In fiscal year 2013, the federal EMSC Program awarded the following six Targeted Issues grants, all of which focus solely on pediatric prehospital research. This represents one of the largest investments, $5.4 million over three years, in pediatric prehospital research. These newly-funded projects will either demonstrate the ability of EMS systems to conduct pediatric research or seek to improve the quality of care by increasing the base of pediatric prehospital research. Below is a brief project description of each grant and an update on their progress one year later.
NEW HAMPSHIRE: Geisel School of Medicine and Dartmouth-Hitchcock Medical Center. Innovating and Improving Prehospital Pediatric Care in Rural New Hampshire and Vermont: The Center for Rural Emergency Services and Trauma (CREST) Network for EMS Providers (Principal Investigator: Scott Rodi, MD). The infrequency of pediatric EMS patient encounters makes retention of knowledge and skills difficult. Add to this, the limited educational trainings available for EMS providers, especially in rural settings. The goal of this project is to increase the knowledge and competency of EMS providers in rural settings through the establishment of a rural EMS training network. To date, the project team has (1) completed a needs assessment for regional EMS providers, (2) developed educational modules for seven pediatric clinical topics, and (3) begun to adapt an existing ambulance into a mobile simulation center.
NEW YORK: Hofstra North Shore-LIJ School of Medicine at Hofstra University. Prehospital Oral Steroids for the Treatment of Status Asthmaticus in Children (POSTSAC) Study (Principal Investigator: Robert Silverman, MD, MS). EMS personnel are currently limited to nebulizer treatments among pediatric asthmatics with acute exacerbations. Allowing EMS personnel to administer steroids in the prehospital setting may prevent possible health consequences for the child, including increased hospital admissions and prolonged ED visits. The goals of this project are to: (1) determine if prehospital administration of oral steroids by paramedics to pediatric patients with moderate to severe asthma exacerbations decreases time spent in the ED and the need for hospitalization and (2) determine if advanced life support (ALS) providers can successfully administer oral steroids (prednisolone) to children with moderate-to-severe asthma. To date, the project team has (1) trained more than 1,200 paramedics on how to administer supplemental steroids to pediatric patients and (2) enrolled 45 patients.
KENTUCKY: University of Louisville Research Foundation. Compassionate Options for Pediatric EMS (COPE) (Principal Investigator: Mary Fallat, MD). EMS providers are often the first line to console grieving parents who have lost a child because of a traumatic event or illness outside the hospital. The initial encounter with grieving parents of pediatric fatalities is overwhelming to EMS providers, and has sometimes resulted in EMS providers leaving the profession. The goal of this project is to develop a systems approach to out-of-hospital pediatric death that equips EMS providers with the knowledge, tools, and skill set needed to manage the emotional and psychological effects for the grieving families they encounter as well as for themselves. To date, the project team has (1) conducted EMS and parent focus groups with more than 100 participants and (2) completed the first version of a mobile application.
INDIANA: Indiana University. Treat the Street: Prehospital Pediatric Asthma Intervention Model to Improve Child Health Outcomes (Principal Investigator: Andrew Stevens, MD). In-home asthma assessments have been successful in reducing repetitive ED visits or ED recidivism rates. Typically, in-home assessments are conducted by a public health nurse. However, the capacity for the public health system to absorb a large number of referrals is limited. Therefore, community paramedics – specially-trained EMS professionals – are ideal candidates to conduct the in-home assessments. The goal of this project is to utilize a novel pediatric community paramedicine program to (1) address identified gaps in pediatric asthma care, (2) reduce ED recidivism rates for children, (3) improve pediatric health outcomes, and (4) enhance paramedic provider roles in care delivery. To date, the project team has (1) completed nearly 300 home visits, (2) added the ED referral process to the inpatient referral process, and (3) reported preliminary results that show families who chose to participate in the paramedic home visit program return to the hospital less frequently and have a shorter length-of-stay.
TEXAS: Baylor College of Medicine and Texas Children’s Hospital. Pediatric Evidence-Based Guidelines Assessment of EMS System Utilization in States (Principal Investigator: Manish Shah, MD). Prehospital care is usually standardized within an EMS system through the use of guidelines or protocols, also known as offline medical direction. However, offline medical protocols vary from one EMS agency to another, making standardization of care across EMS agencies challenging. The goal of this project is to improve the evidence-base for pediatric prehospital care utilizing the National Prehospital Evidence-Based Guideline (EBG) Model Process. To date, the multidisciplinary project team has developed four pediatric-relevant EBGs – airway management, allergic reactions, shock, and spinal care – after a thorough review of the medical literature, including an evaluation using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.
WISCONSIN: Medical College of Wisconsin. Development of the Charlotte, Houston, and Milwaukee Prehospital (CHaMP) Research Node (Principal Investigator: Brooke Lerner, PhD). Limited research exists on how to improve care in the prehospital setting. The scarcity in available EMS research is even greater for pediatric populations. Additionally, the ability to gather statistically significant data through sufficient sample sizes is difficult due to the relatively low number of pediatric EMS encounters across the country. The goal of this project is to develop an EMS Research Node Center that will work in cooperation with the Pediatric Emergency Care Applied Research Network to conduct innovative and significant prehospital pediatric research. To date, the project team has (1) created the infrastructure for the project, including a website, Facebook page, policies, and an EMS research training lecture series; (2) developed five research concepts; (3) received additional funding through the state of Wisconsin to do quality improvement planning; and (4) drafted two manuscripts (one describing pediatric EMS at a single site and another describing pediatric EMS research priorities).