Emergency Medical Services for Children -- Copyright -- Preface -- Acknowledgments -- Contents -- Summary -- RECOGNIZING A NEED FOR EMERGENCY MEDICAL SERVICES FOR CHILDREN -- Origins of the Study and Report -- A Vision of Emergency Medical Services for Children -- Children and Why They Need Special Attention -- Epidemiological Considerations -- Key Historical Developments -- PRIORITY ISSUES IN IMPROVING EMERGENCY MEDICAL SERVICES FOR CHILDREN -- Education and Training -- Programs for the Public -- Programs for Health Care Professionals -- Putting Essential Tools in Place -- Communication -- Public Access to Emergency Services -- Communication Within EMS Systems -- Communication About EMS-C -- Planning, Evaluation, and Research -- Meeting Data Needs for Planning and Evaluation -- Research -- Leadership at the Federal and State Levels -- Agencies and Advisory Councils -- Funding -- LOOKING TO THE FUTURE -- Issues of Benefits and Costs -- A Changing Health Care Environment -- Health Care Reform -- Special Challenges to EMS and EMS-C -- FINAL THOUGHTS -- 1 Introduction -- THE ISSUE: ENSURING EMERGENCY MEDICAL CARE FOR CHILDREN WHO NEED IT -- THE INSTITUTE OF MEDICINE STUDY -- Origins of the Study -- Conduct of the Study -- A VISION OF THE IDEAL SYSTEM: ESTABLISHING CRITICAL LINKAGES -- Linking Components of EMS-C -- Linking Children to EMS -- Linking Emergency Care to Children's Health Care -- GUIDING PRINCIPLES -- ORGANIZATION OF THE REPORT -- AUDIENCE FOR THIS REPORT -- THE COMMITTEE'S GOAL -- NOTE -- 2 Risking Our Children's Health: A Need for Emergency Care -- DEFINITIONS -- Children -- Emergency Medical Services -- WHY CHILDREN NEED SPECIAL ATTENTION -- Children Differ from Adults -- Anatomy and Physiology -- Emotional and Behavioral Development -- Patterns of Morbidity and Mortality -- Special Concerns in Caring for Children.

Recognizing Serious Illness and Injury -- Treating Children -- Helping Children with Special Health Care Needs -- EPIDEMIOLOGY OF CHILDHOOD EMERGENCIES -- Injury -- Illness -- Other Aspects of Pediatric Emergencies -- Settings for Emergency Care -- Emergencies Encountered in the Pediatrician's Office -- Prehospital Care -- ED Care -- General Inpatient Settings -- Intensive or Specialized Inpatient Care -- Rehabilitation Services -- COSTS OF INJURY AND ILLNESS -- Injury -- Illness -- Nonmonetary Costs -- SUMMARY -- NOTES -- 3 Emergency Medical Services Systems: Origins and Operations -- DEVELOPMENT OF EMS AND EMS SYSTEMS -- The 1960s and Earlier -- Recognizing a Need -- Initial Responses -- Other Activities -- The 1970s -- EMS in General -- Children and EMS -- The 1980s to the Present -- The Federal Role in EMS -- Other Developments into the 1980s -- Concerns Emerging in the 1980s -- Children and EMS -- Committee Observations -- PROVIDING EMERGENCY MEDICAL SERVICES -- Essential Services for Emergency Care of Children -- STRUCTURE OF EMS SYSTEMS -- State-Level Activities -- EMS Offices and Advisory Councils -- Public Health and Health Care -- Public Safety -- Two Examples of Unusual State-Level Efforts -- Enhancing EMS-C -- Local and Regional Activities -- Prehospital Services -- Hospitals: Emergency Services and Inpatient Care -- Primary Care Providers -- The Community -- Other EMS Systems -- Enhancing EMS-C at the Local Level -- Professional and Voluntary Organizations -- Funding for EMS Systems -- SUMMARY -- NOTES -- Appendix 3A Recommendations from Accidental Death and Disability: The Neglected Disease of Modern Society -- ACCIDENT PREVENTION -- EMERGENCY FIRST AID AND MEDICAL CARE -- First Aid -- Ambulance Services -- Communication -- Emergency Departments -- Interrelationships between the Emergency Department and the Intensive Care Unit.

THE DEVELOPMENT OF TRAUMA REGISTRIES -- HOSPITAL TRAUMA COMMITTEES -- CONVALESCENCE, DISABILITY AND REHABILITATION -- MEDICOLEGAL PROBLEMS -- AUTOPSY OF THE VICTIM -- CARE OF CASUALTIES UNDER CONDITIONS OF NATURAL DISASTER -- RESEARCH IN TRAUMA -- Appendix 3B Emergency Medical Services for Children Demonstration Grant Program -- 4 Learning How to Provide Good Care: Education and Training -- EDUCATION AND TRAINING FOR THE PUBLIC -- Who Should Be Included -- Parents and Other Responsible Adults -- Other Adults, Adolescents, and Children -- What Needs to Be Taught -- Prevention and Safety -- Basic First Aid and CPR -- When and How to Use EMS -- Opportunities for Education and Training -- Health Care Visits -- Schools, Day Care, Recreation, and Community Programs -- Legislative Actions -- Meeting Local Needs -- A Need for Public Education Programs -- EDUCATION AND TRAINING FOR HEALTH CARE PROFESSIONALS -- General Needs -- Needs of Prehospital Providers -- On-Scene Care -- Dispatchers -- Variation in Authorized Interventions -- Needs of ED Staff -- Needs of Other Health Care Providers -- Providing Professional Education and Training -- Initial Qualifying Training for Prehospital Providers -- Initial Education for Other Health Professionals -- Graduate and Residency Training for Health Care Professionals -- Nursing -- Medicine -- Accomplishing Curriculum Change -- Specialized Continuing Education Courses -- A Sampler of Current EMS-C Training Programs and Courses -- Benefits and Building Blocks -- Drawbacks and Obstacles -- OTHER CONCERNS -- Making Education and Training Available -- Providing the Right Course to the Right Audience -- Evaluating Education and Training Efforts -- Retaining Knowledge and Skills -- Providing incentives for Education and Training -- Financing Education and Training -- SUMMARY -- NOTES.

5 Being Ready to Deliver Good Care: Putting Essential Tools in Place -- DEFINITIONS -- EQUIPMENT -- The Right Kind and the Right Size -- Lack of Pediatric Equipment -- What Should Be There? -- Costs -- PROTOCOLS -- Value of Protocols -- Needs Throughout EMS Systems -- Dispatchers -- Prehospital Personnel -- ED Staff -- Inpatient Hospital Staff -- Personnel in Outpatient Settings -- Comment -- MEDICAL CONTROL -- Extending the Physician's Care -- On-Line Control: Immediate Care -- Off-Line Control: Planning and Management Functions -- Shaping the EMS System -- Need for Pediatric Input -- Comment -- CATEGORIZATION AND REGIONALIZATION -- Categorization: Identifying Appropriate Providers -- Capabilities for Emergency Care for Children -- Implementing Categorization: One Approach -- Comment -- Regionalization: Making Effective Use of Pediatric Resources -- Role of Regional Referral Centers -- Intensive Care Services -- Pediatric Trauma Systems -- Specialized Transport Resources -- Improving Outcomes of Care -- Special Concerns in Regionalization -- Interstate Issues -- Rural Issues -- Encouraging Categorization and Regionalization -- SUMMARY -- NOTES -- 6 Connecting the Pieces: Communication -- PUBLIC ACCESS TO THE EMERGENCY CARE SYSTEM -- Universal Access Through 9-1-1 -- Benefits of 9-1-1 -- Enhanced 9-1-1 -- Important Considerations for 9-1-1 Systems -- Recommendation for 9-1-1 -- Telephone Advice -- Poison Control Centers -- Hospital ED and Other Providers -- PREHOSPITAL COMMUNICATION -- Communications Technologies -- On-line Medical Control -- COMMUNICATION IN HOSPITAL CARE -- Consultation by the ED Staff -- Local Consultation -- Reaching Regional or National Specialists -- Transfers to Other Facilities and Referral Centers -- Written Transfer Agreements -- Centralized Communication System for Transfers -- FOLLOW-UP: ENHANCING CONTINUITY OF CARE.

Primary Care -- Primary Care in the Emergency Department -- Managed Care Plans and Medicaid -- Improving Follow-up Care -- Rehabilitation Services -- FEEDBACK -- OTHER IMPORTANT FORMS OF COMMUNICATION -- System Planning and Coordination -- Communication with the Community -- Professional Communication -- SUMMARY -- NOTES -- 7 Knowing What Is Happening and What Is Needed: Planning, Evaluation, and Research -- UNDERSTANDING THE INFORMATION GAP -- PLANNING, EVALUATION, AND RESEARCH -- Planning -- Evaluation -- Research -- UNDERSTANDING CURRENT AND EMERGING SOURCES OF DATA AND DATA SYSTEMS -- Strengths and Weaknesses -- Prehospital Services -- Hospitals -- Trauma Registries -- Health Insurance Claims and Administrative Data Sets -- Death Records -- Other Data Sets -- Special Concerns -- Lack of Uniformity and Consensus About Data Elements -- Linking and Aggregating Data -- Diagnostic Coding for Mechanism of Injury -- Validity of Data and Performance Indicators -- Patient Outcomes -- Privacy and Confidentiality -- IMPROVING INFORMATION RESOURCES -- National Uniform Data Elements for EMS-C -- Criteria for Inclusion in a National Uniform Data Set -- Priority Data Elements -- An Information Core, Not an Information Constraint -- Further Work -- Federal and State Guidance -- Lessons and Remaining Challenges -- IMPLEMENTING A RESEARCH AGENDA -- High-Priority Topics -- Clinical Aspects of Emergencies and Emergency Care -- Severity and Acuity Measures for Injury and Illness -- Patient Outcomes and Outcome Measures -- Costs -- System Organization, Configuration, and Operation -- Education and Training -- Prevention -- Other Areas for Research -- SUMMARY -- NOTES -- Appendix 7A Methods for Scoring Acuity and Severity of Injury and Illness -- TRAUMA AND INJURY MEASURES -- Selected Measures -- Triss Analysis -- Pediatric Trauma Score.

Other Pediatric-Specific Measures.