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Pages 325-338

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From page 325...
... transport, payer mix, 82 112–113 pediatric utilization, 62, 63–64 pediatric, 158 response times, 75 role of emergency medical technicians, shortcomings of pediatric care 152 capabilities, 50–51 in rural areas, 79–80 See also Transport of patients shortcomings of pediatric care American Academy of Pediatrics, 39, 227, capabilities, 50–51 247, 265, 268 
From page 326...
... Anthrax, 229 National Center for Injury Prevention Asthma management, 176 and Control, 40, 132, 262 Atropine, 237 new lead agency for EMS system and, Automated external defibrillator, 202–203 141 Automobile crashes, 39, 52, 54 recent funding cuts, 135–137 airbag research, 254–255 research activities, 27, 262, 268 structure and operations, 262 transition to new lead agency for EMS B system, 143 Centers for Medicare and Medicaid Bag mask ventilation, 158 Services (CMS) Balanced Budget Act, 80 EMTALA review, 130 Bar code technology, 199–200 payment system, 128–129 Basic life support public reporting activities, 119 role of emergency medical technicians, research support from, 263 152 See also Medicaid; Medicare shortcomings of pediatric care Centers of excellence, 266–267 capabilities, 50 Child, defined, 29 training for, 154, 155 Child abuse/neglect Best Pharmaceuticals for Children Act, ED utilization related to, 69–70 195–196 risk, 54, 55 Bicycle accidents, 54 Children's hospitals Biochemical events capacity and utilization, 19 antidotes, 237 Medicaid reimbursement, 85 health care system preparedness, teaching in, 86–87 227–228 Children's Oncology Network, 268 training for, 238 Clinical Practice Guidelines for Pediatric vulnerability of children, 25 Emergency Care, 176 Boarding, 71–72 Committee on the Future of Emergency Bomb injuries, 225 Care, 2–3, 27–28 Communication, interpersonal, cultural competency of providers, 210–211 C Communications technologies and systems current shortcomings, 3, 103, 222 Carbon monoxide poisoning, 191–192 for disaster response, 222 Cardiac arrest, 202–203 to improve coordination of care, Cardiopulmonary resuscitation, 253 107–108 Categorization of emergency medical model EMS systems, 120–121, 123 services risk of error in emergency care, 189 goals, 111 Computed tomography, 201–202 implementation, 113–115 Congress, recommendations for, 6, 7, pediatric acute care facilities, 47, 49 13, 14, 126, 139, 142–143, 144, recommendations for, 4, 111–112, 146 146–147, 257, 273
From page 327...
...  INDEX Coordination of care See also Agency for Healthcare communications system for, 107–108 Research and Quality; Centers for current shortcomings, 3–4, 102–104 Disease Control and Prevention; establishment of new lead agency for Health Resources and Services EMS system, 7, 138 Administration goals, 4, 106 Department of Homeland Security (DHS) model systems, 106–107, 120–121, disaster preparedness funding, 223 122, 123, 124 FEMA, 132, 263–264 previous efforts to improve, 105–106 recommendations for, 229–230, 239 regulatory impediments to, 129–130 research support from, 263–264 County Hospital Alert Tracking Systems, 121 role of, 132, 263 structure of EMS system oversight and Crossing the Quality Chasm: A New support, 6, 131, 140 Health System for the st Century, 10, 204, 251 Department of Transportation (DOT)
From page 328...
... system accountability for, 115 coordination of care in, 3–4 economic incentives to reduce, 129 current shortcomings, 1–2, 16, 17, 24–26 definition, 29 E demonstration program recommendations, 6, 126, 146 Economics establishment of new lead agency for, demonstration program funding, 6, 137–143, 146–147 126, 127, 146 future reforms, 14 disaster preparedness funding, 223 goals, 3, 24, 101 efficiency of care, 76–77 linkage with other medical care EMS-C funding and grant distribution, providers, 104–105 38, 44–46 model systems, 120–125 establishment of new lead agency for origins and development, 36–37, EMS system oversight and support, 131–132 138, 142–143 performance measurement, 116–117, funding for researcher training, 266, 118 267 public health agencies and, 104–105 hospital ED payer mix, 67–69 readiness for reform, 18 nonurgent care in ED, 66 recent efforts to improve, 17–18 origins and early development of EMS status of pediatric care in, 20–24 system, 36, 37, 38 structure, 249 payment incentives to improve provider Emergency Medical Serices for Children, performance, 128–129 3, 18, 35, 49–51, 108, 246–247 problems of current EMS system, 1–2 Emergency Medical Services for Children recommendations for EMS-C funding, (EMS-C) program 14, 144–145 accomplishments, 13, 47–49, 51 regionalization outcomes, 108–109 administration, 44 research funding, 12, 51, 251, 257–264, clinical practice guidelines, 113, 176 266 coordinators, 51 rural EMS systems, 80 disaster preparedness in, 228 rural poverty, 78 five-year plan, 46 teaching hospital funding, 86–87 funding and grant distribution, 44–46, See also Reimbursement 46–47, 132, 144, 147 EDs.
From page 329...
... See Emergency Medical Services Fostering Rapid Adances in Health for Children (EMS-C) program Care: Learning from System EMS Performance Measures Project, 116 Demonstrations, 125–126 Endotracheal intubation, 1, 172–173 Fragmentation of EMS system, 1, 24, Equity in care access and outcomes, 77–78, 102–103 252 accountability and, 5 effects, 3–4, 6–7, 103, 134–135 sources of, 103–104 F structure of government oversight and support, 6–7, 131–132, 133–134, Family-centered care 135–137 barriers to, 208 See also Coordination of care conceptual development, 205 cultural competency, 210–211 defining characteristics, 10–11, 74, 205 H effectiveness, 205 in emergency care, 205–210 Health Insurance Portability and family presence during medical Accountability Act (HIPAA)
From page 330...
... program Infants, 29, 65 Health Services, Preventive Health Services, Infectious disease and Home Community Based causes of ED visits, 18, 55 Services Act, 44 population surveillance, 104–105 Health status of children in U.S., 52 vulnerability of pediatric EMS system, insurance status and, 59, 83 42 neonatal health problems, 59 Information technologies and systems with special health care needs, 61 clinical information systems, 107, 118 Hill-Burton Act, 36 for continuity of care, 107, 251 Hospital-Based Emergency Care: At the current shortcomings, 3, 251 Breaking Point, 167 future prospects, 250 Hospital emergency departments (EDs) goals, 250 causes of ED visits, 18–19, 55–59 Health Insurance Portability and characteristics of pediatric patients, Accountability Act effects, 130 18–19 to improve patient safety, 199–200 community service obligations, 36, 105 model EMS systems, 121, 123 design, 209 pediatric considerations in emerging disease surveillance role, 104–105 technologies, 10, 203–204 establishment of new lead agency for risk of error in emergency care, EMS system, 7, 139, 141, 146 189–190 family-centered care in, 208 role of new lead agency for EMS hospital admissions from, 19, 70–71 system, 140 Medicaid reimbursement, 83–85 special needs children, 61–62 non-physician care providers, 170–171 trauma registries, 13, 39, 270–273 nonurgent care in, 105 utilization of EMS and EDs, 249–250 nursing staff, 168–170 See also Communications technologies origins and development, 36, 37 and systems; Outcomes research; payer mix, 84 Performance measurement pediatric emergency coordinators, 8, Infusion pump, 26, 200–201 177–179 Injury, pediatric pediatric visits, 2, 15 causes of ED visits, 18–19 pharmacists in, 171–172 causes of prehospital calls, 63 physicians' pediatric training, 161–165 data sources, 52 physician supply, 160, 164 early prevention efforts, 40 provider skill maintenance, 172–173 epidemiology, 52–55 public health linkages, 104 goals of EMS-C program, 44 risk of adverse events in, 188–190, 193
From page 331...
... , pharmacotherapy for, 195 238 prevalence, 59 Josiah Macy, Jr. Foundation, 27 quality of ED care, 60–61 shortcomings of pediatric emergency care, 59–60 K training of EMS providers for, 60 trends, 59 Korean conflict, 36 Metropolitan Medical Response System (MMRS)
From page 332...
...  EMERGENCY CARE FOR CHILDREN National Association of Children's Hospitals Nurse practitioners, 170–171 and Related Institutions, 166 Nurses National Association of Emergency advanced practice, 171 Medical Technicians, 156–157, current ED staffing, 168 259–264 demographic patterns, 168 National Association of EMS Physicians, family presence policies and attitudes, 113 207 National Association of State EMS Officials job stress, 168 (NASEMSO) , 49 pediatric emergency coordinators, 178 National Bioterrorism Hospital roles and responsibilities, 168 Preparedness program, 132 staffing challenges, 169–170 National Cancer Institute, 268 training and certification, 168–169, 174 National Disaster Medical System, 232 National Emergency Medicine Association, O 264–265 National EMS Data Analysis Resource Omnibus Budget Reconciliation Act Center, 247 (OBRA)
From page 333...
... See special medical considerations, 1, 20–24 Pediatric emergency care vital signs, 1 Pediatric Emergency Medical Services vulnerability in disasters, 11, 25, Training Program (PEMSTP)
From page 334...
... See Pediatric emergency care Q pediatric percentage, 158 recommendations for protocol Quality of care development, 5, 113, 146 ambulance diversion and, 71 in rural areas, 79–80 challenges in pediatric emergency care, threats to patient safety in, 190, 26, 70–72 193–194 family-centered care, 10–11 utilization, 249–250 infrastructure for, 26, 187 wait times, 75 mental health interventions, 60–61 workforce, 151–160 pediatric prehospital care, 158–159 See also Ambulance services; Dispatch primary care delivered in ED, 66 of emergency services; 9-1-1 system; recommendations for guidelines and Training of EMS providers standards, 8, 175–177, 179 Prehospital Trauma Life Support, 155 regionalization and, 108 Preventive Health and Health Services role of pediatric emergency Block Grant, 38 coordinator(s) , 8, 177 Preventive interventions shortcomings of pediatric emergency with adolescents, 212 care, 2, 16–17, 18–19, 72–78 automated external defibrillator, skill maintenance among ED providers, 202–203 172–173 early efforts, 40 variation in physician practice patterns, pediatric illness, 40–41 74, 173 public health agency resources for, 104 workforce interventions to improve, rationale, 254 173–179 research needs, 255–256 role of EMS, 254–255
From page 335...
...  INDEX R EMS-C program, 46 establishment of new lead agency for Race/ethnicity EMS system and, 141 cultural competency of providers, funding, 12, 51, 257–264 210–211 infrastructure development, 247–248 disparities in care access and outcomes, medical technology development, 10, 77–78 201, 203, 204, 212 hospital ED utilization, 65 needs. See Research needs wait times and, 77 network approach, 12, 13, 267–270 Radiation exposure, 202, 236 organizational collaboration and Regionalization of EMS coordination, 259 categorization of emergency medical organizational leadership, 256 services and, 4, 111 potential sources of support, 260–264 concerns, 110 private support for, 264–265 goals, 4, 108 rationale for increasing, 256 implementation, 109–110 recommendations for improving, 12–13, model systems, 109, 110–111, 121, 201, 257, 273 122, 123–125 shortcomings of current data collection, quality of care and, 108 51, 248, 251–252, 252, 267 rationale, 4, 108 shortcomings of current evidence base, transport protocol development, 113, 146 12, 25–26, 73–74, 195 Regional variation in EMS systems training for, 13, 258, 264–267 current state, 15–16, 41–42, 125 translational, 253 emergency medical technician training trauma data collection for, 270–273 and credentialing, 154 Research needs Reimbursement basic research, 252 characteristics of pediatric EMS system, effects of preventive interventions, 80–81 255–256 fragmentation of EMS system and, organization and delivery of emergency 103–104 care, 253–254 incentives to improve provider for patient safety improvement, 9 performance, 128–129 pediatric pharmacotherapy, 9, 195–196, Medicaid system, 83–86 197, 212 Medicare system, 86 pediatric trauma, 13, 270 payer mix, 67–69, 81–82 technology-related risks, 201–202 resource-based relative value scale, 86 translational research, 253 shortage of on-call specialists related to, transport protocols, 112 85, 166–167 Reye's syndrome, 40 Research Rhode Island night club fire, 235 barriers to, 257 Robert Wood Johnson Foundation, 176 basic, 252 Rural areas benefits, 245 barriers to care, 78 in centers of excellence, 266–267 causes of prehospital care, 79 cross-cutting nature of emergency care challenges for emergency care providers, research, 258–259 80 development of clinical practice demographic characteristics, 78 guidelines, 175–176 ED utilization, 69, 79–80 disaster preparedness and response, EMS workforce problems, 154, 174 224–226 shortcomings of pediatric emergency dissemination of findings, 248, 259–264 care, 2, 19, 78–80 early pediatric EMS research, 39, volunteer EMS providers, 80 245–248
From page 336...
... See also 162, 163 Biochemical events origins of pediatric EMS specialties, 39, Tertiary-level pediatric intensive care, 108 41 Texas, model EMS system, 122–123 surgical, 165 Timeliness of care, 75–76, 252 suture technicians, 172 risks in pediatric emergency care, variation in physician practice patterns, 190–193 74, 173 Training of emergency care providers See also On-call specialists child abuse identification and treatment, Stand-by emergency departments approved 70 for pediatric, 109–110
From page 337...
...  INDEX children with special health care needs parental involvement, 206–207 and, 157 payer mix, 82 continuing education in pediatric care, recommendations for protocol 2, 8, 16, 25, 42, 157–158, 172–173, development, 5, 112–113, 146 174–175, 179 research needs, 112 disaster preparedness, 222, 232–234, role of emergency medical technicians, 238–239 152 early pediatric-focused programs, 37, See also Ambulance services 39–40 Trauma care emergency department physicians, defined, 29, 42–43 162–165 development of pediatric trauma care, emergency medical technicians, 43–44 154–158 establishment of new lead agency for emergency medicine specialty, 160–161, EMS system, 139, 141, 146 163 historical development, 36 EMS-C efforts, 47 pediatric, 109 for family-centered care, 208 trauma registries, 13, 39, 270–273 findings of 1993 study on pediatric Trauma center EMS, 49–50 defined, 29 first responders, 151–152, 155 features, 43 goals, 173–175 pediatric, 109 graduate medical education, 85, 86–87 Trauma registries, 13, 39, 270–273 to improve patient safety, 198–199 Trauma system instructor support, 156 defined, 29 National Standard Curricula, 155–156 as model of regionalization, 110–111 nurses, 168–169 origins and development, 37 origins of pediatric specialties and regionalization, 109 subspecialties, 39, 41 Triage, pediatric, 192 pediatric emergency medicine disaster response, 228 subspecialty, 161–162 pediatric surgery, 165 U psychiatric, 60 recommendations for, 8, 174, 179 Uninsured children for research, 13, 258, 264–267 emergency transports, 82 shortcomings of current system, 7, 16, health status, 59 25, 73, 157–158 prevalence, 81 simulation exercises, 199 Utilization teamwork training, 198–199 data sources, 249–250 Transfer agreements, 2 deterrents to ED use, 68–69 accountability and, 5, 115 early research, 245–246 shortcomings of current EMS system, historical trends, 36 16, 24, 51, 103 insurance coverage and, 36, 81 Transport of patients Medicaid patient ED visits, 67–68, 81 developments in history of, 36 nonurgent ED care, 65–67, 105 disaster response, 225–226 pediatric ED visits, 2, 15, 18, 19, Emergency Medical Treatment and 64–65, 256 Active Labor Act and, 129–130 prehospital care, 19–20, 62–64, 158 field stabilization and, 112–113 rural EDs, 69, 79–80 interfacility transfers, 19 surge capacity, 222 Medicaid/Medicare reimbursement, trends, 70 63–64, 85–86, 128–129 model EMS systems, 121, 123–124
From page 338...
...  EMERGENCY CARE FOR CHILDREN V current shortcomings in pediatric emergency care, 7, 8, 24–25, 151 Vaccines, 40–41 family presence during medical Vermont Oxford Network, 268 interventions, attitudes toward, Vietnam conflict, 36 206–207, 208 Violence, exposure to, 52, 54, 192–193 friction within EMS system, 104 Vision, of committee, 3–7, 30 goals for pediatric EMS system, 7–8 Vital signs, 1 knowledge required for pediatric care, Volunteer EMS providers 24 credentialing within regional EMS non-physician care providers in hospital system, 122 EDs, 170–171 emergency medical technicians, 153, pediatric disaster expertise, 232–234 154 pediatric emergency coordinators, 8, in rural areas, 80, 154 177–179 Vomiting, 192, 223 prehospital care, 151–160 risk of error in emergency care, 190 in rural areas, 80 W skill maintenance among ED providers, 172–173 Wait times, 71, 77 strategies to improve pediatric care, average ED wait, 192 173–179 nonurgent care in ED, 66 See also Emergency medical technicians patient departure before being seen, 75 (EMTs) ; Nurses; On-call specialists; risks for children, 192–193 Physicians; Training of emergency Workforce, 30 care providers credentialing within regional EMS system, 122 cultural competency, 210–211


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