EMSC Pulse

A digest of EMSC Program News and Activities

Issue #54 | Oct. 15, 2020


Top News

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Pediatric Disaster Preparedness Quality Collaborative

In September 2019, the U.S. HHS Office of the Assistant Secretary of Preparedness and Response (ASPR) funded two Pediatric Disaster Care Centers of Excellence (COE); and charged them with improving disaster response capabilities for children in the United States. Over …

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In the Know

Pulse In the Know

HHS Telemedicine Hack – Wednesdays at 12:00 pm ET through November 25. The U.S. Department of Health & Human Services (HHS) is partnering with the ECHO Institute at the University of Mexico, and the Public Health Foundation’s TRAIN Learning Network to deliver a 10-week peer-to-peer learning community called Telemedicine Hack to provide knowledge and skills for video-based telemedicine. All ambulatory providers (e.g., primary care, surgical, rural/urban, dental, mental health, solo practitioners) are invited to participate.

Comments Requested: Modifications to the Definition of Rural for FORHP Grants – October 23

FEMA Accepts New Applications for COVID-19 Assistance to Firefighters Grant - FEMA is providing an additional chance for volunteer and combination fire departments to apply for funding under this year's Assistance to Firefighters COVID-19 Supplemental grant.

FEMA made $100 million available in funding for personal protective equipment (PPE) and related supplies. This includes reimbursement for expenditures made since Jan. 1, 2020.

Volunteer and combination fire departments are eligible to apply in this round even if they had a successful application in the first round earlier this year. Departments that applied in the first round but were unsuccessful must reapply to be considered for funding in this round. Applications from the first round will not automatically carry over to this round for consideration.

FEMA will host live webinars on Tuesday, Oct. 13, and Thursday, Oct. 15, demonstrating the application process and walking through the questions. Access the full training schedule and information on how to login to the webinars here.

FEMA will accept applications until 5 p.m. ET on Nov. 13. More information on eligibility requirements and how to apply is available on the FEMA website.

Sub-specialists Employ Innovative Strategies to Care for Patients During Pandemic

Members of the AAP sections reflect on the challenges their specialty has faced during the COVID-19 pandemic and how it has changed the way they practice. Click here to read the full text of the article featured in the August issue of AAP News.

Pediatric Emergency Medicine: Learning from Each Other

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Early in the COVID-19 epidemic, the Pediatric Emergency Medicine North American Chiefs (PEMNAC) used our email list to ask questions, provide information and discuss key medical and operational issues with about 140 pediatric emergency medicine (PEM) chiefs across the U.S. and Canada. We learned from firsthand experiences, including those who were affected early or especially hard.

As it became clear that children were not the primary coronavirus target, we discussed other ways we could help, which included refocusing or shutting down pediatric emergency departments (EDs) and caring for older populations in areas of need.

When the Pediatric Academic Societies meeting was canceled, we held a virtual PEMNAC meeting focused mostly on COVID-19. Our meeting included colleagues from Italy, who had been affected by COVID in ways that many of us had not, as well as U.S. ED and infectious disease experts. Through presentations and discussion, we learned an amazing amount about the virus, its trajectory, our successes and failures, and the evolving concern for the Kawasaki-like syndrome reported in Europe and New York City.

The group surveys our members frequently, which provides invaluable data on staffing models, costs and ways to ensure that PEM remains a viable safety net for individual facilities, systems and regions. It was clear that our disaster and infectious disease preparations and the resilience of emergency systems/providers, including physicians, nurses, ancillary team members and prehospital providers, would enable us to care for patients and families in a way that would optimally protect our providers. We used this up-to-date national information and data to inform our leaders and help design new and innovative ways to manage patients, families, personal protective equipment and processes.

We've also learned from each other to recognize and address stress, burnout, anxiety and fear in ourselves and our colleagues.

— George A. Woodward, M.D., M.B.A., FAAP, chair of the Pediatric Emergency Medicine North American Chiefs

Pediatric Palliative Care: Finding Hope in the Face of Uncertainty

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As the COVID-19 pandemic hit, pediatric palliative care (PPC) teams mobilized in a number of truly innovative ways.

The PPC team at Children’s Hospital at Montefiore in Bronx, N.Y., developed an incredible surge-in-place program, quickly training colleagues from other fields to provide palliative and bereavement care to adults in their larger hospital community (https://bit.ly/3k0yBwc, https://bit.ly/3hVoVRQ).

Colleagues in adult palliative care developed the COVID Vital Talk Playbook (https://www.vitaltalk.org/guides/covid-19-communication-skills/) for communication with adults and their families. Shortly thereafter, PPC colleagues released a version adapted for pediatrics. Teams offered their services at neighboring adult hospitals, obtaining emergency privileges and helping them to flex up their palliative care workforce at a time when so many adults are dying of this terrible disease.

Pediatric palliative care subspecialists also helped develop symptom management protocols in the event of ventilator shortages, pivoted to virtual bereavement support groups for grieving families, informed family presence policies and learned new ways to work as an interdisciplinary team while staying safely physically distanced.

As our colleague, Chris Adrian, M.D., wrote so beautifully, “…working with families over months and years teaches you to hope that life reconstitutes on the other side of catastrophe, and that people can find joy in living again on the far side of unbearable loss” (https://bit.ly/2DsGKbR). And so, despite it all, we found hope.

As we all cope with the uncertainty introduced by the COVID-19 pandemic, the experience gives us a glimpse into one aspect of the lives of our patients with serious illness and their families. Many have lived with deep uncertainty before the pandemic and will continue to live with it after the pandemic is gone.

We continue to support patients with serious illness and their families and hope that in the coming months, our services are needed less and less.

— Elissa Miller, M.D., FAAP member of the AAP Section on Hospice and Palliative Medicine

Developmental and behavioral pediatrics: Returning to our roots

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Developmental-behavioral pediatricians (DBPs) thought, “we have to see our patients in person!” Then overnight, we went remote. We adapted and found we’re well-suited to operate in the setting of a pandemic. We’ve shifted much of our practice to supporting families facing uncertainty.

Managing ambiguity is the superpower of DBPs. We’re accustomed to developmental changes, varied symptoms across settings and evolving diagnostic categories.

To diagnose autism, we assess facial expression during play and conversation. Since we can’t play with very young children mask-free, we now rely more on history and observation. None of the remote or “no-touch” diagnostic testing options are yet validated, but the bar isn’t lowered; the priority is to do no harm. Delaying a diagnosis when treatment is most effective would confer harm.

For children and teens with attention-deficit/hyperactivity disorder, we now focus on at-home behaviors. Many parents observe how hard learning is or how short their child’s attention span is. We use digital measures to diagnose learning and cognitive disorders, typically tools already validated for remote use (https://iopc.squarespace.com/teleneuropsychology-research). Recommendations now include supporting students during remote education.

We’ve shifted how we think about mental health disorders. During social isolation, anxiety, depression and sleep disruption may be medication side effects, co-morbid disorders and/or results of pandemic-related upheavals. Children are at increased risk for abuse; family stress is high. We’ve returned to our professional roots, thinking about each child’s strengths, weaknesses and function within an eco-bio-developmental context. The psychosocial stressors of their ecology have become a focus: How can we support a child and family in this moment in history?

Telehealth is a new window into family life. We see more family dynamics and watch children function in the most comfortable setting. As a field, we must develop new ways to diagnose/monitor accurately, without the regularity of school and office materials, but (payment allowing) I suspect telehealth will be a long-lasting part of DBP care.

Alison D. Schonwald, M.D., FAAP, member of the AAP Section on Developmental and Behavioral Pediatrics

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Publications

Research Report Highlights IO Access in Pediatric Population

A new study reported in Pediatric Anesthesia analyzes anatomic dimensions of the proximal tibia in the pediatric population with respect to intraosseous needle placement and needle tip position. Authors report that “radiographs from 190 patients (104 boys/86 girls) were included. When fully inserted to skin level, up to 10.5% of needles do not reach medullary cavity at one and 18.5% at two patient's fingerbreadths distal to tibial tuberosity. The opposite cortical wall is touched or penetrated in 16% and 25%, respectively. Up to 96% of too deep needle tip positions occur in children younger than 24 months, as do too superficial tip positions in 59%.” Conclusions suggest that infants and toddlers are at highest risk for malpositioning. Access the article at https://onlinelibrary.wiley.com/doi/full/10.1111/pan.13979

AHRQ Highlights Patient Handoff Tool for Pediatrics

A new article based on research funding from the Agency for Healthcare Research and Quality (AHRQ) describes one pediatric hospital’s experience adapting and implementing the I-PASS handoff program for inpatient nursing bedside report, physician handoff, and imaging/procedures handoff. The project demonstrates that I-PASS can be successfully used across a hospital system in various settings to reduce handoff-related errors. Click here to read more.

The National Association of State EMS Officials (NASEMSO) Joins National Orgs on Uniform Guidance in Prehospital Use of Ketamine for Trauma Patients

Several national associations have collaborated to establish consensus-based uniform guidance on the use of ketamine in the care of the trauma patient. It is intended for use by emergency medical services (EMS) personnel, EMS medical directors, emergency physicians, trauma surgeons, nurses and pharmacists in their treatment of acute trauma patients both in and out of the hospital and within their respective domains. The document, now published online in Prehospital Emergency care, is not intended to be a comprehensive discussion of pain control options in the trauma patient. Instead, it combines the collective expertise of the author organizations with current published evidence to offer unified guidance on the role of ketamine in this patient population. Dr. Aaron Burnett, State EMS Medical Director for MN, represented NASEMSO on the panel. Read more at https://www.tandfonline.com/doi/full/10.1080/10903127.2020.1801920.

American Academy of Pediatrics Virtual National Conference and Exhibition Available On-Demand!

The AAP offered its first virtual conference in early October, 2020. Individuals who want to learn more about emergency medicine and other critical pediatric topics can still register through the end of the month, which allows access to all educational content through January 2021. The AAP Council on Children and Disasters had its inaugural session on “Advancing Pediatric Readiness” and another session covered preparing for floods and wildfires. Several sessions will cover various topics related to the COVID-19 pandemic. As part of the initial plenary, you can hear Dr. Anthony S. Fauci speak on COVID-19: Public Health and Scientific Challenges. See the schedule or register for this incredible educational event. For assistance, e-mail DisasterReady@aap.org.

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Coronavirus Updates from the Nation's Capital

New resource! Take a look at this new AAP advocacy report, which details the Academy's COVID-19 related efforts at the state and federal level.

Last week, the AAP joined with five other leading medical organizations in sending a letter to congressional leadership expressing the urgent need to support the nation's immunization infrastructure and the physicians who deliver needed vaccinations to children and families.

"A strong vaccine delivery system must be an essential part of the strategy to end the COVID-19 epidemic," the groups said. "It is critical to ensure that as many patients as possible catch up on missed vaccinations, receive the flu shot this fall, and receive a COVID-19 vaccine when it is available."

Please continue to visit this AAP webpage for critical updates on COVID-19, including this page for advocacy information.

New Report Shows More Children Uninsured in 2019

The U.S. Census Bureau issued a report showing that roughly 5.7% of children were uninsured and 14.4% lived in poverty in 2019. While the poverty rate improved since last year, the number of uninsured children increased. Since the historic low in 2016, the number of uninsured children has grown each year, with 726,000 more children becoming uninsured even before the pandemic and associated recession. More from AAP News and this blog post from the Georgetown University Center for Children and Families.

AAP Signs Joint Statement on Cancer Prevention

On Thursday, AAP and other health organizations released a statement calling for action to reduce the burden of cancer by addressing environmental risk factors. The statement notes that children are particularly vulnerable to exposures to hazardous chemicals in the environment that are associated with cancers, and calls for expanded primary prevention to reduce toxic exposures.

COVID-19 CDC

Critical Updates on COVID-19

State-level reports are the best publicly available data on child COVID-19 cases in the United States. The AAP and the Children’s Hospital Association are collaborating to collect and share all publicly available data from states on child COVID-19 cases (definition of “child” case is based on varying age ranges reported across states; see report Appendix for details and links to all data sources).

On October 1, the age distribution of reported COVID-19 cases was provided on the health department websites of 49 states, New York City, the District of Columbia, Puerto Rico, and Guam. While children represented only 10.6% of all cases in states reporting cases by age, over 657,000 children have tested positive for COVID-19 since the onset of the pandemic.

A smaller subset of states reported on hospitalizations and mortality by age, but the available data indicated that COVID-19-associated hospitalization and death is uncommon in children.

At this time, it appears that severe illness due to COVID-19 is rare among children. However, states should continue to provide detailed reports on COVID-19 cases, testing, hospitalizations, and mortality by age and race/ethnicity so that the effects of COVID-19 on children’s health can be documented and monitored. Access a summary of findings (data available as of 10/1/20) by clicking here .

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EMSC 2021 Data Collection

The first week of October, NEDARC staff emailed data quality reports regarding the EMS agency contact information in the online Contact List Management System. These reports are designed to reduce the burden for EMS for Children Program Managers in their efforts to update and verify this information which is vital to the 2021 data collection from EMS agencies. EMS for Children Program Managers are urged to schedule time with their NEDARC technical assistance liaison to review these data quality reports before the end of October.

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Connecting with State Partners

Earlier this month, the EMSC state partnership grantees received an e-mail from the American Academy of Pediatrics (AAP) connecting you to critical state partners and resources. The COVID-19 pandemic has emphasized how important forming critical connections is before a disaster or public health emergency. If you did not receive this e-mail, contact the AAP at DisasterReady@aap.org .


Knowledge Management Domain Update

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The new early access content for October 2020 is now posted in the staging environment and accessible by invitation link. Please go to https://emscimprovement.center/ and on the top right, choose the "sign in/register" button. Next, complete the registration and click on the box to opt in to receive early access content. Check your email for the invitation link and follow the steps to review one or more of the content and provide feedback through the feedback form. Since the launch of the early access content on September 2020, we have had 117 unique users who have signed up to evaluate content ahead of its public inclusion on the EIIC we portal toolkit page.


Child Life Disaster Relief Network

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The Child Life Disaster Relief Network is a nonprofit volunteer network of certified child life specialists that in the event of a disaster or crises are mobilized to help mitigate the traumatic effects on children and families. They also provide education through their website to help providers and caregivers meet the needs of children following a disaster. This QR code is linked to the website to easily locate resources to help children cope following disasters. Resources include videos based on age and post disaster needs.


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On September 24, NEDARC hosted the monthly TechTalk called Microsoft Sway: Creating Engaging and Dynamic Reports- Part 2. This was a second in a 2-part series regarding Microsoft Sway which is a free online tool similar to Adobe Spark Page. With Sway, you can create engaging and dynamic online newsletters, reports, and presentations. You can find the recordings to Parts 1 and 2 on the NEDARC website at https://nedarc.org/tutorials/techTalks.html.


AAP Virtual Town Hall on COVID-19 Will Examine Testing

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The AAP has launched a bi-weekly series of virtual town halls linking members with leading experts to discuss emerging issues related to caring for patients and families during the COVID-19 pandemic. Previous sessions have been recorded and are available for viewing here.


National Pediatric Readiness Project Assessment Pilots with Louisiana and Colorado

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The National Pediatric Readiness Project assessment pilot with Louisiana and Colorado is in full swing. Hospitals are actively responding and we are working with EMSC personnel in those states to encourage response to the assessment from all hospitals. For more information about how to prepare for the May 2021 assessment, visit PedsReady.org.


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