Administered by the U.S. Department of Health and Human Services’ Health Resources and Services Administration

Health Resources and Services Administration

The Health Resources and Services Administration , is an agency of the U.S. Department of Health and Human Services located in Rockville, Maryland...

 (HRSA), Maternal and Child Health Bureau

Maternal and Child Health Bureau

- Key Facts :• HRSA’s Maternal and Child Health Bureau administers programs that serve more than 34 million women, infants and children each year. About 60 percent of U.S. women who give birth receive services through HRSA-supported programs....

 (MCHB), the Emergency Medical Services for Children (EMSC) Program is a national initiative designed to reduce child and youth disability

Disability

A disability may be physical, cognitive, mental, sensory, emotional, developmental or some combination of these.Many people would rather be referred to as a person with a disability instead of handicapped...

 and death due to severe illness

Illness

Illness is a state of poor health. Illness is sometimes considered another word for disease. Others maintain that fine distinctions exist...

 or injury

Injury

-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...

.

Established in 1984, the Program’s purpose is to raise awareness about the importance of providing emergency medical care to children that corresponds to their physiological

Physiology

Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...

 and psychological

Psychology

Psychology is the study of the mind and behavior. Its immediate goal is to understand individuals and groups by both establishing general principles and researching specific cases. For many, the ultimate goal of psychology is to benefit society...

 development. The Program targets primary and acute healthcare professionals, emergency medical services (EMS) and trauma system providers and planners, and the general public.

Background

Although the EMSC Program began 25 years ago, the larger emergency care system of which it is a part dates back to the Korean

Korean War

The Korean War was a conventional war between South Korea, supported by the United Nations, and North Korea, supported by the People's Republic of China , with military material aid from the Soviet Union...

 and Vietnam

Vietnam War

The Vietnam War was a Cold War-era military conflict that occurred in Vietnam, Laos, and Cambodia from 1 November 1955 to the fall of Saigon on 30 April 1975. This war followed the First Indochina War and was fought between North Vietnam, supported by its communist allies, and the government of...

 Wars. Medical experiences in both conflicts demonstrated that survival rates improve dramatically when patients are stabilized in the field and transported immediately to a well-equipped emergency facility. During the 1960s, civilian medical and surgical communities began to recognize the possibilities in applying these experiences within an organized EMS system.

Support for EMSC. In 1973, Congress

United States Congress

The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....

 passed the Emergency Medical Services Systems Act of 1973, establishing a program managed by HRSA to provide additional resources to state and local governments for implementing comprehensive EMS systems. Between 1975 and 1979, state EMS systems dramatically improved the outcomes for adults—however, pediatric surgeons

Pediatric surgery

Pediatric surgery or paediatric surgery is a subspecialty of surgery involving the surgery of fetuses, infants, children, adolescents, and young adults...

, pediatricians, and other concerned groups began to recognize that children’s outcomes did not keep pace.

In 1979, Calvin C.J. Sia, MD, then-president of the Hawaii Medical Association, urged members of the American Academy of Pediatrics

American Academy of Pediatrics

The American Academy of Pediatrics is the major professional association of pediatricians in the United States. The AAP was founded in 1930 by 35 pediatricians to address pediatric healthcare standards. It currently has 60,000 members in primary care and sub-specialist areas...

 (AAP) to develop multifaceted EMS programs designed to decrease disability and death in children. Soon after, Senator Daniel Inouye

Daniel Inouye

Daniel Ken "Dan" Inouye is the senior United States Senator from Hawaii, a member of the Democratic Party, and the President pro tempore of the United States Senate making him the highest-ranking Asian American politician in American history. Inouye is the chairman of the United States Senate...

 (D-HI) joined Dr. Sia’s crusade after learning about the care provided to the daughter of one of his senior staff members. Her treatment demonstrated the average emergency department’s shortcomings in treating a child in crisis.

Senators Orrin Hatch

Orrin Hatch

Orrin Grant Hatch is the senior United States Senator for Utah and is a member of the Republican Party. Hatch served as the chairman or ranking member of the Senate Judiciary Committee from 1993 to 2005...

 (R-UT) and Lowell Weicker (R-CT), backed by other staff members with similar disturbing experiences, joined Sen. Inouye in sponsoring legislation to create the EMSC Program.

In 1984, the U.S. Congress enacted legislation (Public Law 98-555) authorizing the use of federal funds for EMSC. Administered by MCHB, the EMSC Program provides states grant money to help develop and “institutionalize” emergency medical services for critically ill and injured children. The Program does not promote the development of a separate EMS system for children, but rather seeks to enhance the pediatric capability of existing EMS systems.

One year later, Congress appropriated initial funds for EMSC and the first program grant announcements were published. In 1986, EMSC awarded the first federal grants specifically earmarked to improve pediatric emergency medical services to Alabama, California, New York, and Oregon.

Federal EMSC Program

The federal EMSC Program is designed to ensure that all children and adolescents—no matter where they live, attend school, or travel—receive appropriate care in a health emergency. Since its establishment, the EMSC Program has provided grant funding to all 50 states, the District of Columbia, and five U.S. territories. Additional EMSC Program funding has been used to establish national resource centers and to support the infrastructure for a pediatric emergency care research network (Ball et al.). Grants and cooperative agreements funded by the program include the following:

Grants and Cooperative Agreements Funded by EMSC	Description
State Partnership (SP) Grants	State Partnership grants fund activities to improve and integrate pediatric emergency care in a State EMS System. The typical applicant is a State government unless the State decides to delegate responsibility to an accredited school of medicine. Every grantee is required to collect and report data on program-defined performance measures.
Targeted Issue (TI) Grants	Targeted issue grants are intended to address specific needs, concerns, or topics in pediatric emergency care that transcend state boundaries. Grantees are typically schools of medicine looking to find new approaches to providing the best possible emergency care for children across the nation. Typically, the projects result in new products or resources, or demonstrate the effectiveness of model system component(s) or service(s) of value.
Network Development Demonstration Project (NDDP) Cooperative Agreements	NDDP cooperative agreements demonstrate the value of an infrastructure or network that conducts multi-center investigations on the efficacy of treatment, transport, and care responses for children, including those preceding the arrival of children to hospital emergency departments. The Pediatric Emergency Care Applied Research Network (PECARN) currently consists of four NDDP cooperative agreements awarded to academic medical centers.
Central Data Management Coordinating Center (CDMCC)	Following the inception of the Pediatric Emergency Care Applied Research Network (PECARN), a cooperative agreement was awarded to the University of Utah to serve as the Network's Central Data Management and Coordinating Center. The Center provides a central repository for data generated by each of the PECARN research sites, or nodes, and their hospital affiliates. The CDMCC also works with PECARN principal investigators to implement PECARN-wide standards for data collection and analysis in order to ensure uniformity and quality of the data and to monitor the safety and timely progress of PECARN studies.
National EMSC Data Analysis Resource Center (NEDARC)	Funded through a cooperative agreement, NEDARC provides technical assistance to EMSC grantees and state EMS offices in the areas of data collection, data analysis, data communication, quality improvement, grant writing, and research design.
EMSC National Resource Center (EMSC-NRC)	Also funded through a cooperative agreement, the EMSC-NRC provides support to EMSC federal project officers and EMSC grantees.

Additional Information: For more information on the Federal EMSC Program, visit http://bolivia.hrsa.gov/emsc/index.aspx

EMSC Program Accountability

To measure the effectiveness of federal grant programs, HRSA requires grantees to report on specific performance measures related to their grant funded activities. The measures are part of the Government Performance Results Act (GPRA). In order to receive or continue to receive Program funds, all EMSC grantees must measure:

• Performance Measure 71: The percent of prehospital provider agencies in the state/territory that have on-line pediatric medical direction available from dispatch through patient transport to a definitive care facility.

• Performance Measure 72: The percent of prehospital provider agencies in the state/territory that have off-line pediatric medical direction available from dispatch through patient transport to a definitive care facility.

• Performance Measure 73: The percent of patient care units in the state/territory that have essential pediatric equipment and supplies as outlined in national guidelines.

• Performance Measure 74: The percent of hospitals recognized through a statewide, territorial, or regional standardized system that are able to stabilize and/or manage pediatric medical emergencies.

• Performance Measure 75: The percent of hospitals recognized through a statewide, territorial, or regional standardized system that are able to stabilize and/or manage pediatric traumatic emergencies.

• Performance Measure 76: The percentage of hospitals in the state/territory that have written interfacility transfer guidelines that cover pediatric patients and that include pre-defined components of transfer.

• Performance Measure 77: The percent of hospitals in the state/territory that have written interfacility transfer agreements that cover pediatric patients.

• Performance Measure 78: The adoption of requirements by the state/territory for pediatric emergency education for license/certification renewal of BLS/ALS providers.

• Performance Measure 79: The degree to which state/territories have established permanence of EMSC in the state/territory EMS system by establishing an EMSC Advisory Committee, incorporating pediatric representation on the EMS Board, and hiring a full-time EMSC manager.

• Performance Measure 80: The degree to which state/territories have established permanence of EMSC in the state/territory EMS system by integrating EMSC priorities into statutes/regulations.

Partnership Opportunities

Maintaining Partnerships with National and Professional Organizations. The Program works with a variety of national and professional organizations to identify and address the key issues affecting EMS, including but not limited to: managed care, disaster preparedness, children with special healthcare needs, mental health, family-centered care, and cultural diversity. The Program develops national task forces and publishes comprehensive reports drawing attention to many of these critical issues. Past examples of such collaborative work include the following:

(1) The American College of Surgeons Committee on Trauma, the National Association of EMS Physicians, the American College of Emergency Physicians (ACEP), and the EMSC Partnership for Children Stakeholder Group collaborated to revise the recommended equipment list for ambulances in the United States. This revised document will be used to evaluate the availability of pediatric equipment and supplies for Basic Life Support and Advanced Life Support patient care units. It is available at http://www.cnmc.org/files/PDF/EMSC/PubRes/Equipment_for_ambulances_FINAL.pdf

(2) Duke University and the AAP convened a multidisciplinary panel of experts to discuss recommendations to improve pediatric medication safety in the emergency department. The final program for that meeting is available for download at http://www.childrensnational.org/emsc/NationalActivities.

(3) The AAP, ACEP, and the Emergency Nurses Association work together to release the joint policy statement Guidelines for Care of Children in the Emergency Department (see http://www.childrensnational.org/files/PDF/EMSC/PubRes/Guidelines_for_Care_of_Children_in_the_ED.pdf).

(4) In partnership with the The George Washington University School of Public Health and Health Services Department of Health Policy, the NRC published the issue brief “The Application of the Emergency Medical Treatment and Labor Act (EMTALA) to Hospital Inpatients” (see http://www.childrensnational.org/files/PDF/EMSC/PubRes/EMTALAIssueBrief.pdf). The issue brief provides a brief overview of the Emergency Medical Treat¬ment and Labor Act (EMTALA) and focuses on its application to hospital inpatients.

(5) In collaboration with the Federal Interagency Committee on EMS, the NRC conducted a Gap Analysis of EMS Related Research. This project, which involved a review of more than 270 articles, mapped existing literature to priorities described in national research agendas as a mechanism for assisting with the process of making informed decisions regarding policy and funding priorities. For more information, go to http://www.childrensnational.org/files/PDF/EMSC/NationalActivities/Gap_Analysis_of_EMS_Related_Research.pdf.

Collaborating with Federal Organizations. The Program works with numerous federal agencies to improve the quality and quantity of EMSC research, to foster interagency collaboration in highlighting EMSC research topics within research agendas, and to reduce barriers impeding the production of high-quality EMSC research. The Center also collaborates with the Pediatric Emergency Care Applied Research Network (PECARN), the first federally-funded pediatric emergency medicine research network.

Working with Healthcare Providers: Training and Education. The Program addresses contemporary pediatric emergency care issues such as Family Presence in the Emergency Department and Pediatric Disaster Planning and Preparedness from healthcare providers' perspective through the development of online training programs.

External links

EMSC National Resource Center, a department within Children’s National Medical Center, Washington, DC. http://www.childrensnational.org/emsc

The National EMSC Data Analysis Resource Center, Salt Lake City, UT. http://www.nedarc.org

Pediatric Emergency Care Applied Research Network, the first federally-funded pediatric emergency medicine research network in the United States. http://www.pecarn.org/