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EMSC Performance Measures


The focus of the EMSC Program, as previously explained, is to improve pediatric emergency care throughout the nation.  The program has developed and is expecting all states to strive to achieve defined performance measures.  These measures steer all grantees toward a common goal of better pediatric emergency care.  It is important to understand the direction and focus of the program in order to clearly explain your role and better understand how you fit in the scheme of it all.


Your main goal is to promote the improvement of pediatric emergency care.  Your influence and experiences with the EMS system provide a pathway to reach health care professionals, the general public and public officials.  


This chapter will elucidate each performance measure and explain your role to moving the initiatives forward.


Section I.             Pediatric Medical Control


a.         Overview of the Performance Measure


Ensure the operational capacity of the state EMS system to provide pediatric emergency care by ensuring pre-hospital provider agencies have on-line and off-line pediatric medical direction at the scene of an emergency for Basic Life Support (BLS) and Advance Life Support (ALS) providers.


a.                                                      Why is this important?


Children are not just little adults!  Without appropriate pediatric medical direction, a pre-hospital provider could underestimate the pediatric patient’s condition, make a medication dosing error, or be incapable of effectively triaging multiple pediatric patients.


c.         Family Representative Role


            Family representatives can help to ensure that pediatric medical control is available to EMS providers by reviewing the written pediatric protocols to determine whether patient- and family- centered care procedures and policies are included.  An explanation of family-centered care systems is included in the Guide in Chapter Two, Section I.  Please know you are not expected to be familiar with or knowledgeable of the medical terminology within the pediatric protocols.  Family representatives can contribute by providing feedback on the current written protocols and ensuring that EMS providers are required to follow specific procedures that keep families appraised of their children’s medical condition. 



Section II.            Pediatric Equipment and Supplies


a.                  Overview of the Performance Measure


BLS and ALS patient care units in the State/Territory will have the essential pediatric equipment and supplies, as outlined in the American College of Emergency Physicians (ACEP) guidelines.


b.                  Why is this important?


Children come in different sizes.  Without the right sized pediatric equipment, a pediatric airway cannot be managed, an IV cannot be established, a cervical spine (c-spine) cannot be immobilized, and appropriate medication doses cannot be delivered.


c.         Family Representative Role


As a family representative you can help to ensure all patient care units responding to a 911 call have the pediatric equipment and supplies needed to save the life of a child.  First, talk with your EMSC Program manager to find out whether the patient care units in your state have all the required equipment and supplies.  Second, ask how you can help locally to ensure all the equipment and supplies are available on the units.


Develop relationships and partner with civic and community-based organizations.  These types of organizations help to improve communities and often make donations to purchase pediatric equipment.  One such organization that has helped in the past is the Kiwanis International.  The Indiana District of Kiwanis has supported the Indiana EMSC Program and has worked to make EMSC a part of the Kiwanis Young Children Priority One (YCPO) initiative in Indiana.  The YCPO supported EMSC in more than 32 counties through the EMSC Kiwanis Pediatric Bag project, which promoted enhanced pediatric equipment and education throughout the prehospital environment.  In 2001, the Indiana District of Kiwanis, Kids for Riley received the EMSC Community Partnership of Excellence Award.


In 2005 the Nebraska/Iowa Kiwanis Foundation received the EMSC Community Partnership of Excellence Award.  Since 2000, the Nebraska/Iowa Kiwanis Foundation has partnered with the EMSC Program to provide needed basic level pediatric equipment and education to EMS services in Nebraska and Iowa. Each year since then community-based Kiwanis clubs matched by foundation funds have distributed needed pediatric equipment to EMS services.




Section III.                    Hospital Recognition


a.                  Overview of the Performance Measure


Establish a statewide, territorial or regional standardized system that recognizes hospitals that are able to stabilize and/or manage pediatric medical emergencies and trauma. 


b.                  Why is this important?


Without a pediatric emergency healthcare facility designation process, access to appropriate critical care, trauma care or burn care could be delayed. Delays can result in negative patient outcomes.


c.         Family Representative Role


Family representatives can help to ensure the establishment of a statewide, territorial or regional standardized system that recognizes hospitals that are able to stabilize and/or manage pediatric medical emergencies and trauma. First, talk with your state EMSC Program manager to find out whether a standardized system exists.  If so, ask what hospitals have been designated, which have not and why.  If not, learn more about the importance of a designation system -- especially to EMS providers - then work with your state EMSC advisory committee to develop a system.  As a parent/guardian,  it is important to know which hospitals in the state are capable of managing pediatric emergencies and trauma.  If the system merely directs pediatric emergencies to the closest hospital regardless of its capacity to care for children and their unique needs, timely access to urgent specialized care may be jeopardized.






Section IV.                    Transfer Agreements and Guidelines


a.                  Overview of the Performance Measure


Hospitals in the State/Territory will have written pediatric inter-facility transfer agreements and guidelines.


b.                  Why is this important?


The most severely ill and injured children sometimes require specialized care that is only available in selected hospitals. Without effective inter-facility transfer agreements and guidelines, the timely and appropriate transfer of patients to the right level of emergency care is placed in jeopardy.  These delays could result in very negative patient outcomes.


c.         Family Representative Role


Oftentimes, health insurance status and other factors such as a receiving hospital’s patient capacity prevent the immediate transfer of a patient to an institution capable of providing specialty medical treatment.  As a family representative, you can help ensure timely patient transfers by working with your EMSC advisory committee and state program manager to ensure all hospitals in your state have in place interfacility transfer agreements and guidelines.  Talk with your program manager to first determine whether interfacility transfer agreements and guidelines exists and whether they are in place with all hospitals in the state.  Ask how you can work with the hospitals and review the current interfacility guidelines to ensure patient- and family- centered procedures are incorporated during transfers.



Section V.            Pediatric Training of Prehospital Providers


a.                  Overview of the Performance Measure


States/Territories will adopt requirements for pediatric emergency education prior to recertification of BLS and ALS providers.



b.                  Why is this important?


Most EMS providers rarely treat a sufficient number of pediatric patients to develop and maintain the skills necessary to treat pediatric emergencies in the field. Continuing education helps ensure that pre-hospital providers are ready to take care of a pediatric patient in the field. Continuing education also improves the quality and effectiveness of pediatric emergency care, and thereby, improves pediatric outcomes (e.g., reduced morbidity and mortality).


c.         Family Representative Role


Family representatives can help ensure all EMS providers receive pediatric training before they are recertified/relicensed in the state.  First, talk with your EMSC Program manager to learn whether pediatric education is a standard requirement prior to recertification.  You may also ask what type of pediatric training they receive annually.  Should pediatric training not be required, strategize with your EMSC Program manager in partnership with the state EMSC advisory committee to combat existing barriers.  Discuss the challenges and determine how you can help.  Ask your program manager whether you can contact the local EMS agencies to discuss their pediatric training programs and determine the issues that prevent the EMS agency from providing and requiring pediatric education prior to recertification. 



Section VI.                    EMSC Permanence


a.                  Overview of the Performance Measure


Permanence of the EMSC Program will be established in the State/Territory EMS system.


b.                  Why is this important?


Integration of pediatric priorities into existing EMS rules and regulations ensures that your EMS system changes will be permanent. An EMSC Program within your State that has permanence includes a dynamic advisory committee, pediatric representation on your state EMS board, and a full-time EMSC manager.  These components will lead to successful EMS improvements for pediatric patients even if the Federal EMSC grant program were to end.


c.         Family Representative Role


The preceding performance measures must be adopted and integrated into state statute or regulation.  As a family representative, you are in a position to educate your state policymakers regarding the importance of your state EMSC program’s initiatives and the performance measures.  In particular, you may want to share your personal EMS system experiences with the EMS system with your policymakers; sharing such real-life experiences is a compelling way to convince others of the importance of EMSC in your community.  For more information on the legislative process and your involvement in it, see Chapter Five.



Section VII.        Coalition Building and Community Involvement


“Coalition building is the ongoing process of cultivating and maintaining relationships with a diverse network of individuals and organizations who share a common set of principles and values. These individuals and organizations, united by a common mission or cause, agree to collaborate, to work with one another, to achieve results they are more likely to achieve together than alone." (Winer and Ray, pg. 24)


Coalitions within the EMSC Program are networks of support that are broader than state advisory boards and committees:  they encompass both the formal and informal relationships of support and involvement. Coalitions include the many "friends" of your project who contribute in some way to its success, no matter how small the contribution may be.


As an EMSC family representative, you play a critical role in coalition building and community involvement.  You are one of the key members of the EMSC advisory committee that connect the program manager to the community.  You are the voice that supports the program’s efforts to address the needs of the community and oftentimes assist in building bridges to other stakeholders in the community.


Examples of coalition building and community involvement include educating public policy makers or administrators about the need to make improvements in the emergency system of care for children and the need for your project in particular.  Family representatives and partnering organizations provide the leverage state programs need when discussions turn to topics such as the future of EMS and EMSC. To ensure this is done without violating restrictions against lobbying, please refer to Chapter Six for guidance.


Other contributions you can make toward building coalitions include sharing your contacts with the EMSC advisory committee and the EMSC Program manager. By introducing the EMSC Program manager and the advisory committee to other healthcare and community leaders, essential resources and support needed to bring about system change may be actualized. Although they may not be able to donate a substantial amount of time to EMSC, they may be able to share their valuable connections with you.


If you are a member of another community-based organization or know someone who is a member of such an organization, your contact may provide free or inexpensive program resources that have already been developed. For example, the Safe Kids Worldwide organization ( may lend you slides or may donate public education materials. A helmet manufacturer or distributor may contribute bike helmets at a reduced cost. A children's hospital may contribute training materials and equipment. A rehabilitation facility may share data reports demonstrating the cost of providing patient care. 


Utilizing resources already developed by others will save you time, money and energy, and will help to build enthusiasm and support for your project. It is a way to validate the work that others have done and to recognize them as a resource.


You too can build a network of parent community-volunteers to work in partnership with your state EMSC Program manager.  Determine roles other parents can fill to help you increase the visibility of unmet health care needs of children in your state.  Ask them to publish a story about EMSC in their organizational newsletters or to introduce you to journalists or broadcasters they might know who cover health issues. Greater visibility may generate new political, financial and programmatic support for the project.