Developing Pediatric Emergency Preparedness Performance Measures

Recent disaster events, such as September 11th and Hurricanes Katrina and Rita, combined with current concerns for public health emergencies such as pandemic influenza, have led to a continued focus on emergency preparedness. As has been discussed in this article, to optimally prepare for children and advocate for their needs, pediatric-specific performance measures need to be recognized and developed. It is also important that performance measures that address the unique needs of children are not just developed but that they are universally accepted to allow for benchmarking. To develop these measures one must use existing validated approaches to developing performance measures by focusing on the domains of volume, structure, process, and outcome. This can then be supplemented through the use of surrogate measures to overcome the problem caused by the infrequency of disaster events and the benefit of adopting existing validated health care performance measures. In the short term, out of necessity, we will need to use existing volume and structural measures that are currently in use in emergency preparedness but assure that they are adapted to contain pediatric-specific components. We then need to develop unique pediatric specific emergency preparedness performance measures that will be based on empiric quantitative measures. This will allow us in the long term to have the data to develop validated pediatric emergency preparedness performance measures that are based on collected data.The approach, quantitative methodology and consensus development process described in the article, when applied, will significantly advance pediatric preparedness. Ultimately, these pediatric-specific measures must exist and be used to assess current levels of performance and guide resource allocation and targeted improvement efforts.     

Emergency department oral rehydration of children: The best solution?

Oral rehydration therapy is widely recommended as the standard therapy for children with mild to moderate dehydration due to otherwise uncomplicated gastroenteritis. The use of oral rehydration in place of intravenous rehydration has. however, been limited, including in the emergency department (ED) setting. Much of the resistance to use of oral rehydration in the ED is due to logistic difficulties with its administration. The authors review, the history and scientific background of oral rehydration, provide guidelines for its use. discuss the barriers to its adoption in the ED setting and strategies by which they may be overcome, acknowledge the limitations to its use, and suggest areas for future research.     

Categonzation and regionalization of emergency departments caring for children

Population demographics do not allow every area of the county equal access to all health care resources. Services for critically ill and injured children are no exception. Categorization and regionalization of specialized health care services have been shown to improve outcome and reduce the cost of health care for a variety of circumstances. A systems approach to caring for pediatric emergencies that assures access to stabilizing care and timely transfer to definitive care resources can save lives and improve morbidity rates. This approach can be accomplished through a process o1 assuring that every hospital with an emergency department has met minimum standards for the care of children in crisis that includes, when necessary, timely transfer to definitive care. Hospitals should be categorized according to their resources to manage pediatric emergencies and, through a process of regional cooperation, facilities should be linked to assure timely access to definitive care for children who are critically ill or injured.     

The new emergency medical technician-paramedic and emergency medical technician-intermediate curricula: History, changes, and controversies

In recent years there has been considerable change and improvement in pediatric prehospital education. The evolution of ENIS (emergency medical services) for children has paralleled the evolution of EMS hat with a laf of several years. The most recent advance has been the release of the new paramedic and emergency medical technician intermediate (EMT-I) national standard curricula. The new curricula represent a major improvement in the training of EMTs and paramedics in the care of sick or injured children. In fact, what this new curriculum represents is the incorporation of the many continuing medical education efforts that have been developed, produced, and taught by the emergency medical services for children community over the past 15 years. This new curriculum now focuses on assessment-haled medicine that is in-line with the rest of emergency care. In addition, this new curriculum now provides an educational fornmt similar to that undertook by most pediatric continuing medical education courses in an effort to overcome common educational barriers. This curriculum provides significant hands-on training through both skill, practice , and casebased learning. This will hopefully give paramedics basic knowledge, an understanding of disease processes of the child and skills that will allow them to provide care for ill and injured children with confidence. The curriculum also provides a more directed focus on the importance of maintaining an airway and breathing in the child and that a deficiency in these are usually the root of most pediatric emergencies. In addition, it covers relevant topics in pediatric care as well as topics which are of concern to the paramedic student. Although the new curriculum incorporates changes in all we know about pediatric care, to further overcome barriers in pediatric education there trust he better teaching modalities for the EMT and the paramedic, an increase in their experience in dealing with sick and injured children from a multitude of settings, and development of better training models.     

Pediatric airway management

The approach to pediatric airway management should be systematic and well planned. This article will describe the steps in appropriate airway management, from the prehospital to the emergency department (ED) setting. These steps include clinical assessment, preparation of equipment and staff, and a progression through a series of interventions designed to address the clinical condition of the patient. Each intervention is followed by a reassessment. Prehospital airway management is distinetly different from the ED man agement of the airway and must take into account the shill level of the providers, demographics of the emergency medical services (EMS) system, and the risks and benefits of each planned intervention. A good foundation of basic skills, such as understanding of pediatric airway-anatomy, head positioning, and correct bag-valve-mask or bag-mask ventilation (BVM), arc necessary for appropriate airway management. The majority of patients requiring endotracheal intubation (ETI) can be successfully intubated with rapid sequence intubation (RSI). A difficult airway may occasionally be encountered, and the emergency physician (EP) must have alternative methods for the support of ventilation and oxygenation if BVM and ETI fail.