Improving Pre-Hospital Care and Transport for Children with Special Health Care Needs Justine Ropp RRT PPC Capstone January 25, 2011

Why this topic? Identify family knowledge of EMS Identify EMS knowledge for transporting children with special health care needs Identify outside facilities knowledge of activating CHETA Goal 4: Provide regional and national continuing education…based on identified needs

Process Develop Questionnaire/Needs assessment EMS Families Contact surrounding EMS to distribute questionnaires Contact Families Parent member of PPC Family involvement Face to Face interview

EMT Levels EMT-Basic EMT -Paramedic

EMT- Basic (EMT-B) Represents the first level of the EMS System Receive hours of training Basic Life Support (BLS) skills Assess a patients condition and manage respiratory, cardiac, and trauma situations Usually restricted to using oxygen, glucose, inhalers, small volume nebulizers, and auto injectors

EMT-Paramedic Receive 1,200-1,800 hours of training Advanced Life Support (ALS) skills All skills in EMT-Basic Provide the most extensive pre-hospital care administer drugs orally or intravenously interpret EKG perform endotracheal intubations use complex equipment

EMT/Paramedic Questionnaire Madison Fire Department Rockford Fire Department Waunakee Deer Grove Did not hear back from: Green Bay Racine Middleton Merrimac

EMT/Paramedic Response 88% of responses were EMT-Paramedics 18% of responses were EMT-Basics

EMT/Paramedic Age Comfort

Pediatric Experience

EMS Response-Family Family/child visit station or obtain information prior to initiating call Knowledgeable care provider able to ride in ambulance to assist with care/questions Written instructions and medical information

EMS Response-PPC Education Seminars In-services Case Studies Lectures from experts Organize a peds bag BiPAP training Information on specialized equipment

EMS Response-Limitations Lack of equipment options – BiPAP unavailable on ambulance – Cough machine Lack or Pure Sine Wave Inverter to power Cough machine and BiPAP

Family Questionnaire Local families of SMA website 0 response Interviewed families in clinic and inpatient setting 12 responses

Family Questionnaire-Response 33% use EMS to transport to local hospital 100% used own equipment 66% feel they can transport faster and safer 33% notified EMS of their child’s needs and residence 25% notified EMS of their child’s equipment EMS unable to support technology on rig

Family Questionnaire-Response 50% of families are willing to provide in-services 100% of families would like to be transferred to AFCH 66% of families have heard of CHETA 33% Feel they would be comfortable advising the outside facility how to activate CHETA 16.7% of family believe their outside facility has knowledge of CHETA

Family Response-EMS Things families feel EMS should be knowledgeable on Cough machine Suction BiPAP Bag mask ventilation Willingness to take advice from families

Families perception of EMS weakness No Knowledge of child's disease process EMT’s afraid to touch and handle children The ones that did, didn’t realize the lack of muscle strength

Recommendations for Moving Forward

Moving Forward-PPC PPC Provide education for local EMS In-services and other forms of education opportunities for local EMS providers Collaborate with other resources such as CHETA and MATC to provide simulation with scenarios and equipment Provide Case Studies Encourage EMS on Equipment recommendations Pure Sine Wave inverter

Moving Forward-PPC Update discharge process to include contacting patients local EMS providers with pertinent information standardize form Meet with access center to understand each others needs in the process of transporting to AFCH patients diagnosis safest way to transport initiate CHETA at point of transporting to local hospital

Moving Forward-Families Encourage families to: Educate local community providers Local care providers Schools Make contacts with their local EMS Identify child’s needs Review equipment

Outside Facilities CHETA- outreach for medical training and technical assistance Target regions with high census of children with special health care needs Create a quick reference for families to give to outside facilities for initiating a transport. Initiating CHETA at point of transport to local hospital

CHETA: Children’s Hospital Emergency Transport Ambulance A critical care team with life support skills to bridge care between health care facilities A vehicle equipped with state of the art technology and equipment designed specifically for pediatric patients Transport services available 24/7 24/7Consultation with: Pediatric critical care physician Pediatric pulmonologist How to activate CHETA: To arrange transport or to speak to a pediatric critical care physician, call the Access Center at Bringing pediatric critical care to the bedside of children in a community or a referring hospital

Why Wait How can we relay importance of a specialized Pediatric Critical Care team (CHETA) to outside facilities Pediatric Nurse Pediatric Respiratory Therapist CHETA RTs know neuromuscular protocol and how to care for these children

Moving Forward-CHETA PPC Collaborate with CHETA to identify areas of improvement CHETA makes connections with patients and families when they are in clinic or inpatient CHETA reviews process for implementing with family CHETA provides follow up with local hospital/EMT after transport

Questions