1. Emergency Care for Children Community Pediatrics: Legislative Advocacy May 2008 Emily Greenstein MD Clement Bottino MD

2. A Public Health Problem Injury is the #1 cause of death for children in the United States. –In 2004, injury accounted for 60% of all deaths in children younger than 18 years. Each year, 1 in 4 children sustain an unintentional injury that requires medical care.

3. Kids In Adult ERs Most hospitals do not have a separate pediatric facilities (PICU) 10% of hospitals without a PICU admit critically injured children to their ADULT ICUs Few hospitals have protocols for obtaining pediatric consultation on pediatric emergencies.

4. Kids In Adult ERs Evidence basis: Athey, J., et al. “Ability of hospitals to care for pediatric emergency patients.” Pediatric Emergency Care. 17(3):170-174, June 2001 –“Appropriately sized equipment for successful care of infants and children in an emergency situation was more likely to be missing than adult-sized equipment” –Many hospitals did not have adequate equipment to care for newborn emergencies

5. History 1970s - initial legislative advocacy: –Calvin Sia, M.D., president of the Hawaii Medical Association –Urged AAP to develop EMS programs that would decrease illness and death in children –Worked with Hawaii state legislature to accomplish this

6. History 1984: –Senators Orrin Hatch (R-UT) and Lowell Weicker (R-CT) joined Senator Inouye (D- HI) in sponsoring the first EMSC legislation –C. Everett Koop, M.D. and the AAP strongly supported this measure Under Section 1910 of the Public Health Service Act, the U.S. Congress enacted legislation authorizing the development of the Emergency Medical Services for Children (EMSC) Program

7. History 1986: –Alabama, California, New York, and Oregon became the first recipients of Federal grant money specifically earmarked to improve pediatric emergency medical services  This is the Emergency Medical Services for Children (EMSC) Program!

8. So what is EMSC? “Mission Statement”: To ensure that all ill and injured children and adolescents receive state-of-the-art emergency care This includes: –primary prevention –Pre-hospital care –Emergency care –Acute care –Rehabilitation

9. So what is EMSC? Administered by: The U.S. Department of Health and Human Services' Health Resources and Services Administration –in collaboration with – The U.S. Department of Transportation's National Highway Traffic Safety Administration

10. So What is the EMSC? What does it do exactly? The EMSC Program provides grants to States and U.S. territories to improve existing emergency medical services (EMS) systems –and - To develop and evaluate improved procedures and protocols for treating children

11. So What is the EMSC? The EMSC Program is the only Federal program that focuses specifically on improving the quality of children's emergency care Since its establishment, the EMSC Program has allocated $138 million to fund 851 grant awards and…  child injury death rates have dropped by 40 percent!

12. Where Are We Now? April 8, 2008: The House of Representatives approved HR 2464, the Wakefield Act, by a vote of 390-1

13. Where Are We Now? The Wakefield Act: This bill reauthorizes the EMSC Program for five years! –2009: $25,000,000 –2010: $26,250,000 –2011: $27,562,500 –2012: $28,940,625 –2013: $30,387,656

14. Where Are We Now? But To Become Law: Both the House and the Senate must vote on, and pass, their respective versions of the bill!! To date, no action has occurred on S 60, the Senate version of the Wakefield Act

15. What is the AAP’s Position? AAP Position #1 - Congress’ Role: Congress must invest in: –creating effective local, state and federal disaster response systems –a healthy, adequately funded, well- coordinated and functional emergency medical services system

16. What is the AAP’s Position? AAP Position #2 - The MD’s Role: Disaster Planning: –“Primary care pediatricians and pediatric medical and surgical subspecialists should be included in emergency and disaster planning” –“This should occur at every organizational level, at all levels of government, and in all types of planning”

17. What is the AAP’s Position? AAP Position #3 - Pediatric Casualties: “Federal, state and local disaster plans should include specific protocols for the management of pediatric casualties, including strategies to: –Minimize parent-child separation and implement systems for the timely and reliable reunification of families –Improve the level of pediatric expertise on disaster response teams –Address the care requirements of children with special health care needs –Ensure the inclusion of pediatric mass casualty incident drills in both federal and state planning

18. What is the AAP’s Position? AAP Position #4 - Funding: “The Emergency Medical Services for Children (EMSC) program should be reauthorized –Ultimately funded at the level of $37.5 million per year –As recommended by the Institute of Medicine report, to support the continued improvement in pediatric emergency and disaster preparedness”

19. How does this affect you? Case Examples from the ED: –School bus accident –The Black-Out –September 11

20. Write a Letter! The EMSC Program Support HR 2464, the Wakefield Act, and advocate for your pediatric patients! May 21 is “EMSC Day 2008”

21. Or an Email! http://clinton.senate.gov/contact/webform.cfm?subj=issue Dear Senator Clinton: –I am a Resident in Pediatrics at a children’s hospital in New York City. I am writing to ask that you support HR 2464 / S 60, the Wakefield Act, which will reauthorize funding for the Emergency Medical Services for Children (EMSC) Program –Congress must invest in creating effective state disaster response systems and an emergency medical services system that is healthy, adequately funded and well coordinated – and one that can meet the specific needs of New York’s children. –I think that this is an important bill because I believe in the importance of the health and safety of our children. –Thank you for your support.

22. International Pediatric Trauma Myanmar: –May 3 cyclone kills 62,000 - 100,000 people –1.5 million survivors

23. International Pediatric Trauma China: –May 12 earthquake kills at least 10,000 people

24. Pediatric Rescue/Relief UNICEF: www.unisefusa.org Save the Children: www.savethechildren.org

25. References Emergency Medical Services for Children National Resource Center –http://bolivia.hrsa.gov/emsc/index.aspx Press Statement on Legislation to Reauthorize Emergency Medical Services for Kids –http://www.aap.org/advocacy/washing/05-23- 07-emsc-statement.pdf Images –www.nytimes.com