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

Improving Pre-Hospital Care and Transport for Children with

Special Health Care Needs

Justine Ropp RRTPPC 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 120-150 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

0

5

10

15

20

25

30

35

40

45

50

infant-15yr 15-18 yrs All None

EMT/Paramedic

Pediatric Experience

0

5

10

15

20

25

30

35

40

45

50

PALS Limited Zero

EMT/Paramedic

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

FamilyQuestionnaire

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 1-800-472-0111.

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