood death and disability through coordination of pediatric care at the level of EMS agencies, while also establishing a permanent program for recognition of pediatric care coordination.

The hospital and EMS agency entities have entered into an agreement to use a central Institutional Review Board and collate data in the Louisiana Department of Health’s secure servers. EMS data is being submitted to the servers on an ongoing basis. Site investigators at each hospital and EMS agency created a logic model to define process outcomes that will be studied along with health outcomes.

The EMS agencies participating in the project came to a consensus on a job description for their PECCs at the outset of the project. Due to social distancing, regular meetings with the PECCs and project leadership have occurred virtually. PECCs were able to share their own experiences initiating the role at their respective agency and to discuss pearls and pitfalls. At upcoming PECC meetings, updated consensus-based treatment guidelines and ambulance equipment lists will be reviewed to ensure that the PECCs are reliable information sources for their medical directors and colleagues. The founding EMS PECCs serve as regional champions, recruiting additional EMS agencies to institute PECCs, forming an EMS PECC consortium. As the project moves forward with the ability to meet in person, regular meetings will also allow for train-the-trainer exercises to disseminate educational resources to additional EMS agencies.