In the August EMSCPulse, Diana Fendya’s anticipated retirement from the EMSC program was announced. After nearly 30 years of dedication to the emergency care of children across our nation, Diana will formally retire at the end of October. Her husband, …Read More..
A digest of EMSC Program News and Activities
Issue #41 | Sept. 19, 2019
The 2019 EMSC All Grantee Meeting in Arlington, VA covered a broad range of topics, touching on work performed by all the EMSC programs and partners: Targeted Issues (TI), Pediatric Emergency Care Applied Research Network (PECARN), State Partnership Regionalization of …Read More
Members of the NEDARC team led a four-hour pre-conference workshop focused on incorporating elements of storytelling when sharing information and the tools Adobe Spark Page and Adobe Spark Video. Chris Hoffman began by going over the same information twice to …Read More..
Last Days to Provide Feedback on Draft Revisions to the National EMS Education Standards
The first draft of proposed revisions to the National EMS Education Standards is available for public comment. Members of the EMS community and the public are encouraged to review the draft and provide feedback to the team leading the effort. Find more information here. The comment period is open until September 20.
The revision process is supported through the National Highway Traffic Safety Administration (NHTSA) and the Health Resources and Services Administration and comes on the heels of the release of the 2019 National EMS Scope of Practice Model, which drove the proposed changes. “This is a chance for members of the EMS profession to share thoughts on how the standards must evolve alongside the needs of those communities," said Jon Krohmer, MD, director of the NHTSA Office of EMS.
The effort to revise the National EMS Education Standards is led by a team of experienced EMS professionals convened by the National Association of EMS Educators (NAEMSE). The team has engaged with stakeholders across EMS and healthcare to create this first draft of the standards. Following the initial public comment period, all comments received will be reviewed. A new draft will be released for public comment in early 2020.
5 New Grants Awarded for Targeted Issues Grant Program
In August, the HRSA EMSC Program announced five new Targeted Issues (TI) grant awards for the 2019-2022 cycle. The focus of the TI grant program is to build the evidence chain between pediatric readiness and improved pediatric clinical care and outcomes. Two grants will assess the impact of ED pediatric readiness and three grants will assess the impact of the presence of a Pediatric Emergency Care Coordination in prehospital EMS agencies. Awardees include:
- CONNECTICUT: Yale University. Pediatric Emergency Care Coordination in EMS Agencies: Measuring the Influence, Magnifying the Improvement; Mark X. Cicero, MD - Principal Investigator.
- LOUISIANA: Louisiana Department of Health, Office of Public Health. Pediatric Care Coordination in EMS Agencies – Improving Child Health Outcomes in Louisiana; Toni Gross, MD, MPH & Gail Gibson, RN, MSN, FABC - Principal Investigators.
- NORTH CAROLINA: University of North Carolina at Chapel Hill. System Readiness Improvements through the EMS Pediatric Emergency Care Coordinators Program; Jane Brice, MD, MPH - Principal Investigator.
- OREGON: Oregon Health and Science University. A Multi-State Evaluation of Emergency Department Pediatric Readiness: Guideline Update and Association with Quality, Outcomes, and Cost; Craig D. Newgard, MD, MPH - Principal Investigator.
- TEXAS: Dell Medical School at the University of Texas at Austin. Developing a National Pediatric Readiness Project Quality Improvement Data Registry; Katherine Remick, MD - Principal Investigator.
Further details about the awardees can be found on the Targeted Issues Grant Fact Sheet 2019-2022.
Coming Soon! Pediatric Readiness in EMS Systems Joint Policy Statement
For several years, the American Academy of Pediatrics (AAP) Committee on Pediatric Emergency Medicine and Section on Emergency Medicine EMS Subcommittee have been collaborating with the American College of Emergency Physicians, the Emergency Nurses Association, the National Association of EMS Physicians and the National Association of Emergency Medical Technicians to create a joint policy statement on "Pediatric Readiness in Emergency Medical Services Systems." This policy statement is now in its final stages of approval before anticipated publication in early 2020. Similar to how a previously published joint policy statement on "Guidelines for Care of Children in the Emergency Department" provides guidance to emergency departments to be ready to care for children, this policy statement is intended to provide such guidance to EMS systems. The AAP has also created a technical report to accompany the policy statement, with the AAP Section on Surgery as an added author, as a resource for clinical and administrative EMS leaders as they optimize pediatric readiness for their EMS systems."
National Preparedness Month
National Preparedness Month is an annual campaign in September each year to encourage Americans to prepare for emergencies and disasters. This effort is led by the Federal Emergency Management Agency (FEMA) and is sponsored by the Ready Campaign in partnership with Citizen's Corp. This year's National Preparedness Month theme is, “Prepared, Not Scared. Be Ready for Disasters." The FEMA urges people to prepare for specific threats such as a floods, wildfires, hurricanes, and power outages. The FEMA campaign will feature Public Service Announcements that promote the importance of preparing children and teenagers for possible emergencies and disasters. In addition, the campaign will feature 4 weekly themes:
- Week 1: September 1-7 - Save Early for Disaster Costs
- Week 2: September 8-14 - Make a Plan to Prepare for Disasters
- Week 3: September 15-21 - Teach Youth to Prepare for Disasters
- Week 4: September 22-30 - Get Involved in Your Community’s Preparedness
The AAP National Preparedness Month web page includes resources from the Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE), strategies to connect with families to encourage disaster preparedness, steps to enhance influenza prevention and control, and much more.
Pediatric Readiness: In Press
August’s issue of Pediatrics, contains both a commentary by the EIIC’s Dr. Kate Remick and a retrospective cohort study examining the relationship between focusing on hospital-specific pediatric readiness and encounter mortality emergency care for children. The research found that children who presented to an ED with lower pediatric readiness scores had an increased risk-adjusted mortality with critical illness. Continued efforts to improve ED pediatric readiness may reduce mortality for children.
Remick KE. The Time Is Now: Uncovering the Value of Pediatric Readiness in Emergency Departments. Pediatrics. 2019;144(3):e20191636
Ames SG, Davis BS, Marin JR, et al. Emergency Department Pediatric Readiness and Mortality in Critically Ill Children. Pediatrics. 2019;144(3):e20190568
Evidence-Based Guideline for EMS Use of Naloxone Now Available
After a thorough review of published research and collaboration of a multidisciplinary expert panel, an evidence-based guideline (EBG) for the EMS administration of naloxone has been published in Prehospital Emergency Care. The group, led by the National Association of State EMS Officials, the National Association of EMS Physicians and the American College of Emergency Physicians and supported by NHTSA, has also made available a model protocol based on the new EBG and other research. These documents are additional steps designed to improve the quality of EMS clinical care by creating a process to develop, implement and evaluate evidence-based guidelines. The new naloxone EBG, along with other guidelines developed via this process, is available on the new EMS Evidence-Based Guidelines page.
EMS and the Opioid Crisis
The opioid epidemic impacts EMS across the nation every day. EMS clinicians serve on the frontlines, responding to overdoses and related emergencies, often the first contact with the healthcare system for people struggling with addiction. EMS systems also collect vast amounts of data during these encounters that have been used by public health agencies and other organizations at local, state and national levels to inform efforts to reduce overdose deaths. This month, NHTSA debuted a new online resource on the opioid crisis, offering resources for the EMS community, its partners in public health, public safety and healthcare, and the public.
Timely ASPR TRACIE Resources
Active hurricane season has arrived. Dorian devastated the Bahamas and hit Puerto Rico, the U.S. Virgin Islands, Florida and along the east coast, the Office of the Assistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE) would like to call your attention to their Hurricane Resources Page. There, you can find information on hospital and federal patient evacuation, potential public health and medical implications, and lessons learned from recent recovery efforts.
And while the days may be growing slowly shorter, they know your to-do list is not. ASPR TRACIE can help! Did you miss the webinar highlighting new resources and future plans? Access the recording and/or the resources highlighted on August 27 which included resources and technical support for pediatrics. In addition, September is right around the corner—don’t forget to follow ASPR on Facebook, Twitter, YouTube, and LinkedIn as they highlight resources throughout National Preparedness Month.
Finally, ASPR TRACIE has recently published 3 modules designed for healthcare workers in all settings to assist with issues related to disaster behavioral health, provider self-care, suicide prevention, and compassion fatigue. It summarizes the modules, and provides links to previews and content for each one. Check them out here.
EMS Contact List Management System to Go Live Soon!
The production version of the Contact List Management System to all users is in the process of being released by NEDARC. This system will provide EMSC state managers and NEDARC a central location to store the contact information of approximately 17,000 emergency medical service agencies. During the internal testing phase, NEDARC had rigorously tested the system by cataloging the entirety of War and Peace eight times (approx. 8 million characters) in each input field!
Designed to maintain all information in one place, communication during data collection is anticipated to be less error prone and more streamlined. Rhode Island and Minnesota pilot users have responded well. Watch for an email from NEDARC soon with details on how to access the database and contact your Technical Assistance Rep with questions. The link will be https://wiki.utahdcc.org/confluence/display/CLMS/Contact+List+Management+System+Home.
More materials available from NEDARC
Slide Decks for Performance Measures 02 & 03
NEDARC created two PowerPoint slide decks for EMSC state managers to use to present performance measure 02 and 03 data. Users can download the slide decks and customize the experience depending on the intended audience. The slide decks available for download on the NEDARC site.
The slide decks were designed to support and assist EMSC Managers to become more self-reliant and empowered by:
- Modeling/teaching facilitation skills for involving stakeholders in presentations
- Having managers access, understand, and present their own state data
- Explore data and ask questions to implement quality improvement efforts
Emergency Nurses Association Releases New Resources in Support of Pediatric Readiness
- ENA Position Statement: The Emergency Nurse’s Role in Supporting Pediatric Readiness in the Emergency Department
This position statement stresses the importance for ED nurses and EDs to focus on being “Peds Ready” through designation of a nurse pediatric emergency care coordinator (PECC), availability of appropriate sized equipment and supplies, provision of nurse education and competencies, and inclusion of pediatric patients in disaster plans/drills.
This tool provides emergency departments with a method to assess their readiness to include patients and families in care and decision-making processes.
Use the ENA website search function for other pediatric resources.
AAP Disaster Preparedness Reminders
National Healthcare Coalition Preparedness Conference
The National Healthcare Coalition Preparedness Conference (NHCPC) scheduled in Houston TX in early December 2019 highlights best practices of health care coalitions from across the United States and provides opportunities for attendees to network with peers, share ideas, and learn from others' experiences in building and sustaining effective health care coalitions. Registration/housing for the conference is available! On December 5, 2019, a workshop will be held that provides an overview of the Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) Healthcare Coalition Pediatric Surge Annex Template. Additional information about this workshop, as well as other sessions and events that will focus on disaster preparedness and response for children, will be posted on the AAP Upcoming Events Web page.
ASPR TRACIE Mass Casualty Triage Paradigms and Pitfalls White Paper
Mass casualty incidents (MCIs) from violent attacks are becoming more common. These types of events highlight a need for emergency medical services (EMS) medical directors, EMS systems planners, hospital emergency planners, and any others that have a lead role in health care emergency response planning, to be prepared to respond to these types of events. As a result, ASPR TRACIE recently released a Mass Casualty Triage Paradigms and Pitfalls White Paper. This document contains planning considerations that should be reviewed when developing MCI plans and training programs.
New Systematic Review Examines Effectiveness of Prehospital Pain Management Options
EMS clinicians frequently care for people suffering from acute pain. Adequate pain relief is integral to providing people-centered care and has been known to reduce anxiety and cardiac complications in some patients. With multiple analgesic options available, EMS systems face choices when deciding how best to treat acute pain in the prehospital environment.
To help EMS systems develop evidence-based practices, the National Highway Traffic Safety Administration (NHTSA) Office of EMS collaborated with the Agency for Healthcare Research and Quality (AHRQ) to support a review of the evidence and effectiveness of a number of analgesic options. The reviewers analyzed more than 60 published studies and looked at treatments including opioids, ketamine, non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.
The authors concluded that intravenous ketamine, NSAIDs or acetaminophen provide similar relief to opioids, but each medication type has different side effects. They acknowledged, however, that most studies were concluded in emergency department settings and looked at IV administration of medications. Further research examining the effectiveness and safety of other routes and specifically in the prehospital setting is encouraged
"System leaders and clinicians must account for multiple factors when choosing treatment options including safety, effectiveness, cost and availability," said Jon Krohmer, MD, director of the NHTSA Office of EMS. "This report is a great step forward in the EMS community's move toward evidence-based practice."
A recent Notice of Funding Opportunity sought organizations interested in leading development of an evidence-based guideline (EBG) for the pharmacologic management of acute pain by EMS in the prehospital setting. The development of EBGs for prehospital emergency care has been a priority of NHTSA and its federal partners for more than a decade. In that time, NHTSA has published a National Prehospital EBG Model Process and supported the creation of several guidelines. More information about EMS evidence-based guidelines and the model process can be found on the new EMS Evidence-Based Guidelines page.