Last summer, the Institute of Medicine (IOM) released its long-awaited report titled The Future of Emergency Care in the United States Health System. The report was divided into several areas, including one on pediatric emergency care, which reviewed the challenges of delivering emergency care for children and considered the progress that has been made in this area since establishment of the federal Emergency Medical Services for Children (EMS-C) program 20 years ago.
For this month's column, I spoke with Tommy Loyacono, MPA, NREMT-P, the chief operations officer in the city of Baton Rouge and parish of East Baton Rouge (LA) Department of EMS, where he has served for 22 years. Loyacono was a member of the Pediatric Subcommittee of the Institute of Medicine Future of Emergency Care in the U.S. Health System Committee. He shared his thoughts on the report's findings, and how EMS can prepare to meet the needs of pediatric patients.
What are the most important recommendations in the IOM report regarding pediatric care?
Pediatric experts have long recognized that an effective EMS system for children does not exist separately. The care of children must be a facet of EMS that is integrated into all aspects of the EMS system. If I were going to pick a single most important recommendation for children, I would say it is the direction that:
"Every pediatric and emergency care-related health professional credentialing and certification body should define pediatric and emergency care competencies and require practitioners to receive the appropriate level of initial and continuing education necessary to achieve and maintain those competencies."
Nearly one-third of all emergency department visits in the U.S. involve children, but children make up less than 10% of the nation's prehospital EMS runs. The relatively low number of pediatric prehospital encounters makes it difficult for EMS professionals to maintain the special skills they need to effectively evaluate and manage critically ill or injured children.
What is "family-centered care" and how does it relate to EMS?
Family-centered care is a concept that was founded by former Surgeon General C. Everett Koop in 1987. It can be defined as a mutually beneficial relationship between the patient, the healthcare provider and the patient's family members. It recognizes the value of the family's knowledge about the patient's condition and the value of their skills and presence during care. The core principles of family-centered care include: treating patients and families with dignity and respect, communicating with family members during and after the call with unbiased two-way information sharing that promotes participation in care decisions, helping family members retain a sense of control during emergency care, and providing the opportunity for family presence during invasive procedures and during transport, as long as the safety of the patient is not compromised. It is especially important when dealing with children with special healthcare needs, but its usefulness is not limited to pediatric care. The National Association of Emergency Medical Technicians (NAEMT) has published several products to help teach EMS professionals about the value of family-centered care. More information on this topic can be found online at www.naemt.org/emsc. There is also an interactive CD-ROM on this subject--On the Same Team: Involving the Family in Prehospital Care--which is available from the EMS-C National Resource Center.
Are there areas specific to pediatric prehospital care that most EMS systems seem to be lacking, and are there easily implementable practices for them to follow to ensure more success?
Through grant activities, the federal EMS-C program has established minimum pediatric equipment and supply lists for both emergency departments and ambulances, but information about the degree to which states have adopted these lists is not available. Model pediatric prehospital protocols are available from the National Association of EMS Physicians (www.naemsp.org), but here too, there is no central reporting about the degree to which these or other pediatric protocols are in place across the nation. Requirements for pediatric training also vary widely from state to state.
The IOM report recommends that "EMS agencies should appoint a pediatric coordinator-to provide pediatric leadership for the organization." Having a passionate champion for any cause is often key to its success. Most every EMS organization probably has an individual with the interest and skills to oversee pediatric quality improvement initiatives. Identifying such an individual and providing him or her with the resources to ensure availability of pediatric equipment, supplies and medications, help assure adequate skills and knowledge among the organization's emergency care providers, and act as a liaison to other pediatric stakeholders in the community could go a long way toward improving the readiness of EMS professionals to care for children in the prehospital arena.
Raphael M. Barishansky, MPH, EMT-B, is executive director of the Hudson Valley Regional EMS Council in Newburgh, NY, and a member of EMS Magazine's editorial advisory board. He can be reached at firstname.lastname@example.org.