emergency medical services for children plan program evaluation

Emergency Medical Services Agency

Emergency Medical Services for Children Plan Program Evaluation and Update

January 1, 2009

TABLE OF CONTENTS ___________________________________________________________________________ Introduction ......................................................................................................... 1 I. Authority and Purpose ........................................................................................ 2

II. Summary of the Contra Costa EMSC Plan......................................................... 3 III. Planning Basis: Then and Now........................................................................... 5 IV. Organizational Structure Update 2009 ............................................................. 18 V. EMS for Children System Design and Resources............................................ 22 VI. EMSC Program Monitoring and Evaluation ...................................................... 28

VII. Next Steps: EMSC……………………………………………………………………30 VIII. Appendices ....................................................................................................... 31

A. EMSC Advisory Group Stakeholder List B. EMS Plan Update Process: Activity Timeline C. 2009 Pediatric Field Treatment Notes and Protocols D. ALS/BLS Equipment EMSC Equipment Survey

E. Contra Costa County Paramedic Accreditation Policy F. Emergency Department Consultation Visit Survey tool and Results

G. Contra Costa County Injury Prevention Resource List

H. Contra Costa EMSC Pediatric Emergency Training Programs

This document has been prepared in collaboration with the Contra Costa EMSC Advisory Group and is respectfully submitted by

Contra Costa EMSC Coordinator Pat Frost RN, MS, PNP

Contra Costa Emergency Medical Service Agency Page 1 EMS for Children Plan January 1, 2009

Introduction ___________________________________________________________________________ In early 1999 the Contra Costa Emergency Medical Service (EMS) Agency identified integrated emergency and critical care services for children within the county as a priority. The California Emergency Medical Services for Children (EMSC) Model provided the ideal framework for development and implementation of a system that could provide these essential services. To this end, the county pursued and was granted in July 2000, funding from the California EMS Authority to plan, develop, and implement a comprehensive EMSC system for Contra Costa County. Over the course of the two-year project, special care was taken to develop an EMSC program that would meet the unique needs required of the county's pediatric population. As an end result, Contra Costa EMS designed an EMSC system that would ensure accessibility and availability of services to all children in need of emergency and critical care. In February 2007 Contra Costa EMS began the process of updating the EMSC Program Plan. The EMSC plan update began with a comprehensive re-assessment of the Contra Costa County current EMSC Plan and pediatric capabilities of our EMS stakeholders. The previous plan was reviewed and opportunities for improvement identified. The chronology of this process is defined in the EMS Plan Update Activity Timeline. The EMSC Advisory Committee was re-identified and new members were recruited in this process. EMSC capabilities of our Emergency Departments and stakeholder agencies were re-explored with the intention of supporting an integrated system of EMSC activities for our EMS system. Surveys and site visits were completed and retrospective prehospital data was collected and articulated in the EMSC Plan review document “The State of EMSC for Contra Costa County.” The Contra Costa County EMSC Program wishes to acknowledge the EMSC Advisory Committee and our committed EMS stakeholders who have spent countless hours in the support of the EMSC program in Contra Costa County. This group contributed their time and expertise to this project and should be credited for their on-going commitment to improve the quality of pediatric emergency care to the children of Contra Costa County.


I. Authority and Purpose ___________________________________________________________________________ Authority The Contra Costa Emergency Medical Services Agency under the authority of California Health and Safety Code Division 2.5 and the Contra Costa County Board of Supervisors has the authority to develop, implement, and monitor the Emergency Medical Services for Children (EMSC) Plan. Mission Statement To ensure that quality emergency medical services are available for all people in Contra Costa County and that emergency medical care is provided in a coordinated, professional and timely manner. Purpose of the Emergency Medical Services for Children Program The purpose of Contra Costa County's EMS for Children Program is to establish, monitor and maintain a coordinated and comprehensive EMSC system that promotes high quality, contemporary pediatric care for the children of Contra Costa County.

Numbers correspond to Supervisorial Districts


II. Summary of the Contra Costa EMSC Plan ___________________________________________________________________________ Prior to the inception of the Contra Costa EMSC Program, prehospital and hospital services for children existed without the benefit of a specific organized plan for Pediatric Emergency Care. The 2000 EMSC Plan provided a comprehensive framework for the ongoing efforts by the Contra Costa EMS Agency to address the emergency medical needs of the county's children. The EMSC Plan assisted the Agency in promoting high quality care in the prehospital setting, ED, trauma and tertiary care centers, and interfacility transfer arena. The 2009 EMSC Plan will further enhance these efforts by facilitating the ongoing integration of the EMSC system throughout the EMS system in addition to the promotion of illness and injury prevention and educational activities. This document describes the area and populations served, organization, planning basis, resources, challenges, activities, monitoring mechanisms, and other features of the EMSC program. Definitions The following are definitions of terms that will be used throughout the Contra Costa EMSC Plan and system component documents. PEDIATRIC PATIENT is defined for the Contra Costa County prehospital setting as a patient fourteen years or less. PEDIATRIC CRITICAL CARE CENTER is a center that has met the established standards as set forth by Contra Costa EMS and undergone a formal site review and designation process. PEDIATRIC INTENSIVE CARE UNIT (PICU) is a pediatric-specific critical care unit in a licensed acute care hospital specially staffed and equipped to provide critical care services to children. Standards for PICUs have been defined by the California Children's Services (CCS) Program and adopted by Contra Costa EMS. PEDIATRIC TRAUMA CENTER is licensed acute care hospital which usually treats (but not limited to) persons fourteen (14) years of age or less; that is approved as part of the Contra Costa County's Trauma Care System Implementation Plan, meets all relevant criteria, and has been designated as a pediatric trauma center, in accordance with the California Code of Regulations, Title 22, Division 9, Chapter 7 100255. PEDIATRIC EDUCATION FOR PREHOSPITAL PERSONNEL (PEPP) is a training program sponsored by the American Academy of Pediatrics, which encompasses the majority of emergencies encountered in pediatric patients. EMERGENCY NURSING PEDIATRIC COURSE (ENPC) is an educational program developed for RNs by the Emergency Nurses Association to standardize the approach to pediatric emergency care by nurses. PEDIATRIC ADVANCED LIFE SUPPORT COURSE (PALS) is an educational program developed for all emergency health care providers (MDs, RNs, EMT-Ps) by the American Heart Association and Academy of Pediatrics to standardize the approach to pediatric resuscitation.


PEDIATRIC EMERGENCY ASSESSMENT, RECOGNITION, AND STABILIZATION (PEARS) is an educational program developed for health care providers who do not routinely deal with pediatric emergencies (MDs, RNs, EMT-Ps) by the American Heart Association and Academy of Pediatrics to standardize the approach to assessment and management of the pediatric pre-arrest state. ADVANCED PEDIATRIC LIFE SUPPORT COURSE (APLS) is an educational program developed for all emergency health care providers (MDs, RNs, EMT-Ps) by the American College of Emergency Physicians and Academy of Pediatrics to standardize the initial assessment and early treatment of ill and injured children. EMS for CHILDREN (EMSC) ADVISORY GROUP is a multi-disciplinary advisory group that contributes to primary pediatric policy, procedure, protocol, and guideline development, monitors contemporary pediatric practices and other issues, and makes recommendations to Contra Costa EMS concerning the EMSC Program. TRAUMA SYSTEM is a regional system for field care and transport, destination determination, ED care, tertiary care and quality assurance of patients sustaining major trauma.


III. Planning Basis: Then and Now ___________________________________________________________________________ EMSC Program Overview The Contra Costa County EMSC Program seeks to promote contemporary and high quality emergency care throughout the county by providing tools to support practitioners at all levels to provide appropriate care of children and get these children to the facilities that best meet their EMS needs. Concurrent promotion of injury and illness prevention efforts is recognized as the most promising means to keep children healthy and out of the EMS system. Specific Issues and Areas for Improvement Identified in Contra Costa County The following are specific issues and areas for improvement that were identified by Contra Costa EMS in 1999 prior to the planning and implementation of the current EMSC system. The EMSC Program plans from1999 are in blue text. Since implementation of the EMSC Program in 2000 significant progress has been met. Progress and opportunities are captured under “Outcomes to Date”. EMSC Administrative and Organizational Structure Then and Now In order to plan, develop, and implement an EMSC system in Contra Costa County, an administrative and organizational structure with appropriate EMSC staff and resources has been identified as a need. Developing an on-going structure for maintaining the system when the grant has ended is included in the grant objectives. The State EMSC guidelines for “System Planning, Implementation and Management Model for the Integration of EMSC in Local EMS Systems” are being used as a guide for developing this structure. Outcomes To Date: The initial EMSC Task Force & Advisory Committee was established in 2000. An EMSC Role has continued since first inception. The current EMSC Program Coordinator was assigned in January 2007 to update of local EMSC program plan. The EMSC Advisory Committee was re-identified, new members recruited and electronic consultation, feedback and networking mechanisms were established. EMSC Plan Then and Now While prehospital and hospital services for children do exist in Contra Costa County, neither a specific EMSC Plan nor system is in place locally. A plan for development of an integrated EMSC system in Contra Costa will be adopted and incorporated into the local agency’s EMS System Plan. A comprehensive plan for an EMSC system that includes implementation and maintenance of all major components of the EMSC system, and that integrates the EMSC system with the overall EMS system, is to be developed. Outcomes to Date: Current EMSC plan was reviewed and progress of stakeholders assessed based on 2008 national and state EMSC goals and objectives. This process included re-education of EMSC system participants on the new EMSC guidelines for equipment and emergency department care of children. Contra Costa EMSC Plan now integrates all EMSC state guidelines as part of local EMSC plan. When variations exist


between local and state guidelines, those areas are evaluated for opportunities for improvement if applicable to the local EMS System. 1. Prehospital Services Then and Now Various studies in both California and the nation have indicated that many prehospital services are adult oriented and are often inadequate in providing pediatric care. They do not always have appropriate pediatric equipment and supplies, pediatric protocols, or sufficient pediatric training for prehospital personnel. Contra Costa is committed to assuring that prehospital services meet the needs of critically ill and injured children. This commitment includes assessment of equipment and skills, revision of treatment guidelines and protocols, and development and provision of specialized training for prehospital personnel to adequately prepare them to care for our younger population. Outcomes to Date: Surveys conducted in 2008 demonstrate that appropriate pediatric emergency equipment is in place throughout the system. All prehospital agencies and Emergency Departments have effectively implemented ongoing pediatric training programs on pediatric emergencies. Variations exist in type of courses and training mechanisms used to accomplish these objectives based on the needs and preferences of stakeholders. All courses are national pediatric emergency care curriculums of value in our EMS system. An information course comparison sheet was created by EMS in 2008 and distributed to stakeholders as a resource of the types of programs currently available for emergency personnel. Information on a new curriculum “Pediatric Emergency Assessment, Recognition & Stabilization” (PEARS) was introduced to stakeholders as part of the EMSC update. This curriculum is particularly exciting with its strong focus on pediatric emergency assessment and robust course materials. This program’s focus is on the new national standard for pediatric emergency assessment developed by the American Heart Association (AHA) and American Academy of Pediatrics (AAP). The new assessment model is called Assess, Categorize, Decide and Act (ACDA). This new assessment standard is already taught in Pediatric Advanced Life Support (PALS). All Contra Costa EMS stakeholders have been encouraged to integrate ACDA as a component to current pediatric emergency care training. Adoption of this new assessment model would provide a tremendous opportunity for EMS system providers to “speak the same language” when it comes to pediatric assessment. It would enable Contra Costa to use one assessment model throughout county for the identification and assessment of the pre-arrest state in children. Evidence-based medicine consistently demonstrates that assessment and early management of the pre-arrest state is key to improving outcomes in critically ill children. Prehospital Pediatric Protocols were established in 2000 and have been consistently updated based on current Pediatric Advanced Life Support standards and evidence-based medicine. As part of the Contra Costa EMSC update comparisons were made between National EMSC, State EMSC and Contra Costa prehospital protocols. Opportunities for new protocols were identified and will be one area of focus for future EMSC activities. In addition the EMSC Coordinator actively participates on the State EMSC Coordinator Group which has been updating the State pediatric protocols. These protocols serve as a


resource and model to the EMS community in California. Contra Costa pediatric protocols are consistent with those updated protocols. 2. Pediatric Capabilities of Emergency Departments (EDs): Then and Now In the absence of local EMSC standards or guidelines, emergency departments vary in training, equipment and supplies available for the evaluation, stabilization and transfer/transport (when indicated) of children. Emergency departments are particularly important in pediatric EMS systems because ill and injured children are brought directly to the ED in local hospitals by their parents or caretakers. Relatively few children are transported to EDs through the EMS system. Therefore, it is imperative that all ED’s have appropriately trained staff, equipment, and supplies for the evaluation, stabilization and transfer/transport (when indicated) of children. Guidelines for community hospital EDs will be developed with implementation and site visits to follow. Contra Costa has eight acute care facilities capable of receiving ALS patients. Local facility designation of receiving hospitals is based solely on State requirements for approval as a basic or comprehensive emergency department. There is strong support for the development and implementation of Pediatric ED guidelines from all hospitals, the EMCC and many other groups in the County. Outcomes to Date: In 2000, Contra Costa County established separate Pediatric ED guidelines consistent with EMS authority EMSC guidelines. Upon review of the 2000 Local EMSC guidelines and the 2008 State EMSC guidelines, local guidelines were determined to be redundant the and the state guidelines were adopted as our local guidelines. In 2008 the State EMSC guidelines were used to survey each receiving hospital in the system. The current State EMSC guidelines were distributed to all facilities along with their facilities previous 2000 EMSC self-assessments if they participated. This allowed each hospital to evaluate their own progress during this period of time and recognize “how far they had come” in implementing the EMSC guidelines. Each facility completed a written self-assessment survey and participated in an educational site visit to discuss their status with new guidelines and to identify opportunities for improvement. See addendum for hospital survey and summary. In 2007 Kaiser Antioch opened a new hospital in our community increasing our receiving facilities to nine for the county. All hospitals were found to be in compliance and common opportunities for improvement were identified in the area of training, disaster preparedness and quality improvement. EMSC program coordinator will act as facilitator to provide information and consultation to hospitals working on improvement in these areas. 5. Inter-facility Pediatric Consultation/Transfer Guidelines and Transfer Agreements

Then and Now Children identified as critically ill or injured require the expertise available through pediatric consultation and/or transfer, yet guidelines and agreements for consultation or transfer are not standardized or necessarily in place locally. The State EMSC project as well as other EMSC projects in California has developed pediatric consultation/transfer guidelines to assist physicians and hospitals in identifying children who might benefit from consultation


with pediatric critical care or trauma specialists. Such guidelines help to promote appropriate consultation and transfer when indicated to pediatric critical care and trauma referral hospitals. Pediatric interfacility transfer agreements also help to establish closer working relationships between referral centers and community hospitals. In Contra Costa County some centers and community hospitals have developed such agreements, but a number have not. Studies conducted by the Pediatric Intensive Care Network of Northern and Central California show that transports of critically ill and injured children from community hospitals to pediatric referral centers are significantly greater for designated centers that are part of an organized EMSC system and have signed transfer agreements with community hospitals. The EMSC project will develop pediatric interfacility consultation and transfer guidelines with the intent for them to be adopted by the receiving facilities within Contra Costa County. This will include developing and implementing interfacility transfer agreements with pediatric critical care centers and trauma centers. Outcomes To Date: Since 2000, formal and informal interfacility transfer agreements have been well established between referral centers and community hospitals. Formal transfer agreements are not global. The need for formal agreements is highly influenced by insurance and reimbursement patterns not within the EMS jurisdiction or influence. However all facilities have mechanisms in place to facilitate timely transfer of pediatric patients and do so accountably within the current system. In 2009, timely interfacility transfer will be increasingly scrutinized by other regulatory agencies such as Joint Commission. Incentives for compliance with timely appropriate transport of children to a higher level of care will be supported by these new Joint Commission standards on an ongoing basis. 6. Pediatric Interfacility Transport Services Then and Now

Interfacility critical care transport services guidelines do not currently exist in Contra Costa County. Children brought directly to EDs by their parents may require a higher level of care or specialized services not available at community hospitals. To obtain optimal care, these children may need to be transferred from the receiving ED to pediatric critical care centers or trauma centers. In addition, the condition of pediatric patients already admitted to community

hospitals may deteriorate and they may also require transfer to these specialized centers. Interfacility transport of critically ill and injured children involves mobile intensive care for a variety of complex pediatric medical and trauma conditions, and interfacility transport providers should have appropriately trained personnel and the capabilities for the management of pediatric patients during transport. Specialized pediatric center-based transport teams provide inter-facility transports when receiving a critically ill child. However, private ground and air transport providers are also involved in Contra Costa County. These include contracted ALS provider and air ambulance services. Guidelines will be developed and implemented for pediatric interfacility ground and air transport programs and assuring that all interfacility transport providers meet these guidelines. Outcomes To Date: As part of the EMSC plan development Contra Costa developed pediatric critical and trauma interfacility consultation and transfer guidelines in 2002. As of


2008 these guidelines were felt to be redundant and all facilities had transfer processes and/or agreements that were consistent with State EMSC standards. For that reason Contra Costa’s 2009 EMSC plan will adopted the State EMSC guidelines to evaluate EMSC performance issues within our county. Within our EMSC system both air and ground transport providers such as AMR, CALSTAR, REACH, and Pediatric Critical Care Center Transport Teams are involved in inter-facility transport of children. Our base hospital, John Muir Medical Center-Walnut Creek is a resource in facilitating transfer of critically ill pediatric patients transported to Children’s Hospital Oakland or other Pediatric Critical Care facilities. The 2008 EMSC Emergency Department survey summary demonstrates that each facility has identified appropriate pediatric transfer centers and mechanisms to facilitate timely transport of children requiring a higher level of care. In the fall 2008 Contra Costa EMS acted to support the collection of public comment among the EMSC stakeholders on the revised State EMSC Guidelines for Pediatric Inter-facility Transport Programs (#181) and Interfacility Pediatric Trauma and Critical Care Consultation and/or Transfer Guidelines (#183). Monitoring of these issues occurs as part of the Contra Costa Trauma Continuous Quality Improvement (CQI) process, Helicopter utilization oversight and EMS Event reporting (Contra Costa EMS patient safety reporting system). 7. Pediatric Referral Centers – Pediatric Critical Care and Trauma Centers Then and

Now Contra Costa County does not have a medical center with separate distinct pediatric intensive care units (PICUs). Critically ill and injured patients are for the most part transferred to out-of-county facilities, primarily Children’s Hospital and Research Center at Oakland, the regional pediatric treatment and trauma center for this catchment area. Children’s Hospital serves as a referral center for critically ill and injured children. However, the designation or official recognition as the specialized center is not fully integrated into an organized system of care for all critically ill and injured

children in Contra Costa. Standards for Pediatric Critical Care Centers (PCCC) have been developed by the state and used locally in the designation of the PCCC in Alameda County. A more formal integration into the neighboring EMSC system including referral to the PCCC/trauma center by each receiving facility within Contra Costa will occur as part of this grant project. Outcomes To Date: The recent EMSC survey of our receiving hospitals showed a significant decrease in the number of general care pediatric beds in Contra Costa. Contra Costa Regional Medical Center (CCRMC), Doctors San Pablo, John Muir Medical-Concord Campus (formerly known as Mount Diablo Hospital) have closed their pediatric units. The costs associated with providing trained pediatric nursing personnel with access to pediatric physician coverage in those communities have been prohibitive. In addition evidenced based pediatric care studies support directing pediatric care to pediatric specialty providers and facilities to improve outcomes. Pediatric care in our community has become quite consolidated.


Hospitals who have preserved pediatric services have augmented them with pediatric hospitalists available for 24/7 consultations. Overall all hospitals in our county have increasingly relied on moving children to facilities with definitive care for children. Children’s Hospital and Research Center at Oakland (CHO) located in Alameda County serves as the primary regional pediatric treatment and trauma center for our EMS system. The Contra Costa/Alameda County EMS Trauma Advisory Committee (TAC) provides appropriate oversight for Pediatric Trauma Triage. Each hospital in our EMS system has mechanisms in place to appropriately transfer pediatric patients requiring higher levels of care to CHO or other facilities if beds are not available. Transport of children typically occurs using a variety of resources including Pediatric Transport Teams sent from the receiving facility, Critical Care Transport, Air Transport and Ground Transport with trained specialists. The requirement for using these resources is very infrequent consistent with the low incidence of pediatric critical patients seen in our county. In addition the Contra Costa EMS system supports patient choice of facilities. This enables transport of pediatric special needs or chronically ill patients established at a particular pediatric center to be transported where they receive their care. Other pediatric/neonatal critical care facilities that receive patients from our facilities include: UC Davis Lucile Salter Packard Children’s Hospital at Stanford UCSF Kaiser Oakland, San Francisco, Sacramento and Santa Clara Santa Clara Valley Medical Center Shriners Sacramento California Pacific Medical Center Saint Francis Burn Center

8. Pediatric Rehabilitation Resources Then and Now

The provision of quality health care does not stop in the emergency department or upon discharge from hospital admission, yet specific pediatric rehab resources are not identified locally. The continuum of care would include the rehabilitation and additional supportive care provided to those in need of such services. State recommendations for pediatric rehabilitation programs will be reviewed in conjunction with the PCCC standards and recommendations for referral guidelines will be developed.

Outcomes To Date: Pediatric Rehabilitation Resources are highly specialized services accessed through referral and consultation with appropriate Pediatric Specialists and Pediatric Referral Centers. Currently pediatric patients who qualify for California Children’s Services (CCS) and/or Regional Center Services have rehabilitation and special services available to them. Access to these services is facilitated by appropriate CCS authorized


physicians and nurse specialists. Each facility in Contra Costa County has appropriate mechanisms in place to facilitate referral of pediatric patients to these resources. 9. Illness and Injury Prevention Programs/Public Information and Education Then and Now

At the inception of Contra Costa EMSC Plan a number of agencies had active illness and injury prevention programs, these programs were not integrated component of the EMSC system. Contra Costa County has had a strong commitment to illness and injury prevention programs. Many agencies, organizations, institutions, and providers in Contra Costa had worked for a number of years to improve emergency and critical care services for children. The Childhood Injury Prevention Coalition (CIPC) of Contra Costa County was key to those injury prevention efforts at the time. CIPC made considerable progress in identifying predominate injury

prevention issues and target areas for education and injury prevention efforts. CIPC was active in drowning prevention, home and crib safety, and passenger, bicycle and pedestrian safety. Contra Costa was the first county to pass a Countywide Action Plan to Prevent Violence, a comprehensive blueprint that was approved by 78.8% of the voters in 1994. A series of county residential pool-fencing ordinances to prevent child drowning was championed by CIPC in partnership with the Drowning Prevention Foundation. Both coalitions worked for a county ordinance covering the county’s unincorporated areas, which was followed by a majority of Contra Costa cities each passing similar ordinances for their areas. The county’s trauma center, John Muir Medical Center Walnut Creek has had a long-standing active and progressive injury prevention service, which includes a model Child Passenger Safety Program, and collaborates with the county’s services. EMS staff participates on the Child Death Review team that reviews pediatric deaths in the County. Recommendations for injury and illness prevention programs were developed in conjunction with existing prevention programs and integrated into the EMSC system. Outcomes To Date: Contra Costa EMSC provides information, referral, data and resources for stakeholders in Health Services, and our EMSC community to facilitate awareness and participation in a wide variety of pediatric injury prevention programs. Prevention activities are detailed in the addendum of this document. Prehospital data is available and provides information for injury prevention activities. This data is reported to appropriate constituencies within the EMS system. EMS staff are assigned to participate on Contra Costa County’s Child Death Review Team. This multidisciplinary team is responsible for the review of pediatric deaths in the County. After 2000 the Childhood Injury Prevention Coalition (CIPC) became inactive, but work has continued in the targeted area of bicycle and pedestrian injury prevention. In 2007 Contra Costa EMS joined the East-Bay Childhood Injury Prevention Network (EBCIPN). This inclusive organization supports opportunities for collaborative pediatric injury prevention activities including advocacy and facilitating public awareness. Its vision is to “create a safer world for all children by reducing preventable injuries.” Members represent a wide variety of interdisciplinary child injury prevention individuals and agencies throughout the East Bay Area. Contra Costa County has several stakeholders who participate regularly in this group.


10. Prehospital and Hospital Information Management/Data Then and Now System assessment and indications for improvement are realized through review of outcomes and other data, yet specific data on pediatric emergency care is not thoroughly collected. In 1999, the Contra Costa EMS Agency received a Prevention 2000 block grant to implement a prehospital information integration and management data system. The EMS Agency is committed to fund the continuation of this resource. The EMS Agency also currently collects some hospital outcome data utilized in its trauma system and first responder defibrillation program reviews. Coordination will

be established between the EMSC project, the prehospital data linkage project and hospital outcome data collection to compile appropriate pediatric EMS data needed to monitor the system. Outcomes to Date: Since 2000, EMS has successfully implemented two electronic prehospital care record (ePCR) systems in our County. American Medical Response ePCR system called “MEDS” is used by our EMS contract transport service and represents approximately 90% of all 911 transports in the system. This other ePCR has been in use in our county for about 10 years. Fire agencies utilize the “Zoll” electronic patient care record system. Zoll data generated from this ePCR system represents Fire first responders and Fire transport providers. This program was launched system-wide in 2007 and is in the process of being fully implemented. In 2008 we started to collect limited data from that ePCR system for process improvement. Contra Costa EMS has used both these electronic data systems to access information about pediatric prehospital patient care since 2007. Contra Costa EMS has also participated in the California State EMSC Performance Measures (CQI) study during in early 2007 and the National EMSC Performance Measures Project in early 2008. Our county had 100% participation with data collection on the National EMSC Performance Measures Project. This project supported California EMS Authority EMS for Children Program efforts to meet their funding outcome requirements as part of the National EMSC Program. Overall Contra Costa EMS has made extraordinary progress in this area and has fully integrated pediatric indicators into all EMS CQI processes. We continue to work to refine our pediatric performance measures. Pediatric EMS performance and descriptive data are captured in the document “The State of EMSC for Contra Costa County.” EMS continues to explore opportunities for prehospital data linkages to hospital outcome data. At this time outcome data continues to rely on the “human” interface to successfully obtain and compile successfully. Contra Costa EMS is well positioned to be successful with linking to data networks yet to be established to facilitate outcome analysis in the prehospital arena for children.

11. Continuous Quality Improvement Then and Now Any healthcare system or program implemented in an area requires an on-going review and assessment for adherence to standards, enhancement of quality of service, and need for revision or additions to the program. Thus EMSC system review must be incorporated into the existing local CQI program. Contra Costa is committed to developing a


total system Continuous Quality Improvement (CQI) program, which will include review and assessment of the EMSC program, developed for the county. Throughout the two and a half year grant process, Contra Costa EMSC Program developed and implemented EMSC system components and materials that provide a wide variety of tools and incentives necessary to achieve widespread excellence in pediatric care. These efforts include:

• Policies, procedures and protocols • Facility guidelines and standards • Consultation, recognition, and designation of specialty centers • Educational training and materials • Other assistance as needed Outcomes to Date: Since 2000 Contra Costa EMS has successfully implemented the EMSC system components supporting CQI as bulleted above. Pediatrics has been a strong focus of EMS System CQI activities and is now fully integrated as part of our CQI program. Annual EMS system prehospital provider needs assessments have consistently demonstrated that providers have ongoing needs for pediatric training and education. In response to these identified needs curriculums on pediatric emergency topics have been developed and standardized throughout the prehospital providers facilitated by the Contra Costa Fire EMS Training Consortium. Contra Costa “EMS Best Practices” newsletter routinely focuses on pediatric emergency care. CQI performance reports incorporating pediatric data to Emergency Medical Care Committee, Medical Advisory Committee, Facilities and Critical Care Committee and Fire EMS Training Consortium have strengthened efforts to provide information and awareness. Tools such as the new Prehospital Pediatric Color Coded Medication Cards facilitating safe pediatric field medication delivery have been developed. Improved processes to notify our emergency department stakeholders have been established to provide quick access to updates from the State EMSC, National EMSC and other groups such as the American Heart Association and the American Academy of Pediatrics. Contra Costa EMS Event (patient safety) Reporting System is designed to capture data as part of the QA process for QI analysis. Variations in pediatric prehospital protocol and skills success are monitored at appropriate intervals to identify opportunities for improvement. Examples of evidence-based changes taken based on CQI issues in our pediatric population include: Removal of Pediatric Intubation Removal of Charcoal for Pediatric Ingestions Instituting use of D10W for the treatment of pediatric hypoglycemia Instituting EZIO for pediatric use Adoption of ACDA assessment model Development of pediatric medication cards consistent with Color Length-Based Tape

Dosing (e.g. Broselow) Opportunities for improvement will continue to be identified and pediatric performance measures monitored moving forward.


Optimal EMSC System Design Then and Now In 2000 an optimal EMSC Program and System design for Contra Costa County was described as including the following features. As of 2009 the EMS System Design status is:

2000EMSC Design Recommendations 2009 EMSC System Design Opportunities An administrative and organization structure within the Contra Costa EMS would be established to oversee the activities of the EMSC Program.

EMSC Coordinator designated and function supported within the EMS Agency. EMSC Program oversight in place and well integrated in current advisory forums.

A multi-disciplinary EMSC Task Force would be established to facilitate the efforts of the EMS Agency for effective monitoring, evaluation and updating of the EMSC Program.

EMSC Advisory Group re-established. Networking and EMSC program update mechanisms put in place. Efforts to establish Emergency Department Physician and Nurse “EMSC Champions” throughout the community to facilitate EMSC program goals and objectives explored.

An organized system of Pediatric Advanced Life Support capabilities accessible throughout the county.

PEPP is the approved Pediatric Prehospital Provider training program. PALS, APLS, ENPC, and PEARS are all appropriate programs for ED providers based on provider role and responsibilities. All hospitals in compliance with appropriate training based on EMSC state guidelines. 2008 Survey revealed opportunities for additional training needs to be considered due to shrinking opportunity to maintain pediatric hospital expertise in the community. Pediatric general care and specialty beds have been significantly reduced since 2000. This trend is expected to continue placing new demands for improved pediatric skills in pediatric assessment, triage and appropriate treatment by emergency department professionals. Emergency Departments will increasingly be on the front lines of pediatric emergency care and need to be “ready” to rapidly assess, recognize, stabilize and transport the child in extremis. These events while rare require high-level pediatric skills. Contra Costa EMSC moving forward is positioned to continue to encourage and support training critical to the development and maintenance of those skills.


2000 EMSC Design Recommendations 2009 EMSC System Design Opportunities All levels of field personnel would be well trained and practiced in pediatric assessment and treatment skills.

ACDA “Assess, Categorize, Decide, Act” 2008 National Pediatric Emergency Assessment Model approved by the American Heart Association and American Academy of Pediatrics adopted as the county assessment standard for EMS system providers. A limited program of pediatric simulation training is currently in place for prehospital providers facilitated by the Fire-EMS Training Consortium. Simulation training has also been incorporated into some PEPP training for Fire-EMS providers. Opportunities for expanded pediatric simulation training resources for emergency department personnel are being explored. Interest in simulation training is growing in the emergency department and hospital community. EMS is committed to supporting an ongoing dialogue with the hospital community on creating opportunities for these resources to be developed.

Contemporary and practical pediatric field treatment protocols/guidelines would be maintained.

Prehospital pediatric protocols are currently up to date and in line with national standards and evidenced based medicine. Ongoing evaluation of protocols will emphasize evidence-based practice, patient safety and recognition of the pediatric pre-arrest state with rapid transport to definitive care. New protocols and resources in development.

All emergency departments would meet or exceed the recommended minimum criteria of the Administration, Personnel and Policy Guidelines for the Care of Pediatric Patients.

Facilities completed a self-assessment and participated in a site visit as part of EMSC program plan update. All facilities in compliance with current 2008 guidelines. See details in the survey results in the addendum of this document.

A minimum of one Pediatric Critical Care Center and one Pediatric Trauma Center would be designated for the County.

Children’s Hospital Oakland is the designated Pediatric Critical Care and Pediatric Trauma Center for Contra Costa County. Collaborative relationships in place to facilitate appropriate follow-up on CQI pediatric issues and trauma cases.


2000 EMSC Design Recommendations 2009 EMSC System Design Opportunities A comprehensive data collection system that includes the collection of recommended pediatric data would be established.

Comprehensive data collection system for review and evaluation of prehospital pediatric care implemented with reporting on pediatric performance measures. These include prehospital skills, pain, glucose, seizure, and medication safety.

Efforts of existing Contra Costa County injury prevention and public education programs would be supported.

Funding sources for injury prevention activities continue to be shrinking. This requires increasing improved collaboration among injury prevention stakeholders in their activities. Opportunities exist for EMSC to participate and support injury prevention by providing leadership, data, awareness and advocacy. In 2007, an EMSC web page was created as part of the Contra Costa County EMS website to improve access to information and resources about EMSC to our community. Enhancements are planned to add information and resources for emergency providers and the public in the areas of injury prevention, special needs, emergency first aid for schools as part of Contra Costa ongoing support of EMSC activities. Internet resources will continue to be explored and improvements implemented as opportunities are identified with the input of constituent groups.

Conclusion EMSC Program for Contra Costa County has met or exceeded 2000 program design objectives with opportunities for future innovative EMSC program enhancements.


In 2000, the initial development of Contra Costa’s EMSC created a free standing system of EMSC program coordination, oversight and advisory process. This model was very effective in establishing the EMSC program in Contra Costa but over time this program development model was unable to be sustained in its original configuration. Lack of EMSC dedicated personnel, resources & created barriers for stakeholders to fully participate. Instead the work of EMSC became integrated as part of other groups including Medical Advisory Committee, Facilities and Critical Care and Trauma Advisory Committee. The plans and objectives set out by the original EMSC plan succeeded with the commitment of numerous individuals within the EMS system during those years. The EMSC plan of 2000 successfully positioned Contra Costa EMSC stakeholders in effectively implementing a wide array of pediatric resources to improve emergency care for the children of our community.

Moving forward, the new EMSC program will continue to use an “integrated” approach to EMSC advocacy while supporting and recruiting “EMSC Champions” within our community. This approach is supported by our EMS stakeholders and is recommended as a best practice model to maintain and enhance the EMSC programs for all communities. Our EMSC workflow process model is below.

EMS-C Program

Pediatric Event

Review

Child Death

Review

Pediatric QI

Indicator Reports

California EMS-C

Program

Pediatric Trauma

PreTac & TACEMS QI Committee

Medical Advisory Committee

Facilities & Critical Care

EMS Medical Director

Prehospital Care

Coordinators

Fire-EMS Stakeholder QI Coordinators

EMS-C Coordinator

EMS-C Advisory

Committee

ED-EMSC Liaisons

Fire-EMS Training Consortium

Injury Prevention

Groups

Pediatric EMS-C Issue Identification

EMS for Children Improvement Process

Contra Costa EMS-C Program Workflow“Getting the Business of EMS-C Done”


IV. Organizational Structure Update 2009 ___________________________________________________________________________ Contra Costa County Geographic Characteristics Contra Costa is one of the nine counties comprising the Bay Region in Northern California. It is the ninth most populated county in California with a population of 1,051,677 as of January 1, 2008 and a geographical area of 732.5 square miles. There are nineteen incorporated cities within the County. Contra Costa is divided into three distinct sub-regions defined by topographic features: the bay plan and series of valleys in the western region; hills that separate the western region, the eastern plain and delta area in the eastern region. The delta lowlands have miles of waterways for recreation; the bay and river shorelines are traversed by rail lines and dotted with many heavy industries including major petrochemical facilities. Nine major highways connect Contra Costa with adjacent counties and are heavily traveled, particularly during commute periods. There are several two-lane county roads which traverse the hills and rural areas in a winding fashion and which have provided the scene for many severe motor vehicle crashes. Contra Costa has several Bart stations traveling through the county. Bart functions as the high-speed commuter rail system for the East Bay. There are two airports in the county Buchanan Field: located in Concord, and Byron Airport, located two miles south of Byron. Demographic Characteristics

Ethnic statistics reflect the increasingly diverse ethnic distribution of Contra Costa’s pediatric population. As of 2007 Contra Costa is home to approximately 255,915 children, ages 0-17, which is 3 % of California’s child population TPF

1FPT. As the table demonstrates, Contra

Costa’s pediatric population is ethically diverse and between 2001 and 2008 Racial/Ethnic data remained stable while the proportion of Caucasian/White children fell from 48% in 2001 to 43% in 2008.TPF

2FPT During that same period of time Hispanic/Latino children increased

from 25% to 32%.P

2P

TP

1PT Children Now, “Contra Costa County”, 2007 California County Data Book, childrennow.org

TP

2PT Kidsdata.org website, (2008) retrieved 10/20/08, from wwwkidsdaa.org


Center for Social Services Research

UC BerkeleyTPF

3FPT

Totals

Black White Hispanic Asian PI

Native Other

Total 255,915 23,041 (9%)

111,941 (43.7%)

78,582 (30.7%)

28,721 (11.2%)

822 (0.3%)

12,808 (5%)

< 1 yr 13,104 (5%)

1,177 (0.5%)

5,374 (2.1%)

4,531 (1.7%)

1,730 (0.7%)

33 (0.01%)

259 (0.1%)

1-2 yrs 26,233 (10.3%)

2,176 (0.9%)

10,296 (4%)

9,036 (3.5%)

3,108 (1.2%)

45 (0.02%)

1,572 (0.6%)

3-5 yrs 40,138 (15.7%)

2,917 (0.9%)

17,007 (6.6%)

12,734 (5%)

3,885 (1.5%)

46 (0.02%)

3,549 (1.4%)

6-10 yrs 68,515 (26.8%)

5,926 (2.3%)

29,597 (11.6%)

21,442 (8.4%)

7,422 (2.9%)

209 (0.8%)

3,919 (1.5%)

11-15 yrs 75,597 (29.5%)

7,383 (2.9%)

34,322 (13.4%)

22,290 (8.7%)

8,732 (3.4%)

329 (0.1%)

2,541 (1%)

16-17yrs 32,328 (12.6%)

3,462 (1.4%)

15,345 (6%)

8,549 (3.3%)

3,844 (1.5%)

160 (0.06%)

968 (0.4%)

Percentages reflect ethnic group by age/total number of children < 17 years

Between 2002-2006, 432 children less than 14 years of age died in Contra Costa County; 23% of those deaths were associated with preventable injury. TPF

4FPT Among the national leading

causes of death the most common cause of death in Contra Costa County in all ages groups was unintentional injury, followed by assault/homicide. In 2005 unintentional injuries resulted in 429 injury hospitalizations in children less than 15 years of age. TPF

5FPT Overall the

Bay Area injury hospitalization rate has declined since 1993 by more than 25%. Bay Area injury prevention programs supported by EMS for Children and other injury prevention groups have certainly played a roll in this decline. However one disturbing trend noted over since 2000 has been the incidence of gang violence in West and East Counties. Violence has steadily increased in these communities resulting in an increase in pediatric victims. Injury prevention efforts directed at violence need to developed and supported in order to reduce this trend. Child Deaths in Contra Costa and Injuries 2002-2006TPF

6FPT

Age of Decedent All Injuries Homicide Unintentional Self Inflicted 0-14 years 86 21 62 1

<1 year 21 4 16 0

1-4 years 25 7 18 0

5-14 years 40 10 28 1

TP

3PT Needell, B., et.al. (2007). Child Welfare Services Reports for California, Retrieved 3/28/08, from

www.csssr.Berkeley.edu/CWSCMSreports TP

4PT Department for Health Services, Death Statistical Data, retrieved on 10/21/08 from www.applications .dhs.ca.gov/vsq

TP

5PT State of California Department of Public Health, EPIC branch, retrieved from Kidsdata.org on 10/21/08.

TP

6PT California Department of Public Health, Vital Statistics Death Statistical Master File, retrieved on 10/21/08 from

www.applications.dhs.ca.gov/epic


Economically, the population in Contra Costa ranges from the affluent communities of south and south-central regions to the poor urban and rural areas. According to Children Now the medium income for a household in the county was $65,459 in 2005, and the medium income for a family was $73,039. The per capita income for the county was $30,615. About 5.4% of families and 7.6% of the population were below the poverty line, including 9.8% of children under the age of 18. Between 2001 and 2005 the number of children living in poverty below the age of 17 was 11%. TPF

7FPT Percentage of Children with

continuous health insurance between 2001 and 2005 has fluctuated between 97% in 2003 and 95% in 2005. Hispanic children are more likely to not have health insurance when compared to other groups in the county. With the recent fiscal constraints services for children and families in the areas of injury prevention, affordable insurance and access to medical care are all being affected. The economic downturn nationally will continue to present challenges to Contra Costa EMS system. Traditionally EMS and Emergency Departments have acted as a community safety net in times of economic hardship. These factors will act to influence the EMS system and present many challenges for Contra Costa EMSC as we move forward.

TP

7PT Children Now, CLIKS: Community Level information on Kids:Profile for Contra Costa County, retrieved on 10/20/08

from www.kidscount.org


EMSC System Overview 2009 EMS Agency

The Contra Costa Health Services Emergency Medical Services Agency was established in 1983 and has provided leadership and support in the development of the EMS system for the county. The Agency is an integral part of the Contra Costa Health Services system. This system also includes the Contra Costa Regional Medical Center, the Contra Costa Health Centers, Community

Substance Abuse Services, the Contra Costa Health Plan, Environmental Health, Hazardous Materials Programs, Homeless Programs, Mental Health, and Public Health. The inclusion of all of these services under one umbrella has resulted in closer communication and integration of EMS services and other related County health care programs and activities. The EMS Agency is charged with the overall planning, implementation and evaluation of emergency medical services within Contra Costa County. The EMS Director, EMS Medical Director and Agency Staff carry out the EMS functions of Health Services. The EMS Medical Director has statutory responsibilities to oversee medical aspects of the EMS program. Emergency Medical Care Committee An Emergency Medical Care Committee (EMCC) provides advice regarding EMS matters to the Board of Supervisors, to Health Services and to the EMS Agency. This committee consists of representatives from 21 key participating system organizations, as well as, five consumers. The EMCC meets quarterly and all meetings of the EMCC and its subcommittees are open to the public. Prehospital Services

First responder services are provided by the County’s nine fire services, six of which provide paramedic level staffing to some or all of their units. One private and two fire service agencies provide emergency paramedic ambulance service to the County. Air ambulance services are available and provided primarily by CALSTAR and REACH, though additional services are available in surrounding counties.

Receiving Hospitals and Specialty Centers The EMS system further consists of nine receiving hospitals. John Muir Medical Center-Walnut Creek is the county's designated Level II Trauma Center and is also the base hospital providing on-line medical direction to the County’s paramedics. The County has also made provisions to treat critically ill and injured children by recognizing Children's Hospital Oakland as a Pediatric Trauma Center (PTC) and Pediatric Critical Care Center (PCCC).


V. 2009 EMSC for Children System Design and Resources ___________________________________________________________________________ Program Organization and Management The EMS Agency has the overall responsibility for planning, implementing, maintaining, and evaluating the EMS system and related programs, including the County EMSC Program. A member of agency's permanent staff is assigned oversight of the EMSC program. Responsibilities include coordinating program activities, and acting as the agency's liaison with the EMSC Task Force, system participants, the California EMS Authority and other groups interested in pediatric- related issues. 1. EMS for Children Advisory Committee

In 1999, the Contra Costa EMSC Task Force was appointed and served as the primary advisory group to the EMS Agency on issues related to pediatric emergency care, injury prevention, and other issues, during the Program's developmental and implementation stages. An EMSC Advisory Committee was established in 2000 to undertake the role and responsibility of advising the EMS Agency on EMSC program and system monitoring, evaluation and

maintenance. EMSC Advisory Committee membership consisted of representatives from key participants in the Contra Costa EMS and pediatric community. The EMSC coordinator in collaboration with the EMS Medical Director acts as the facilitator and coordinator for the group. The EMSC membership reviews EMSC issues electronically and the feedback is appropriately addressed and integrated as part of established standing EMS work groups. These EMS work groups include Quality Improvement, Medical Advisory Committee, East Bay Injury Prevention Network, Child Death Review, Fire EMS Training Consortium and Emergency Medical Care Committee of Contra Costa County. Secretarial and support services for the EMSC projects are to be provided by EMS Agency Staff. The EMSC Coordinator and EMSC Advisory activities have included:

• Adoption of State EMSC guidelines and standards for EMSC system components: Administration, Personnel, and Policy Guidelines for the Care of Pediatric Patients in the Emergency Department, Pediatric Critical Care and Trauma Consultation and Interfacility Transfer Guidelines

• Organization of EMSC consultation visits to all County emergency departments • Oversight of EMSC projects and activities • Review and revision of all pediatric-related ALS/BLS polices and treatment protocols • Participation in Contra Costa County prehospital education, and childhood injury and

illness prevention efforts

• Supporting the adoption of common standards in pediatric emergency assessment and training throughout the EMS system.

2. Facilities and Services Receiving Hospitals: • Contra Costa Regional Medical Center • Doctors Hospital, San Pablo


• John Muir Medical Center-Walnut Creek Campus • Kaiser Medical Center, Walnut Creek • Kaiser Medical Center, Richmond • Kaiser Medical Center, Antioch • John Muir Medical Center-Concord Campus • San Ramon Regional Medical Center • Sutter Delta Medical Center Base Hospitals: • John Muir Medical Center-Walnut Creek Trauma Center: • John Muir Medical Center- Walnut Creek

3. Pediatric Specialty Centers and Services Children's Hospital Oakland serves as the main pediatric referral center for Contra Costa County as well as other counties in Northern California. Pediatric trauma, critical care, and rehabilitation services are only a few of the specialized services offered at this facility. Shriner’s Hospital in Sacramento and Saint Francis Medical Center in San Francisco are receiving

facilities for burn patients. 4. Interfacility Linkages and Transfers EMTALA has eliminated the need for specific transfer agreements when the patient needs a higher level of care. To facilitate consistent, appropriate and orderly consultation and transfer of pediatric patients, Contra Costa 2008 Survey found that all facilities had policies or processes consistent with EMSC Interfacility Consultation and Transfer Guidelines. (Appendix) 5. Prehospital Care

First Responder Programs • Contra Costa County Fire Protection District • Crockett-Carquinez Fire Protection District • East Contra Costa Fire • Pinole Fire Department and Protection District • El Cerrito Fire Department • Richmond Fire Department • San Ramon Valley Fire Protection District • Rodeo-Hercules Fire Protection District • Moraga-Orinda Fire Protection District • East Bay Regional Parks Paramedic-First Responder Programs • Moraga-Orinda Fire Protection District • American Medical Response - Byron/Discovery Bay/Oakley and Crockett


• Contra Costa County Fire Protection District • San Ramon Valley Fire Protection District • El Cerrito Fire Department • Rodeo-Hercules Fire Protection District • Pinole Fire Department • California Highway Patrol Emergency Ambulance Providers • American Medical Response • San Ramon Valley Fire Protection District • Moraga-Orinda Fire Protection District Air Ambulance Providers • CALSTAR • REACH • Services available in surrounding counties include: Stanford Life Flight, Palo Alto;

UC Davis LIFE FLIGHT, Sacramento; Medi-Flight, Modesto; and Air Med Team, Stanislaus

Rescue Aircraft Providers • California Highway Patrol • East Bay Regional Parks • U.S. Coast Guard

6. Critical Illness and Injury Prevention Programs Injuries are a major cause of significant death and disability to children in our EMS system. This is well known to the stakeholders who have been active since 2000 in creating effective programs like “Every 15 Minutes” a nationally renowned program educating teens to the danger of driving under the influence creating “acted out” simulations of the deadly consequences for high schools throughout our community. The Contra Costa Trauma Program at John Muir

Medical Center-Walnut Creek leads this tremendously effective injury prevention effort. Injuries are a major cause of hospitalization in Contra Costa in children less than 18 years of age. Leading Causes of Hospitalized Non-fatal Injuries in Contra Costa County 0-18 years Top 5 Causes of Injury 2003 2004 2005 2006 Unintentional-Fall 233 238 212 164 Unintentional-MVT, Occupant 84 78 63 50 Homicide/Assault 58 60 60 61 Suicide/Self Inflicted 87 52 68 54 Unintentional-Struck by an object 49 51 32 40 Source: California Department of Public Health, Vital Statistics Death Statistical Master File, retrieved on 10/21/08 from www.applications.dhs.ca.gov/epic


From 1991-1997, a total of 104 youth ages 0-14 died from injuries in Contra Costa County, an average of 14.8 children per year. During 2002-2006 the average number of deaths associated with injury increased to15.8 per year. TPF

8FPT While these numbers are small they

represent preventable deaths in our EMS system and demonstrate the importance of the ongoing need for effective injury prevention activities. All stakeholders are involved in injury prevention in our system, however, many opportunities exist for improved injury prevention networking and coordination of activities. EMS has the opportunity to play a key role in supporting collaboration with injury prevention coalitions, networks and specialists throughout the system. The Contra Costa County EMSC Program participates with a number of local organizations and programs to promote childhood injury and illness activities. These include the East Bay Childhood Injury Prevention Network and Child Death Review. 7. Pediatric Rehabilitation Services

Children's Hospital Oakland has a pediatric rehabilitation service that has been approved by the Children's Services (CCS) Division of the California Department of Health Services. Children throughout Northern California are referred to Children's Hospital Oakland for rehabilitation. In addition, John Muir Medical Center is an approved CCS rehabilitation facility for children over the age of fourteen.

8. Public Education Public education is conducted by a number of entities in the county and works in tandem with injury prevention activities. The designated Pediatric and Adult Trauma Centers provide public injury prevention educational programs and activities. Historically, the fire services have also been active to promote fire-related injury prevention programs to the county's schools and the general public. With increasing numbers of medical and traumatic injury responses, fire agency injury prevention services have broadened beyond just fire safety. In the last five years the national recognition of childhood obesity as a factor in cardiovascular disease and diabetes risk has galvanized many in

our community to improve resources and information on the benefits of good nutrition and regular exercise. Contra Costa Health Services is a leader in our community supporting healthy lifestyle activities and programs.

Weight and Physical Fitness (7P

thP grade students meeting all fitness standards)

2003 2004 2005 2006 28.8% 32.3% 33.3% 31.5%

Source: Children Now: Contra Costa County Summary, retrieved on 10/20/08 from www.kids.data.org TP

8PT California Department of Public Health, Vital Statistics Death Statistical Master File, retrieved on 10/21/08 from

www.applications.dhs.ca.gov/epic


9. Professional Education Emergency ambulance service providers are responsible for assuring that paramedic employees have specialized training in caring for ill or injured pediatric patients. In addition, on-going continuing education in topics related to pediatrics is highly recommended though not mandated. In 2000 as part of the initial EMSC Program planning, the Pediatric Education for Prehospital Professionals (PEPP) course was introduced. This program received excellent evaluations and was adopted as the training standard for prehospital care providers since 2003. Since then, new programs such as Pediatric Advanced Life

Support (PALS) have come on to the scene and some stakeholders have required their providers to enhance their skills further by supporting tuition for attending these programs. EMS has a process of continuous review of training and works collaboratively with the Contra Costa Fire EMS Training Consortium to update and evaluate standards for prehospital pediatric training. Efforts to improve the standards in pediatric prehospital education will continue to be a focus for the EMSC program. Contra Costa EMSC recommends that pediatric continuing education for all levels of emergency department be consistent with the State EMSC guidelines Administration, Personnel, and Policy Guidelines for the Care of Pediatric Patients in the Emergency Department (EMSA # 182 revised in 2008). In addition, the Contra Costa County Trauma Center contract includes specific educational requirements for specialty services staff that are also consistent with State EMSC guidelines. 10. Quality Improvement and Evaluation Activities

Contra Costa EMS Quality Improvement program was approved by EMSA in April of 2008. This program is designed to fully integrate pediatric CQI throughout the EMS system using data analysis and supporting QA/QI activities of stakeholder agencies. CQI Programs currently exist at each of the emergency ambulance transport agencies and most first responder agencies as well as at Contra Costa County Fire Protection District, the County’s largest first responder agency.

In 2007 a comprehensive countywide EMS safety event reporting system was implemented based on best practices and provides mechanisms for timely reporting, review and appropriate corrective measures implemented. Identification of problem issues or system improvements can now be made at any level within the system including anonymously. These are communicated to EMS through prehospital care coordinators and the EMS Medical Director. Identified system issues that merit study or action are discussed at the Quality Improvement Committee. Action items and work groups are appropriately established as needed. The EMSC coordinator collaborates with appropriate groups to facilitate process improvement and support the development of programs, tools and resources for pediatric emergency care.


11. Coordination with Neighboring EMS Systems The EMSC program has worked closely with the California EMS Authority, and neighboring counties, in particular Alameda County, since its inception and is committed to continuing to do so. Currently our Trauma Advisory Committee is a Bi-County group providing trauma oversight in our system for both pediatric and adult trauma issues. Our EMSC program coordinator sits on the State EMSC Coordinator Committee as an active participant

and supports the States Annual EMSC conferences. State EMSC coordinators have been active in updating the State EMSC prehospital treatment guidelines and supporting many other collaborative EMSC projects. Contra Costa EMSC is an active participant in the East-Bay Childhood Injury Prevention Network.


VI. EMSC 2009 Program Monitoring and Evaluation ___________________________________________________________________________ General EMSC Coordinator in conjunction with the EMS Medical Director oversees activities of the EMSC Program. Pediatric Quality Improvement activities are integrated into the Agency's EMS QI Program. The EMSC Advisory Committee provides consultation as part of these activities on an ongoing basis. Protocols, guidelines and other EMSC products will be reviewed in accordance with the Agency's scheduled reviews to ensure that pediatric-related practices remain evidence-based and responsive to the needs of the county's children and system participants. An EMSC Program report will be provided to the California Emergency Medical Services Authority at appropriate intervals. EMSC System Components 1. Emergency Departments

ED Guidelines and Consultation Visits In 2000 Contra Costa EMS created separate ED guidelines for EMSC to facilitate implementation. Upon review of those guidelines and the states updated 2008 guidelines it was found that it was no longer necessary to create and maintain a separate guideline document. Effective 2007 Contra Costa EMSC adopted the State EMSC guidelines as the model to evaluate the pediatric emergency preparedness in our community.

The EMSC Coordinator will review State EMSA Emergency Department Guidelines and update the Contra Costa EMSC Emergency Department self-assessment tool at appropriate intervals. The EMSC coordinator will advise the EMS Agency of any suggestions or recommendations that should be presented to the receiving facilities on an ongoing basis. A facility self-assessment tool will be developed and updated by the EMSC coordinator based on the document “ Administration, Personnel and Policy for the Care of Pediatric Patients in the Emergency Department” (EMSA # 182 guideline). It is recommended that the survey be conducted at minimum with each update of the EMSA (#182) guidelines. Facility consultations should be conducted with each EMSA update and on an as needed basis. The EMS Agency staff member assigned the EMSC Project will be responsible for the scheduling of ED consultation visits and may engage the services of pediatric specialists to participate in these consultations.

2. Prehospital Pediatric Field Care Protocols Maintaining standards in Prehospital pediatric care is a critical function of the EMSC program. Protocols will continue to be monitored on an ongoing basis. EMSC Advisory members and other stakeholders may make recommendations at any time. Protocols will be reviewed annually or as needed. Recommendations for changes will be submitted to EMS Agency for consideration.


Prehospital Equipment and Supplies Pediatric equipment and supplies will be reviewed with any update of State or National EMSC equipment guidelines. They will also be reviewed in conjunction with changes to pediatric field treatment protocols or as determined by the EMSC Coordinator working with constituent advisory groups. Recommendations for changes will be submitted to EMS Agency for consideration.

Prehospital Pediatric Education

Since 2003 Contra Costa EMS has required current PEPP course certification of all prehospital providers. PEPP will continue to be the foundation of county prehospital provider training. The EMS will evaluate new pediatric

courses for opportunities to improved prehospital training in pediatric populations on an ongoing basis. Specific educational programs in addition to PEPP may be identified and developed based on needs identified through the Contra Costa Quality Improvement Program.

3. Specialty Centers Contra Costa County will continue its recognition and work collaboratively with Children's Hospital Oakland as the system's primary pediatric critical care and trauma center. Joint reviews with Alameda County EMS are part of our Trauma Review Process. The EMS Agency will periodically review the availability and location of other specialty care for pediatric patients.

4. Data Collection Computerized EMS data collection in Contra Costa is implemented and in use. Contra Costa EMS has a required data set that is consistent with CEMSIS. Contra Costa EMS data standards will use and collaborate with the State EMSC in the refinement of prehospital data standards for pediatrics and pediatric trauma.

5. Quality Improvement

Pediatric QI is integrated into the Contra Costa Quality Improvement Program. EMS stakeholders actively participate on all levels. EMS works collaboratively with stakeholders to support and implement pediatric EMS system performance through annual review and update of prehospital pediatric protocols. EMS staff participate in prehospital and emergency department pediatric education and training regularly. Stakeholders are


welcome to send comments and make recommendations to EMS through formal and informal communications. Plans and outcomes of pediatric QI activities are routinely communicated to the EMSC Advisory Group, Medical Advisory Committee and EMCC at appropriate intervals. Pediatric safety reporting is also integrated into EMS CQI program reports.

6. Illness and Injury Prevention

Contra Costa EMS continues to support and promote quality pediatric emergency care and injury prevention throughout the county. This includes collaborating with the East Bay Childhood Injury Prevention Network and other existing programs to promote the prevention of childhood illness' and injuries throughout the county and state. EMS will continue to be an active participant with assigned staff to the Child Death Review Committee.


VII. 10 Key Next Steps for Contra Costa EMSC

Contra Costa EMSC in the next 3-5 years will:

1. Support timely communication and feedback among EMSC system stakeholders through email, newsletters and outreach visits with stakeholders.

2. Support networking and collaboration among EMSC system stakeholders by

providing opportunities for participation and collaboration on local, state and national EMSC issues.

3. Maintain a current list of EMSC Champions and support activities within the

resources of the Local EMS agency.

4. Identify and distribute information and resources to improve stakeholder and public access to resources on pediatric injury prevention and childhood emergencies.

5. Explore and establish opportunities for joint stakeholder pediatric emergency

training.

6. Improve pediatric simulation training opportunities within EMS Local resources.

7. Maintain and support ongoing pediatric prehospital continuing education through curriculum development and the development and implementation of pediatric training standards for pediatric emergency assessment (ACDA) and pediatric trauma & medical protocols.

8. Evaluate innovative equipment and tools to increase safety and improve pediatric

prehospital care.

9. Maintain staff support for participation in local, state and regional EMSC activities.

10. Identify and distribute EMS stakeholder resources in the care for children in a disaster.


VIII. Appendices ___________________________________________________________________________

I. EMSC Advisory Group Stakeholder List J. EMS Plan Update Process: Activity Timeline K. 2009 Pediatric Field Treatment Notes and Protocols L. ALS/BLS Equipment EMSC equipment survey and updated equipment lists M. Contra Costa County Paramedic Accreditation Policy N. Emergency Department Consultation Visit Survey tool and survey results O. Contra Costa County Injury Prevention Resource List

Northern California EMS, Inc. EMS for Children Plan November, 1998

Appendix A: Acknowledgements: EMS for Children Advisory Group

Joe Barger MD Medical Director Contra Costa EMS

Art Lathrop Director Contra Costa EMS

Lauren Kovaleff RN Assistant Director EMS Contra Costa EMS

Pat Frost RN, MS, PNP EMSC Coordinator Contra Costa EMS

Pam Dodson RN Prehospital Care Coordinator Contra Costa EMS

Jim Betts MD Trauma Surgeon Children’s Hospital Medical Center Oakland

Stacey Hanover RN ED Director Children’s Hospital Medical Center Oakland

Kacey Hansen RN Trauma Coordinator John Muir Medical Center Walnut Creek

Nancy Daniel RN QI Coordinator Moraga Orinda Fire

Greg Sekera EMT-P QI Coordinator Pinole Fire

Ellen Leng MD ED Physician & EMCC Chair John Muir Medical Center Walnut Creek

Lori Altabet RN Base Coordinator John Muir Medical Center Walnut Creek

Karen Hamilton RN, CES AMR Contra Costa County

Dave George EMT-P Captain Contra Costa Fire

Dawn Reis RN ED Manager Kaiser Antioch

Paul Harper EMT-P CES AMR Contra Costa County

Keith Cormier EMS Chief Contra Costa Fire

Randy Lyman QI Coordinator REACH

Renee Juster RN ED Director John Muir Medical Center Concord

Monica Teves EMT-P AMR Contra Costa County

Judy Smith RN Trauma Coordinator Contra Costa EMS

Paul Naas QI Coordinator CALSTAR

Jay Colas RN ED Manager Kaiser Walnut Creek

Peter Fromm RN InterimED Director Contra Costa Regional Medical Center

Sam Bradley EMT-P QI Coordinator East Contra Costa Fire

Maria Beza RN Interim ED Director San Ramon Regional Medical Center

Andy Swartzell RN QI Coordinator San Ramon Valley Fire

Chris Eberle RN EMS Training Coordinator San Ramon Valley Fire

Jeff Burris EMT-P EMS Chief East Contra Costa Fire

Phyllis McClanahan RN ED Director Sutter Delta Medical Center

Gary Hashimoto MD ED Director Kaiser Walnut Creek

Jeanne Mills RN QI Coordinator Contra Costa Fire

Chuck Coleman EMT-P QI Coordinator Rodeo-Hercules Fire

Terri Pillow-Noriega RN ED Director Kaiser Richmond

Jim Carpenter MD Chair Child Death Review Contra Costa Health Services

Susan Ancell RN ED Director Doctors San Pablo Medical Center

Dave Gibson EMT-P EMS Chief El Cerrito Fire

Nancy Baer MSW Manager Injury Prevention & Physical Activity Promotion Projects. Contra Costa Health Services

Amy Buoncristiani MD ED Physician EMSC Liaison Physician Contra Costa Regional Medical Center

Cathy Seithel RN ED Nurse Educator Kaiser Walnut Creek

Greg Kennedy RN QI Coordinator Contra Costa Fire

Bob Buehl MD ED Medical Director San Ramon Regional Medical Center

Anita Fligge RN, MSN,CEN,MICN ED Nurse Educator Pediatric Liaison Nurse John Muir Medical Center Walnut Creek

Ross Fay Program Director CALSTAR

Hope Freidman RN Outreach Nurse Children’s Hospital and Medical Center Oakland

Charlene Boyer RN Director of Emergency Services Kaiser Walnut Creek

Jenna Timm MD Pediatric Liaison Physician Kaiser Richmond

Julie Crouse RN Director of Emergency Services John Muir Medical Center Walnut Creek

Northern California EMS, Inc. EMS for Children Plan November, 1998

EMS for Children Advisory Group (continued)

Jack Choi MD ED Physician & Pediatric Liaison Physician Kaiser Walnut Creek & Kaiser Antioch

Bev Jacobs Director of Clinical Programs Contra Costa Health Plan

Bev Jones Senior VP for Patient Care Services John Muir Medical Center Walnut Creek

William Mills MD Pediatric Liaison Physician John Muir Medical Center Walnut Creek

Lowry Mitchell, RN Emergency Services Director Kaiser Antioch/Diablo Service Area

Vicki Loftquist RN, MS,PNP Clinical Nurse Specialist & Pediatric Nurse Manager San Ramon Regional Medical Center

Kathy O’Brien Director of Regulatory Compliance Kaiser Walnut Creek

Sean Russell Program Director REACH

Bernice Rodriguez MD ED Physician & Pediatric Liaison Physician John Muir Medical Center Walnut Creek

Dr. Khoury MD ED Medical Director John Muir Medical Center Walnut Creek

Desmond Carson MD ED Medical Director Doctors Medical Center San Pablo

Mary Shaw RN Executive Director Nursing Doctors Medical Center San Pablo

Laurel Hodgson MD ED Assistant Medical Director Doctors Medical Center San Pablo

Robert Mooney MD ED Physician Kaiser Walnut Creek

Michael Lucas MD ED Physician Kaiser Antioch

Keith Harris RN Pediatric Liaison Nurse Kaiser Antioch

Pam Pshea Chief Nursing Officer San Ramon Regional Medical Center

Nicholas Giardini MD Director Pediatric Hospitalist San Ramon Regional Medical Center

David Birdsall MD ED Medical Director John Muir Medical Center Concord

Jeff Leinan MD ED Medical Director Sutter Delta Medical Center

Dr. Sen MD Chief Pediatric Hospitalist Sutter Delta Medical Center

Richard Leahy MD ED Medical Director Kaiser Richmond

David Goldstein MD ED Medical Director Contra Costa Regional Medical Center

Noel Luiz EMT-P Captain/Paramedic Contra Costa County Fire

Leslie Mueller Director of Operations AMR Contra Costa County

Adriene Clark-Wilkenson RN Nurse Educator Sutter Delta Medical Center Assistant Nurse Manager Kaiser Antioch

Rebecca Rozen Regional Vice President Hospital Council of Northen California

Gene Hern MD Medical Director AMR Contra Costa County

Alvin Tang MD ED Physician Kaiser Richmond

Constance Donovan RN ED Program Manager Contra Costa Regional Medical Center

Jen Gossett RN ED Informatics Nurse Contra Costa Regional Medical Center

Dr. Sen Pediatric Hospitalist Sutter Delta Medical Center

This document has been prepared and is respectfully submitted by

Pat Frost RN, MS, PNP EMS for Children Coordinator

Quality Improvement Coordinator Contra Costa Emergency Medical Services

Questions and comments should be submitted to [email protected]

Appendix B

EMSC Plan Update Process

Activity Timeline

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Th

e co

mm

ittee

is c

oord

inat

ed b

y an

EM

SC

coo

rdin

ator

in c

olla

bora

tion

with

the

EM

S M

edic

al D

irect

or. I

n 20

07 th

e E

MS

C A

dvis

ory

Com

mitt

ee w

as re

-est

ablis

hed

and

revi

ews

issu

es e

lect

roni

cally

. EM

SC

Adv

isor

y fe

edba

ck is

app

ropr

iate

ly a

ddre

ssed

and

inte

grat

edas

par

t of e

stab

lishe

d st

andi

ng E

MS

wor

k gr

oups

. The

se in

clud

e Q

ualit

y Im

prov

emen

t, Fa

cilit

ies

Crit

ical

Car

e C

omm

ittee

, Med

ical

A

dvis

ory

Com

mitt

ee, C

ontra

Cos

ta/A

lam

eda

Chi

ld P

reve

ntio

n N

etw

ork,

Chi

ld D

eath

Rev

iew

, Con

tra C

osta

Cou

nty

Fire

-EM

S C

onso

rtium

an

d th

e E

mer

genc

y M

edic

al C

are

Com

mitt

ee o

f Con

tra C

osta

Cou

nty.

3/25

/200

8S

take

hold

er

PE

AR

S

prev

iew

2/23

/200

7C

CE

MS

EM

SC

C

oord

inat

or d

esig

nate

d

1/31

/200

8-4

/30/

2008

EM

SC

Pla

n S

take

hold

er

Re-

educ

atio

n &

Pub

lic C

omm

ent P

erio

d

3/29

/200

820

08 E

MSA

Equ

ip G

uide

lines

st

akeh

olde

r dis

tribu

tion

and

Ped

i inf

o re

ques

tdu

e 4/

30/0

83/27

/200

8C

CE

MS

Ped

i Tra

nsfe

r G

uide

lines

doc

re

view

to

advi

sory

par

ticip

ants

du

e 4/

30/0

8

4/2/

2008

ED

Sel

f Ass

essm

ent

Dis

tribu

ted

Dea

dlin

e 8/

1/08

8/1/

2008

ED

EM

SC

O

n-si

te s

urve

ype

riod

begi

ns

3/3/

2008

Ped

i Cou

rse

Com

paris

on D

evel

oped

fo

r sta

keho

lder

s1/23

/200

8E

MS

A A

nnua

lE

MS

C C

onfe

renc

e

1/26

/200

8-3

/13/

2008

NE

DA

RC

Sur

vey

Par

ticip

atio

n

3/23

/200

7-6

/11/

2007

Sta

te E

MSC

CQ

I In

dica

tor S

tudy

P

artic

ipan

t

8/1/

2007

CA

EM

SC

C

oord

inat

or M

tg

4/9/

2008

CA

EM

SC

per

form

ance

m

easu

re &

ped

i pro

toco

l in

put s

ubm

itted

1/7/

2008

EM

SC

web

reso

urce

s ad

ded

to E

MS

web

site

3/1/

2007

-1/3

0/20

0820

02 E

MS

C p

lan

docu

men

ts a

nd in

trodu

ctor

y si

te v

isits

con

duct

ed

9/1/

2008

ED

Sta

keho

lder

s E

MS

C

surv

ey d

ata

com

pile

d

1/30

/200

9E

MS

C p

lan

& re

port

Subm

itted

for

stat

e ap

prov

al

11/1

1/20

08M

AC

pre

sent

atio

n

10/1

/200

8-1

/15/

2009

Loca

l EM

SC

Pla

n ap

prov

al p

erio

d

6/11

/200

8E

MC

C re

port

EM

SC

up

date

pro

cess

12/1

1/20

08E

MC

C p

rese

ntat

ion

3/2/

2008

-8/6

/200

8S

tate

EM

SC

Pro

toco

l Rev

iew

7/7/

2008

MA

C p

edi e

quip

upda

te in

put

12/9

/200

8E

MS

C S

ite

Vis

its C

ompl

ete

10/1

/200

8E

MS

C G

uide

lines

18

1 &

183

D

istri

bute

d to

st

akeh

olde

rs fo

r com

men

t

12/1

/200

818

1 &

183

Gui

delin

e co

mm

ents

to

EM

SA

11/4

/200

8-1

2/4/

2008

EM

SC

Pla

n P

ublic

Com

men

t

Appendix C

Contra Costa Emergency Medical Services

2009

Pediatric Field Treatment Notes

And

Protocols

2008

-200

9 C

ompa

riso

n of

Ped

iatr

ic P

re-h

ospi

tal P

roto

cols

/Pro

cedu

res/

Gui

delin

es

Nat

iona

l, St

ate,

and

Con

tra

Cos

ta C

ount

y N

atio

nal

Stat

e C

ontr

a C

osta

Cou

nty

Gen

eral

pat

ient

car

e Pe

diat

ric p

rimar

y su

rvey

P1

:Rou

tine

Med

ical

Car

e

PHC

M: N

otes

on

Pedi

atric

Pat

ient

s Tr

aum

a Pe

diat

ric tr

aum

a B

lunt

trau

ma

Pene

tratin

g tra

uma

P14:

Tra

uma

patie

nts (

high

risk

) P1

5: M

inor

Tra

uma

P1

6: T

raum

atic

Arr

est

Bur

ns

Pedi

atric

bur

ns

Ther

mal

El

ectri

cal

Che

mic

al

P17:

Bur

ns

PHC

M: N

otes

on

Bur

ns

Fore

ign

body

airw

ay o

bstru

ctio

n Pe

diat

ric re

spira

tory

dis

tress

U

pper

airw

ay o

bstru

ctio

n Lo

wer

airw

ay o

bstru

ctio

n N

on o

bstru

ctiv

e

P12:

Airw

ay O

bstru

ctio

n PH

CM

: ALS

Not

es

Res

pira

tory

dis

tress

, fai

lure

, or a

rres

t Pe

diat

ric re

spira

tory

dis

tress

U

pper

airw

ay o

bstru

ctio

n Lo

wer

airw

ay o

bstru

ctio

n N

on o

bstru

ctiv

e

P13:

Acu

te re

spira

tory

dis

tress

; Cro

up/E

pigl

ottis

, A

cute

Ast

hma/

Bro

ncho

spas

m

Res

pira

tory

Dis

tress

in th

e ch

ild o

n ve

ntila

tory

supp

ort

PH

CM

: ALS

Not

es

Res

pira

tory

dis

tress

in th

e ch

ild w

ith a

tra

cheo

stom

y

PHC

M: A

LS N

otes

Bro

ncho

spas

m

P1

3: A

cute

resp

irato

ry d

istre

ss; C

roup

/Epi

glot

tis,

Acu

te A

sthm

a/B

ronc

hosp

asm

N

ewbo

rn re

susc

itatio

n N

eona

tal r

esus

cita

tion

P2: N

eona

tal R

esus

cita

tion

Bra

dyca

rdia

Pe

diat

ric b

rady

card

ia

P4: B

rady

card

ia

Tach

ycar

dia

Pedi

atric

tach

ycar

dia

P5: T

achy

card

ia S

tabl

e, u

nsta

ble

SVT

Poss

ible

V

Tach

N

on-tr

aum

atic

car

diac

arr

est

Pedi

atric

car

diac

arr

est

Asy

stol

e/PE

A; V

Fib/

Puls

eles

s Vta

ch

P3:C

ardi

ac a

rres

t- no

n-tra

umat

ic; s

ectio

n Pr

imar

y th

erap

y

Vas

cula

r Acc

ess:

Intra

osse

ous

PH

CM

: ALS

Not

es

PFro

st E

MS

QI

Page

1

12/2

3/20

08

Nat

iona

l St

ate

Con

tra

Cos

ta C

ount

y V

entri

cula

r fib

rilla

tion

or p

ulse

less

ve

ntric

ular

tach

ycar

dia

Pedi

atric

car

diac

arr

est

Asy

stol

e/PE

A

VFi

b/Pu

lsel

ess V

tach

P3: C

ardi

ac a

rres

t - n

on-tr

aum

atic

; sec

tion

Ven

tricu

lar f

ib/p

ulse

less

VTa

ch

Asy

stol

e an

d pu

lsel

ess e

lect

rical

act

ivity

Pe

diat

ric c

ardi

ac a

rres

t A

syst

ole/

PEA

; VFi

b/Pu

lsel

ess V

tach

P3

: Car

diac

arr

est -

non

-trau

mat

ic; s

ectio

n A

syst

ole

& P

EA

Alte

red

men

tal s

tatu

s Pe

diat

ric a

ltere

d le

vel o

f co

nsci

ousn

ess

P7: A

ltere

d le

vel o

f con

scio

usne

ss

Seiz

ures

Pe

diat

ric se

izur

es

P8: S

eizu

res

Non

-trau

mat

ic h

ypop

erfu

sion

(sho

ck)

Pedi

atric

shoc

k P6

: Hyp

oten

sion

/sho

ck

Ana

phyl

actic

shoc

k/al

lerg

ic re

actio

n Pe

diat

ric a

llerg

ic re

actio

n/ a

naph

ylax

is

P10:

Ana

phyl

axis

/alle

rgic

reac

tion

P11:

Ana

phyl

actic

Sho

ck

Ana

phyl

actic

shoc

k tre

ated

with

aut

o-in

ject

or d

evic

e

NA

: Aut

o-in

ject

ors n

ot p

art o

f loc

al sc

ope

Toxi

c ex

posu

re

Pedi

atric

toxi

c ex

posu

re

P9: P

oiso

ning

N

ear-

drow

ning

Pe

diat

ric N

ear-

drow

ning

N

o cu

rren

t PH

CG

Pedi

atric

Env

ironm

enta

l em

erge

ncie

s H

ypot

herm

ia

Hea

t illn

ess

Loca

l col

d in

jury

No

curr

ent P

HC

G

Pain

man

agem

ent

Pedi

atric

Pai

n A

sses

smen

t and

M

anag

emen

t P1

9: P

ain

Man

agem

ent (

nont

raum

atic

) PH

CM

: Pai

n ev

alua

tion

and

treat

men

t le

ngth

-bas

ed c

olor

cod

ed m

edic

atio

n ca

rds

Dea

th o

f a c

hild

No

curr

ent P

HC

G

Polic

y: D

eter

min

atio

n of

Dea

th

Pe

diat

ric B

ehav

iora

l Em

erge

ncie

s (n

ew 2

009

ID)

No

curr

ent P

HC

G

A

LTE

(new

200

9 ID

) P1

8: A

LTE/

Nea

r mis

s SID

S

Chi

ld A

buse

& N

egle

ct

(new

200

9 ID

) N

o cu

rren

t PH

CG

Po

licy:

Abu

se a

nd A

ssau

lt re

porti

ng

ID=

In d

evel

opm

ent

PFro

st E

MS

QI

Page

2

12/2

3/20

08

Appendix D

Prehospital

ALS/BLS Equipment

Survey Summary

and

Updated Equipment Lists

Con

tra

Cos

ta E

mer

genc

y M

edic

al S

ervi

ces

EM

S Fo

r C

hild

ren

Prog

ram

Ped

iatr

ic E

quip

men

t Lis

t Rev

iew

20

08 P

reho

spita

l Equ

ipm

ent L

ist A

sses

smen

t and

Upd

ate

Rec

omm

enda

tions

As p

art o

f Con

tra

Cos

ta 2

008

EM

S fo

r C

hild

ren

(EM

SC) u

pdat

e pr

oces

s, an

ass

essm

ent w

as d

one

of th

e pr

ehos

pita

l pro

vide

rs p

edia

tric

equ

ipm

ent.

The

follo

win

g ite

ms w

ere

iden

tifie

d as

NO

T p

art o

f 200

7 C

ontr

a C

osta

’s m

anda

tory

BL

S/A

LS

Prov

ider

equ

ipm

ent l

ist.

This

list

of i

tem

s was

com

pile

d af

ter c

ompa

ring

our

Loca

l EM

S Eq

uipm

ent L

ist t

o up

date

d 20

08 re

com

men

datio

ns o

f the

Cal

iforn

ia E

MSC

Tec

hnic

al A

dvis

ory

Com

mitt

ee a

nd N

atio

nal E

MSC

gui

delin

es.

Alth

ough

man

y of

thes

e ite

ms w

ere

not o

n ou

r cur

rent

cou

nty

EMS

equi

pmen

t lis

t, it

was

kno

wn

that

maj

ority

of i

tem

s wer

e al

read

y in

use

thro

ugho

ut o

ur E

MS

syst

em.

Surv

ey P

roce

ss: A

ped

iatri

c eq

uipm

ent s

urve

y w

as c

ondu

cted

am

ong

a re

pres

enta

tive

sam

ple

of C

ontra

Cos

ta

preh

ospi

tal p

rovi

der g

roup

s. Th

ese

grou

ps in

clud

ed a

mbu

lanc

e ba

sed

trans

port

BLS

/ALS

pro

vide

r: A

MR

, firs

t re

spon

der f

ire B

LS/A

LS p

rovi

der:

Con

tra C

osta

Fire

and

com

bine

d fir

e fir

st re

spon

der a

nd tr

ansp

ort p

rovi

der:

San

Ram

on V

alle

y Fi

re.

Each

age

ncy

revi

ewed

thei

r cur

rent

equ

ipm

ent a

nd a

nsw

ered

the

follo

win

g qu

estio

ns.

This

in

form

atio

n w

as th

en u

sed

to u

pdat

e an

d re

vise

to o

ur lo

cal E

MS

equi

pmen

t lis

t for

BLS

/ALS

pro

vide

rs.

1.

Doe

s you

r ag

ency

alr

eady

car

ry th

is it

em(s

) eve

n if

it is

not

spec

ified

on

our

equi

pmen

t lis

t? If

so

plea

se sp

ecify

wha

t siz

es y

ou d

o ca

rry

if di

ffer

ent t

han

wha

t is o

n st

ated

. 2.

If t

he e

quip

men

t ite

m is

not

one

cur

rent

ly c

arri

ed is

ther

e a

need

to c

arry

this

pie

ce o

f equ

ipm

ent?

C

onsi

der

cost

and

freq

uenc

y of

use

as t

he m

ajor

fact

ors i

n yo

ur r

ecom

men

datio

ns.

3.

If y

ou d

o no

t rec

omm

end

carr

ying

an

item

stat

e yo

ur r

atio

nale

. As p

art o

f the

upd

ate

of o

ur E

MSC

pl

an if

var

iatio

ns e

xist

from

the

stat

e re

com

men

datio

ns it

is n

eces

sary

to c

aptu

re th

e re

ason

s why

. Pa

t Fro

st E

MSC

Coo

rdin

ator

Pa

ge 1

12

/30/

2008

Con

tra

Cos

ta E

mer

genc

y M

edic

al S

ervi

ces

EM

S Fo

r C

hild

ren

Prog

ram

Ped

iatr

ic E

quip

men

t Lis

t Rev

iew

20

08 P

reho

spita

l Equ

ipm

ent L

ist A

sses

smen

t and

Upd

ate

Rec

omm

enda

tions

EM

SC p

rogr

am 2

008

pedi

atri

c ad

ditio

ns to

Con

tra

Cos

ta E

MS

BL

S/A

LS

equi

pmen

t lis

ts a

re n

oted

in th

e la

st c

olum

n.

Pe

di E

quip

men

t not

list

ed o

n ou

r re

quire

d cu

rren

t man

dato

ry E

MS

equi

pmen

t lis

t for

BLS

/ALS

pro

vide

rs.

Item

s ar

e no

ted

as c

omin

g fro

m B

LS o

r A

LS s

tate

/nat

iona

l gui

delin

es

Che

ck if

car

ry n

ow

2008

EM

SC U

pdat

e R

ecom

men

datio

ns

M=

Man

dato

ry L

ist A

dditi

on

N=N

ot re

com

men

ded

ratio

nale

incl

uded

SR

VFPD

CC

CFP

DA

MR

Late

x fr

ee e

quip

men

t?

Y Y

Y M

(B

LS) P

edi N

asop

hary

ngea

l airw

ays

(fren

ch)

18,2

0,22

,24,

26 A

re a

ll si

zes

avai

labl

e an

d in

us

e?

Y Y

Y M

(BLS

) Por

tabl

e su

ctio

n w

ith re

gula

tor h

igh/

low

se

tting

s (lo

w s

ettin

gs m

ay b

e ap

prop

riate

for

pedi

-all

prov

ider

s ha

ve b

ut n

eed

to s

peci

fy

to m

eet s

tate

gui

delin

es)

Y Y

Y M

(BLS

) Sph

ygm

oman

omet

er o

r oth

er B

/P

mea

surin

g de

vice

s pe

di/a

dult

(reg

ular

and

la

rge)

cuf

fs fo

r exa

mpl

e th

igh

size

s w

e ha

ve?

Y Y

Y M

(BLS

) Tem

pera

ture

mea

surin

g de

vice

-opt

iona

l ite

m

Y Y

N

N

Opt

iona

l ite

m a

nd fr

eque

ncy

of u

se d

oes

not

just

ify m

anda

tory

equ

ipm

ent r

equi

rem

ent

(BLS

) Inf

ant n

asal

can

nula

s

Y Ex

cept

in

fant

siz

e

Y Ex

cept

in

fant

siz

e

Y M

=Ped

i N

=Inf

ant

Blo

w-b

y m

ore

effe

ctiv

e in

infa

nt a

nd fr

eque

ncy

of

use

& c

ost o

f car

ryin

g do

es n

ot ju

stify

man

dato

ry

equi

pmen

t req

uire

men

t (B

LS) W

ide

bore

tubi

ng fo

r por

tabl

e su

ctio

n

Y Y

Y M

(B

LS) S

uctio

n ca

thet

er a

dd 6

fren

ch

Y Y

Y M

Pat F

rost

EM

SC C

oord

inat

or

Page

2

12/3

0/20

08

Con

tra

Cos

ta E

mer

genc

y M

edic

al S

ervi

ces

EM

S Fo

r C

hild

ren

Prog

ram

Ped

iatr

ic E

quip

men

t Lis

t Rev

iew

20

08 P

reho

spita

l Equ

ipm

ent L

ist A

sses

smen

t and

Upd

ate

Rec

omm

enda

tions

(BLS

) AE

D w

ith p

edi c

apab

ilitie

s –s

trong

ly

reco

mm

ende

d if

do n

ot h

ave

acce

ss to

ALS

re

com

men

ded

porta

ble

defib

/mon

itor

Y Y

N

M

All

BLS

age

ncie

s ha

ve A

ED

with

ped

iatri

c ca

pabi

litie

s or

acc

ess

to m

anua

l def

ibril

lato

rs w

ith

capa

bilit

ies

via

ALS

sup

port.

(B

LS) a

rm s

plin

ts s

peci

fy p

edia

tric/

adul

t (Jo

e th

inks

that

pro

vide

rs h

ave

pedi

siz

es b

ut

not s

ure)

Y N

Y

M

Spe

cify

as

splin

ts th

at c

an b

e ac

com

mod

ated

for

infa

nts

& p

edia

tric

patie

nts.

(B

LS) C

hild

saf

e re

stra

ints

-opt

iona

l ite

m

Y N

Y

M

For t

rans

port

prov

ider

s.

(BLS

) ped

i bac

kboa

rd (K

ED a

ccep

tabl

e)

Y Y

Y M

(B

LS) t

ract

ion

splin

ts lo

wer

ext

rem

ities

pe

diat

ric/a

dult

Y Y

Y M

(B

LS) P

ain

asse

ssm

ent t

ool (

in o

ur tr

eatm

ent

guid

elin

es b

ut n

eed

to s

peci

fy to

mee

t sta

te

guid

elin

es) –

optio

nal i

tem

N

Y Y

M

Add

ing

to p

edia

tric

colo

r bas

ed d

rug

refe

renc

e ca

rds

effe

ctiv

e 1/

1/20

09

(BLS

Nat

iona

l) na

sal s

alin

e dr

ops

for i

nfan

ts

(sal

ine

pillo

ws

coul

d be

use

d)

N

N

N

N

Freq

uenc

y of

use

doe

s no

t jus

tify

cost

s to

m

anda

te.

(BLS

) Bul

b sy

ringe

(Cur

rent

ly li

sted

as

item

in

obs

tetr

ical

kit.

Sho

uld

we

or d

o w

e in

clud

e se

para

tely

so

peop

le d

o no

t nee

d to

op

en k

its to

acc

ess

bulb

syr

inge

)

Y O

nly

in

OB

kit.

Y O

nly

in

OB

kit.

Y M

(O

B ki

t acc

ess

suffi

cien

t)

(ALS

) Nee

dle

size

s 24

gau

ge (?

nee

d)

Smal

ler

need

les s

o ra

rely

use

d ?

nece

ssity

Y Y

Y M

Li

st a

s 24

-25

gaug

e ne

edle

s. M

anuf

actu

rers

su

ppor

t onl

y 25

G

(ALS

) IV

cat

hete

r siz

es 2

4 ga

uge

(? n

eed)

Sm

alle

r IV

cat

hete

rs so

rar

ely

used

?

nece

ssity

Y Y

Y M

P

revi

ousl

y on

list

will

re-a

dd.

(ALS

) Vol

ume

limiti

ng d

evic

e /IV

adm

in s

ets

(vol

utro

ls n

ot u

sed,

min

i bag

s, m

icro

drip

de

vice

s to

lim

it flo

w in

use

)

Y Y

Y/N

M

M

ini b

ags

and

mic

ro d

evic

es p

rovi

de s

uffic

ient

sa

fety

con

trols

. Cos

ts a

nd fr

eque

ncy

of u

se d

o no

t ju

stify

vol

utro

ls.

Pat F

rost

EM

SC C

oord

inat

or

Page

3

12/3

0/20

08

Con

tra

Cos

ta E

mer

genc

y M

edic

al S

ervi

ces

EM

S Fo

r C

hild

ren

Prog

ram

Ped

iatr

ic E

quip

men

t Lis

t Rev

iew

20

08 P

reho

spita

l Equ

ipm

ent L

ist A

sses

smen

t and

Upd

ate

Rec

omm

enda

tions

(A

LS) E

TT c

uffe

d 6.

5 an

d 7.

5 ad

ditio

ns

N

Y Y

N

Freq

uenc

y of

use

doe

s no

t jus

tify

cost

s.

Ped

iatri

c in

tuba

tion

bein

g re

mov

ed fr

om lo

cal

scop

e ef

fect

ive

1/1/

2009

(ALS

) ETT

unc

uffe

d 6.

5 ad

ditio

n (s

tate

re

com

men

ds a

nd w

ould

be

appr

opria

te fo

r 40

kg

patie

nt) M

edic

al d

irect

or d

oes

not

wan

t to

add

sinc

e te

chno

logy

mov

ing

to

smal

ler t

ubes

with

cuf

fs

N

N

N

N

Freq

uenc

y of

use

doe

s no

t jus

tify

cost

s.

Ped

iatri

c in

tuba

tion

bein

g re

mov

ed fr

om lo

cal

scop

e ef

fect

ive

1/1/

2009

(ALS

) Mon

itor/D

efib

rilla

tors

(por

tabl

e) w

ith p

edi

and

adul

t def

ib p

ads/

padd

les

(cap

able

of

disc

harg

ing

belo

w 2

5 w

att s

econ

ds)

Y Y

Y M

(ALS

) Ped

i end

tida

l CO

2 de

tect

or

Y Y

Y M

(A

LS) p

ulse

oxi

met

er a

nd p

edi a

nd a

dult

prob

es

Y Y

Y M

(A

LS) 2

D10

W 2

50 m

l bag

s (n

ew b

ased

on

our u

pdat

es)

N

N

N

M

Cur

rent

trea

tmen

t gui

delin

es to

cha

nge

in 2

009

to

use

D10

for p

atie

nt s

afet

y (A

LS) C

olor

met

ric P

edi a

nd a

dult

end

tidal

CO

2 de

vice

s or

qua

ntita

tive

end-

tidal

CO

2 m

onito

rs

(opt

iona

l sco

pe it

em)

Y Y

Y M

Pat F

rost

EM

SC C

oord

inat

or

Page

4

12/3

0/20

08

Contra Costa EMS reviewed & revised 10/2008 Effective 1/1/2009

CONTRA COSTA HEALTH SERVICES EMERGENCY MEDICAL SERVICES First Responder Paramedic Equipment List 1. Vehicles

a) Vehicles shall be equipped with appropriate mobile and/or portable radios for communications with: 1) Provider agency dispatch center 2) Contra Costa County Sheriff’s dispatch center 3) Base hospitals on the County-designated radio system

b) Vehicles shall be maintained, clean and in sound mechanical and body condition at

all times.

2. General Emergency Care Equipment and Supplies Paramedic First Responder units shall meet requirements for emergency care equipment and

supplies specified by Contra Costa EMS. Patient care equipment and supplies should be latex-free. All equipment and supplies carried for use in providing emergency medical care shall be maintained in clean condition and good working order and shall include, but not be limited to:

BLS/ALS First Responder ITEMS Minimum In-service

Requirement Oropharyngeal airways: 00, 0, 1, 2, 3, 4, 5, 6 1 each

Nasopharyngeal airways: 18, 20, 22, 24, 26, 28, 30, 32, 34 1 each

Oxygen mask – adult/pediatric (non-rebreather) 2 each

Oxygen mask – infant/pediatric 2 each

Nasal cannula – pediatric/adult 2/adult – 2/ped Portable O2 tank with regulator (sufficient to provide patient with not less than 10 lpm for 20 minutes) 1

Self-inflating resuscitation Bag-Valve device, with clear mask capable of use with O2: Infant, Pediatric, Adult 1 each

Portable Suction with regulator or Portable suction with adult/pediatric (e.g. high/low) settings– mechanical/hand powered 1

Pharyngeal tonsil tip (rigid) for suctioning 2

Wide bore tubing for portable suction 1

Suction catheters: 6F, 8FR, 10FR, 18FR 1 each

Band-Aids 12

4” Sterile bandage compresses or equivalent 12


3x3” or 4x4” sterile gauze pads 4

2” or 3” rolled bandages 6

40” triangular bandages 4

10x30” or larger universal dressing 2

1”, 2” or 3” adhesive tape 2 rolls

Bandage shears 1

Vaseline gauze 2 Arm splints – with soft or cushioned surface or equivalent padded board, wrap around, wire ladder, inflatable or cardboard (able to accommodate adult/pediatric/infants)

2

Leg splints – with soft or cushioned surface or equivalent padded board, wrap around, wire ladder, inflatable or cardboard (able to accommodate adult/pediatric/infants)

2

Traction splints – with lower extremity limb support slings, padded ankle hitch traction strap and heel rest or equivalent (reel, sager or equivalent): Adult, Pediatric - (required on designated apparatus)

1 each

Spineboard – long with 4 straps (or equivalent) 1

Head immobilzer – disposable or impervious to bodily fluids 2

Cervical collars – Hard: sizes to fit all patients over one (1) year of age 2 each Optional: adjustable cervical collar (hard only – sizes to fit all patients

over one (1) year of age) 2

Blood pressure cuffs with sphygmomanometers (portable): Adult, Large arm (obese), Pediatric, Infant 1 each

Stethoscope: Adult/Pediatric combination 1 Burn sheets (sterile) – may be disposable or linen (with date of sterilization and expiration indicated) 1 set

Irrigation tubing 1

Sterile saline for irrigation 2000cc

Cold packs 2 Obstetrical Kit (sterile, to include minimum of umbilical cord tape or clamps (2), 1 scissors or scalpel, 1 aspirating bulb syringe, 1 pair gloves, 2 drapes, dressings & towels, clean plastic bag)

1

Newborn stocking cap 1

Emergency thermal blanket (reflective foil) or equivalent 2

Triage tags 20

Current Contra Costa EMS Field Treatment Guidelines and policies 1

Faces Pain scale (for adult & pediatric use) 1

Battery operated flashlight 1

Glucose paste 2


AED with pediatric capabilities*. *Pediatric capabilities requirement may be met by responding ALS ambulance.

1


First Responder Paramedic Equipment and Supplies: In addition to the BLS supply/equipment requirements, advanced life support units shall include, but not be limited to, the following:

ALS First Responder ITEMS Minimum In-service

Requirement Cellular telephone 1 Monitor/defibrillator (portable) – must have strip chart recorder and synchronized cardioversion capabilities. Defibrillator capable of discharging below 25 joules for pediatric use.

1

Pulse oximetry capable device 1

Pulse oximeter adult & pediatric probes 1 set each

Extra charged batteries for monitor/defibrillator 1

Defibrillator paddles/pads: Adult, Pediatric 1 set each

Laryngoscope handle 1

Laryngoscope blades: #0, 1, 2, 3, 4 Miller 1 each

Laryngoscope blades: #2, 3, 4 Macintosh 1 each

Endotracheal tubes: 6.0, 7.0, 8.0, 9.0 cuffed 2 each

Endotracheal tube introducer (e.g. Bougie) 1

Water soluble lubricant – individual packets 3

Magill forceps: Adult, Pediatric 1 each

Batteries (extra) for laryngoscope 1 set

Bulbs (extra) for laryngoscope 1

ETT securing device: Adult 1 each

Stylet: Adult 1 each

Pen light 1

End-Tidal CO2 (ETCO2) detector 2

ETT placement assessment device (bulb) 1 King Airway Kit

Tube – size 3, 4 and 5 Syringe Lubricant

1

Hand-held nebulizer for inhalation 2

ETT Nebulizer Adapter 1

Nebulizer mask – adult and pediatric 1 each Pleural Decompression/Needle Thoracostomy kit: (or equivalent)

Angiocatheter – 12 - 14ga Syringe – 30cc One-way valve

2 sets


Rubber connecting tube Betadine swabs (4) Alcohol swabs (4) Vaseline gauze (2) Sterile gauze pads (2) Tape

IO insertion device e.g. EZIO 1

Intraosseous needle – adult/pediatric 2 each

Pressure bag for adult IO 1

Syringes: 1cc, 30cc 2

Syringes: 3cc, 5cc, 10cc or 12cc 2 each

Needles: 18ga 1”, 20ga 1”, 22ga 1”, 24 ga or 25ga” - 2 each

Medication-added labels 2

IV catheters: 16ga, 18ga, 20ga, 22ga, 24ga 4 each

Alcohol swabs 5

Tourniquet 2

Razor 1

Armboard(s) adaptable for infant, child, adult 1 each

Normal Saline solution – 500ml or 1000ml bags for adult patients 2 liters

Normal Saline solution – 100ml or 250mlbags for pediatric patients 2 each

Universal vial adapter/dispensing pin 2

Saline lock with extension tubing 2

IV tubing: mini drip (60gtt), macro drip (10/15gtt) or equivalent (4) 2 each

IV extension tubing 2

Secured drug box 1 Pediatric length-based weight determination tape e.g. Broselow or equivalent 1

Glucometer (with lancets and test strips) 1

Adenosine (6mg) 5

Albuterol (2.5mg/3ml unit dose ampule) 4

Amiodarone (150mg/3ml ampule) 3

Atropine (1mg preload) 4

Aspirin (81mg tablets) 1 bottle

Diphenhydramine (Benadryl) (50mg/1cc) 2


Calcium Chloride (1 gm) 1

Dextrose 10 W (250 ml/bags) 2

Dextrose 50% (25gm/50cc) 2

Epinephrine 1:10,000 (1mg/10cc) 4


Glucagon (1mg/1cc) 1

Lidocaine 2% for IO pain control 100 mg

Midazolam (Versed) (5mg/ml ampule/vial) 10 mg

Morphine Sulfate (10mg/1cc ampule/vial) 20 mg

Naloxone (Narcan) 4 mg

Nitroglycerin (0.4 mg/tab or multidose spray) 1 bottle

Sodium Bicarbonate (50mEq/50cc) 1


CONTRA COSTA HEALTH SERVICES EMERGENCY MEDICAL SERVICES AMBULANCE EQUIPMENT AND SUPPLY REQUIREMENTS 1. Vehicles

a. Ambulance vehicles shall meet standards specified in Title 13, California Code of Regulations, and each shall possess a valid emergency vehicle permit issued by the California Highway Patrol.

b. Vehicles shall be maintained, clean and in sound mechanical and body condition at all times. c. All ambulances shall have adequate space in the patient care compartment to accommodate at least

one stretcher patient and two providers. There shall be sufficient space to allow for patient care activities during transport.

d. Vehicles shall be equipped with appropriate mobile and/or portable radios for communications with:

1) Provider agency dispatch center 2) Contra Costa County Sheriff’s dispatch center 3) Base hospitals on the County-designated radio system

2. Personal Protective Equipment (PPE)

All ambulance providers are encouraged to adhere to the California Emergency Medical Services Authority (EMSA) guideline #216 – Minimum Personal Protective Equipment (PPE) For Ambulance Personnel in California (see attachment). Those providers that have received equipment through the PPE grant project are required to adhere to this guideline.

3. General Emergency Care Equipment and Supplies Ambulances shall meet the State requirements for emergency care equipment and supplies. Patient

care equipment and supplies should be latex-free. All equipment and supplies carried for use in providing emergency medical care shall be maintained in clean condition and good working order and shall include, but not be limited to:

BLS/ALS Ambulance ITEMS Minimum In-service

Requirement Oropharyngeal airways: 00, 0, 1, 2, 3, 4, 5, 6 1 each

Nasopharyngeal airways: 18, 20, 22, 24, 26, 28, 30, 32, 34 1 each

Oxygen mask – adult/pediatric (non-rebreather) 2 each

Oxygen mask – infant/pediatric 2 each

Nasal cannula – pediatric/adult 2/adult – 2/ped

O2 tank – fixed in vehicle with regulator (M-tank or equivalent) 1 Portable O2 tank with regulator (sufficient to provide patient with not less than 10 LPM - for 20 minutes) 1

Self inflating resuscitation Bag-Valve device, with clear mask, capable of use with O2: Infant, Pediatric, Adult 1 each

Portable Suction with regulator or Portable suction with adult/pediatric (e.g. high/low) settings – mechanical/hand powered 1


Wide bore tubing for portable suction 1

Pharyngeal tonsil tip (rigid) for suctioning 2

Suction catheters: 6F, 8FR, 10FR, 18FR 1 each

Band-Aids 12

4” Sterile bandage compresses or equivalent 12

3x3” or 4x4” sterile gauze pads 4

2” or 3” rolled bandages 6

40” triangular bandages 4 10x30” or larger universal dressing 2 1”, 2” or 3” adhesive tape 2 rolls Bandage shears 1 Vaseline gauze 2 Arm splints – with soft or cushioned surface or equivalent padded board, wrap around, wire ladder, inflatable or cardboard (able to accommodate adult/pediatric/infants)

2

Leg splints – with soft or cushioned surface or equivalent padded board, wrap around, wire ladder, inflatable or cardboard (able to accommodate adult/pediatric/infants)

2

Traction splints – with lower extremity limb support slings, padded ankle hitch traction strap and heel rest or equivalent (reel, sager or equivalent): Adult/Pediatric

1 each

Spineboard – long with 4 straps (or equivalent) 1 Spineboard : (pediatric capable) – short with 2 straps or equivalent (Kendrick Extrication Device) 1

Head immobilizer – disposable or impervious to bodily fluids 2

Cervical collars – Hard: sizes to fit all patients over one (1) year of age 2 each Optional: adjustable cervical collar (hard only): sizes to fit all patients over one (1) year of age 2

Scoop stretcher with straps (or equivalent) 1 Blood pressure cuffs with sphygmomanometers (portable): Adult, Large arm (obese), Pediatric, Infant 1 each

Stethoscope: Adult/Pediatric (or combination) 1 Burn sheets (sterile) – may be disposable or linen (with date of sterilization and expiration indicated) 1 set

Irrigation tubing 1

Saline for irrigation, sterile: 2000cc

Cold packs 2 Obstetrical Kit (sterile, to include minimum of umbilical cord tape or clamps (2), 1 scissors or scalpel, 1 aspirating bulb syringe, 1 pair gloves, 2 drapes, dressings & towels, clean plastic bag)

1


Newborn Stocking Cap 1

Emergency thermal blanket (reflective foil) or equivalent 2 Ambulance gurney – capability for elevating the head and be adjustable, straps for securing patient to gurney, wheels, non-permeable covering material, means of securing gurney in vehicle.

1

Portable cardio-respiratory monitor with pulse oximetry capability 1

Pulse oximeter adult & pediatric probes 1 set each AED with pediatric capabilities*. *Pediatric capabilities requirement may be met by responding ALS ambulance. 1

Triage tags 20

Current map (within 2 years) of entire county or ambulance zone maps 1

Current Contra Costa EMS Field Treatment Guidelines and policies 1

Faces Pain Scale (for adult & pediatric use) 1

Ankle and wrist restraints (4 per set) 1 set

Child safe restraints (infant/pediatric) 1 set each

Battery operated flashlight 1

Emesis basin or disposable emesis bags and covered waste container 1

Linen – towels, sheets, pillow cases, blankets, pillows 2 each

Glucose Paste 1 tube


ALS Ambulance Emergency Care Equipment and Supplies: In addition to the BLS ambulance supply/equipment requirements, advanced life support units shall include, but not be limited to, the following:

ALS Ambulance ITEMS Minimum In-service

Requirement Cellular telephone 1 Monitor/defibrillator (portable) – must have strip chart recorder, 12-lead and synchronized cardioversion & ETCO2 monitoring capabilities. Defibrillator capable of discharging below 25 joules for pediatric use.

1

Extra charged batteries for monitor/defibrillator 1

Defibrillator paddles/pads: Adult, Pediatric 1 set each

12-lead patches 2 sets

Laryngoscope handle 1

Laryngoscope blades: #0, 1, 2, 3, 4 Miller 1 each

Laryngoscope blades: #2, 3, 4 Macintosh 1 each

Endotracheal tubes: 6.0, 7.0, 8.0, 9.0 cuffed 2 each

Endotracheal tube introducer (e.g. Bougie) 1

Water soluble lubricant – individual packets 3

Magill forceps: Adult, Pediatric 1 each

Batteries (extra) for laryngoscope 1 set

Bulbs (extra) for laryngoscope 1

ETT securing device: Adult 2

Stylet: Adult, 1 each

Pen light 1

End-Tidal CO2 (ETCO2) detector 2 ETT placement assessment device (bulb) 1 ETT Nebulizer Adapter 2 King Airway Kit

Tube – size 3, 4 and 5 Syringe Lubricant

1

Hand-held nebulizer for inhalation 2 Nebulizer mask – adult and pediatric 2 each Pleural Decompression/Needle Thoracostomy kit: (or equivalent)

Angiocatheter – 12 - 14ga Syringe – 30cc

2 sets


One-way valve Rubber connecting tube Betadine swabs (4) Alcohol swabs (4) Vaseline gauze (2) Sterile gauze pads (2) Tape

Continuous Positive Airway Pressure (CPAP) device 1

IO insertion device e.g. EZIO 1

Intraosseous needle – adult and pediatric 2 each

Pressure bag for adult IO 1

Syringes: 1cc, 30cc 2

Syringes: 3cc, 5cc, 10cc or 12cc 2 each

Needles: 18ga 1”, 20ga 1”, 22ga 1”, 25 or 24 ga ” 2 each

Medication-added labels 2

IV catheters: 16ga, 18ga, 20ga, 22ga, 24ga 4 each

Alcohol swabs 5

Tourniquet 2

Razor 1

Armboard(s) (adaptable for infant, child, adult) 1 each

Normal Saline solution – 500cc or 1000cc bag for adult patients 4 liters

Universal vial adapter/dispensing pin 2

Normal Saline solution – 100ml, 250ml for pediatric patients 2 each

Saline lock with extension tubing 2

IV tubing: mini drip (60gtt), macro drip (10/15gtt) or equivalent (8) 4 each

IV extension tubing 4

Glucometer (with lancets and test strips) 1

Secured drug box 1

Pediatric length-based weight determination tape e.g. Broselow or equivalent 1

Adenosine (6mg) 5

Albuterol (2.5mg/3ml unit dose ampule) 4

Amiodarone (150mg/3ml ampule) 6

Atropine (1mg preload) 4


Aspirin (81mg tablets) 1 bottle

Diphenhydramine (Benadryl) (50mg/1cc) 2

Calcium Chloride (1 gm) 1

Dextrose 10% (250 ml) 2

Dextrose 50% (25gm/50cc) 2

Dopamine (400mg/250cc premixed bag) (or equivalent) 1



Glucagon (1mg/1cc) 1

Lidocaine 2% for IO pain control 100 mg

Midazolam (Versed) (5mg/ml ampule/vial) 10 mg

Morphine Sulfate (10mg/1cc ampule/vial) 20 mg

Naloxone (Narcan) 4 mg

Nitroglycerin (0.4 mg/tab or multidose spray) 1 bottle

Sodium Bicarbonate (50mEq/50cc) 1

Appendix E

Contra Costa County Paramedic Accreditation

Policy

POLICY #: 2

Contra Costa Emergency Medical Services

PAGE: 11 of 11

EFFECTIVE: 01/01/09

PARAMEDIC ACCREDITATION REVIEWED: 11/01/08

I. PURPOSE

To identify the process for paramedic accreditation in Contra Costa County. II. ACCREDITATION

A. All candidates shall meet the following accreditation requirements: 1) Possess a current California paramedic license. 2) Be employed as a paramedic with a designated ALS service provider or the EMS Agency. 3) Attend a Contra Costa EMS Orientation provided by the provider agency and approved by

the EMS Agency or provided by the EMS Agency. 4) Successfully complete the Contra Costa County EMS Optional Scope Skills Session

provided by the provider agency. 5) Complete an application form, available online or at the provider agency or the EMS

Agency. B. Documentation that the accreditation requirements have been met must be submitted to the

EMS Agency, by the applicant’s employer, with the candidate’s application and accreditation fee.

The EMS Agency shall notify individuals applying for accreditation of the decision to accredit within thirty (30) days of application.

III. MAINTAINING ACCREDITATION A. Accreditation to practice shall be continuous as long as: 1) State licensure is maintained, 2) Employment as a paramedic with a designated Contra Costa ALS service provider or the

EMS Agency is maintained, 3) A current and valid ACLS card, according to the standards of the American Heart

Association is maintained, 4) Verification of skills competency is completed every two years, and 5) Any other local requirements are met. B. Documentation that the above requirements to maintain accreditation have been met must be

submitted by the applicant or the applicant’s employer prior to expiration of the paramedic’s license.

Appendix F

Contra Costa EMSC Emergency Department

Consultation Visit Survey Tool and Results

Contra Costa County 2008 EMS for Children Emergency Department Self Assessment

“Approximately 30 million children are seen each year in our nation’s emergency departments (EDs). Most of these children (90%) will arrive by private car and 10% will arrive by ambulance. Each ED must be prepared with appropriate staff, equipment, supplies, and procedures to ensure quality care regardless of the patient’s age or presenting complaint.” Source: Joint policy statement American Academy of Pediatrics & American College of Emergency Physicians (2001) Introduction In 2002 the Contra Costa EMS Agency implemented the county’s first Emergency Medical Services for Children (EMSC) Plan. This plan helped establish many recommendations and guidelines to assist Emergency Departments in providing minimum and uniform administrative, personnel, and policy guidelines for the care of pediatric patients within the county. Our current EMSC Plan is due for review and update. The process will begin with each Emergency Department completing a self-assessment. This will allow the EMS Agency to evaluate the effectiveness of our current EMS for Children Program. It will be followed at a later date with a facility educational consultation and site visit. The site visits will further assist us in collecting information for our State mandated EMSC Plan review. Emergency departments in Contra Costa County vary in pediatric patient volume, education of staff caring for pediatric emergencies, and in availability of equipment to care for pediatric patients. This new self-assessment tool is based on the recently updated 2008 EMSC ED Guidelines for Pediatric Care (document #182). It is designed to further assist Emergency Departments in assessing their readiness to provide care for pediatric patients. It will also be helpful in preparation for the County EMSC facility educational consultation. This consultation should take about 2 hours. If you have any questions about this self-assessment or the EMSC facility educational consultations, please contact Pat Frost EMSC Coordinator at [email protected]. I will be contacting you to schedule the consultation site visit at a later date. Enclosed are the revised California State EMS Authority Guidelines for Administration, Personnel and policy for the Care of Pediatric Patients in the Emergency Department (document #182). Please compare these guidelines to your current practices and identify opportunities for improvement where applicable. This survey will be due by August 1, 2008.

mailto:[email protected]


Definitions and Terms used in this ED self-evaluation are consistent with EMSA document # 182 revised in 2008 and are listed here for your convenience. The numbers correspond to the endnotes dispersed throughout this survey document and are identical to the endnotes in EMSA document #182. 1 Personnel guidelines for a physician and a nurse coordinator for pediatric emergency medicine may be met by staff currently assigned other roles in the department and may be shared between EDs. 2 “Qualified specialist” means a physician licensed in California who has: 1) taken special postgraduate medical training, or has met other specified requirements, and 2) has become board certified within six years of qualification for board certification in the corresponding specialty, for those specialties that have board certification and are recognized by the American Board of Medical Specialties. For Standby Emergency Departments: A physician who is not a qualified specialist may perform the role if:

(1) the physician can demonstrate to the appropriate hospital body and the hospital is able to document that he/she has met requirements which are equivalent to those of the Accreditation Council for Graduate Medical Education (ACGME) or the Royal College of Physicians and Surgeons of Canada; (2) the physician can clearly demonstrate to the appropriate hospital body that he/she has substantial education, training, and experience in treating and managing pediatric patients which shall be tracked by the pediatric quality improvement program;

(3) the physician has successfully completed a residency program and (4) is current with Advanced Pediatric Life Support: The Pediatric Emergency Medicine Course (APLS) or Pediatric Advanced Life Support (PALS)

3 These guidelines do not promote or suggest that any particular continuing education course is required for competency. Competency as stated in this document is defined by local (hospital) credentialing requirements which should include requirements for all ages of patients from newborns through the elderly. 4 Refer to Section V of the Guidelines: Quality Improvement 5 For physicians staffing a general emergency department, a pediatric emergency department or for physicians staffing an emergency department in a children’s hospital, certification in Emergency Medicine or Pediatric Emergency Medicine is the preferred standard of competence. For all other situations or areas in which physician resources are limited, then a physician specialist as described in section ll.B.1. is desirable. 6 The Pediatric consultant should be a specialist in pediatrics or pediatric emergency medicine and may be board certified or prepared. Requirements may be fulfilled by supervised senior residents who are capable of assessing emergency situations in their respective specialties. When a senior resident is the responsible specialist: the senior resident shall be able to provide the overall control and leadership necessary for the care of the patient, including initiating care; the pediatric consultant shall be on-call and promptly7 available; the pediatric consultant shall be advised of all admissions, participate in major therapeutic decisions, and be present in the ED for major resuscitations. 7 May be met by PALS or APLS 8 Endtidal CO2 monitoring is considered the optimal method of assessing for and monitoring of endotracheal tube placement in the trachea, however for low patient volume hospitals, CO2 colorimetric detector devices could be substituted. Clinical assessment alone is not appropriate. 9 Feeding tubes (size 5F) may be utilized as a UVC catheter

10 A spinal stabilization device should be a device that can also stabilize the neck of an infant, child or adult in a neutral position. 11 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Recommendations (or most current)


Promptly available means being within the emergency department within a period of time that is medically prudent and proportional to the patient’s clinical condition and such that the interval between the arrival of the patient to the emergency department and the arrival of the respondent should not have a measurably harmful effect on the course of the patient management or outcome.

ADMINISTATION /COORDINATION Circle one Y N Medical Director for the ED. Name___________________________________

Y N Y N Y N

Physician coordinator for pediatric emergency medicine.1Name:________________________ This may be met by staff currently assigned other roles in the department and may be shared between EDs. Qualifications: 1. Qualified specialist2 in Pediatric Emergency Medicine or Emergency Medicine, of

MD who is a qualified specialist2 in Pediatrics or Family Medicine and is current in APLS or PALS training.

2. Demonstrates special interest, knowledge, and skill in emergency medical car of children as demonstrated by training, clinical experience, or focused continuing education.

3. Maintains competency3 in pediatric emergency care as defined by local (hospital) credentialing requirements.

Responsibilities: 1. Oversight of ED pediatric quality improvement (QI). 2. Liaison with appropriate hospital-based pediatric care committees 3. Liaison with pediatric critical care center, trauma centers, the local EMS agency,

base hospital, prehospital care providers, and community hospitals. 4. Facilitates ED physician pediatric emergency education and competency4

evaluations. 5. Ensure pediatric disaster preparedness for emergency department

Comments: Y N Y N

A Nursing Coordinator for pediatric emergency care.1 (eg: Pediatric Liaison Nurse) Name:_______________________________ This may be met by staff currently assigned other roles in the department and may be shared between EDs. Qualifications: 1. RN with at least two years experience in pediatrics or emergency nursing within the

previous five years. 2. Completion of PALS, ENPC, APLS, or other equivalent pediatric emergency course.


Y N Responsibilities

1. Coordination with the pediatric physician coordinator for pediatric QI activities 2. Facilitation of ED nursing continuing education and competency3 evaluations in

pediatrics. 3. Liaison with pediatric critical care center, trauma centers, the local EMS agency,

base hospitals, prehospital care providers, and community hospitals. 4. Liaison with appropriate hospital-based pediatric care committees 5. Ensure emergency nursing preparedness for pediatric disasters.

Comments:

PERSONNEL Circle one Y N Y N Y N

Physicians staffing – ED physician on duty 24 hours/day as per Title 22: Ref. 70415. Qualifications/Education: 1. Qualified specialist2 in Pediatrics or Emergency Medicine, or 2. Physicians who are not qualified specialists2 in Emergency Medicine or Pediatric

Emergency Medicine should be current in PALS or APLS5. 3. Complete pediatric competency3 evaluations that are age specific and include

neonates, infants, children and adolescents as required by local credentialing.

Comments Y N Y N Y N

Back up MD Specialty Services: There is a plan for pediatric patients to receive specialized care 1. A designated pediatric consultant6 is available for in-house consultation or through

phone consultation and transfer agreements. 2. Pediatric specialty physicians available for in-house consultation or through phone

consultation and transfer agreements. Comments:

Nurses staffing the ED Qualifications:


Y N Y N Y N

1. At least one ED RN per shift with current completion of ENPC, PALS, APLS, or equivalent pediatric emergency nursing course.

2. All RNs regularly assigned to the ED complete four hours of CE in topics related to pediatrics every two years. This may be met through completion of ENPC, PALS, or APLS. 7

3. Complete pediatric competency3 evaluations that are age specific and include neonates, infants, children and adolescents as required by local credentialing.

Comments: Y N

MID LEVEL PRACTITIONERS (Physician Assistants, Nurse Practitioners) Qualifications:

1. All mid-level practitioners regularly assigned to the ED and who car for pediatric patients should demonstrate current completion of PALS, APLS, ENPC or other equivalent pediatric emergency care course.

2. Complete pediatric competency4 evaluations that are age specific and include neonates, infants, children, and adolescents as required by local credentialing.

Comments:


QUALITY IMPROVEMENT (QI)

Circle one Y N A Pediatric QI Plan should be established

This plan may be a component of the comprehensive ED QI plan. Y N Components of the plan include; a plan for interface with prehospital, ED, trauma, in-

patient pediatrics, pediatric critical care, hospital-wide QI activities. Y N Y N Y N Y N

The pediatric QI plan may include the following: 1. A periodic review of aggregate data of pediatric emergency visits 2. A review of prehospital and ED pediatric patient care. Select indicators which may

include: • Deaths • Transfers • Child Maltreatment cases • Cardiopulmonary or respiratory arrests • Trauma admissions from the ED • Operating room admissions from the ED • ICU admissions from the ED • Patient safety including adverse events involving medication delivery.

3. Mechanism to monitor professional credentialing, education and competencies • Airway management • Burn care • Critical care monitoring • Medication delivery and device/equipment safety • Pain assessment and treatment • Trauma care • Vascular access

4. A mechanism to provide for integration of findings from QI process and reviews into education and clinical competency evaluations of ED staff.

Comments:


POLICIES, PROCEDURES AND PROTOCOLS

Circle one Y N Check those P/P currently in place

Policies, procedures or protocols for emergency care of children are not limited to but should include the following: Pediatric policies, procedures or protocols may be a component of ED or hospital policy and procedure or may be addressed as separate pediatric specific documents.

1. Illness and injury triage 2. Pediatric Assessment 3. Physical or chemical restraint of patients 4. Child maltreatment 5. Safe surrender and child abandonment 6. Consent (including situations in which a parent is not immediately available) 7. DNR orders 8. Procedural sedation 9. Death in ED to include SIDS and care of the grieving family 10. Radiation dosage protocol 11. Scheduled resuscitation medical and supply inventory check 12. Immunization status 13. Mental health emergencies 14. Family Centered Care, including:

• Education of the patient, family and regular caregivers • Discharge planning and instruction • Family presence during care

15. Communication with patient’s primary health care provider. 16. Pain assessment and treatment 17. Disaster preparedness plan that addresses the following pediatric issues:

• A plan to minimize parent-child separation and improved methods for reuniting separated children from their families

• A plan that addresses pediatric surge capacity for both injured and non-injured

• A plan that includes access to specific medical and mental health therapies, as well as social services, for children in the event of a disaster.

• A plan which ensures that disaster drills include a pediatric mass casualty incident at least once every 2 years

• Decontamination 18. Medication safety

• Record all weights in kg • Process to solicit feedback from staff including medical error reporting • Involvement of families in medication safety process. • Medication orders that are clear and unambiguous

An Inter-facility Consultation and Transfer Plan for tertiary or specialized care

should include at a minimum the following:


Y N A plan for sub-specialty consultation (telephone or real-time telemedicine 24

hours/day) Y N Identification of transferring and receiving facilities’ responsibilities in compliance

with EMTALA. Establishment of inter-facility transfer agreements (including repatriation of the child

back to his/her community as appropriate) should include the following pediatric specialty referral resources.

• Medical and surgical pediatric intensive care • Trauma • Re-implantation (replacement of severed digits or limbs) • Burns • Psychiatric emergencies • Obstetric and perinatal emergencies • Child maltreatment

Comments/issues/areas for improvement:

GUIDELINES FOR SUPPORT SERVICES FOR THE ED Circle one Y N

Respiratory Care Practitioners (who respond to the ED) should include qualified staff and necessary equipment and supplies to care for children in the ED

Y N Respiratory Care Staffing: At least one Respiratory care or equivalent practitioner n house 24 hours/day Complete pediatric competency4 evaluations that are age specific and include

neonates, infants, children and adolescents as required by local credentialing Y N Radiology Services should include qualified staff and necessary equipment and

supplies to provide imaging studies of children including Protocols that include modification of radiation exposure of children based on

age and weight, pediatric radiation dosing and protective shielding of children for plain radiography and CT

Y N Clinical Laboratory Services should include qualified staff and necessary equipment and supplies to provide laboratory services and testing/analysis including but not limited to: Obtaining samples from children of all ages Micro-capabilities

Comments/issues/areas for improvement:

EQUIPMENT, SUPPLIES AND MEDICATIONS FOR THE CARE OF PEDIATRIC PATIENTS IN THE EMERGENCY DEPARTMENT


Circle one Y N Pediatric equipment, supplies and medications should be easily accessible, labeled

and logically organized Y N Emergency department staff should be appropriately education as to the location of all

items Y N Method of daily verification of proper location and function of equipment and

supplies in place. Y N Mobile pediatric crash cart present in ED Y N Length based pediatric weight measurement system used for assessing pediatric

weight in an emergency (eg: Broselow) Y N Pediatric medication chart, tape or medical software or other system in place to assure

ready access to proper sizing of resuscitation equipment and proper dosing of medication should be easily accessible.

Y N Resuscitation medications as per American Heart Association PALS guidelines available11

Y N Please review the State EMSC Guidelines for equipment listed in document #182. Resuscitation equipment and supplies should be located in the ED. Trays and other items may be housed in other departments eg: newborn nursery or central supply as long as items are immediately accessible to the ED staff.

Emergency Department Characteristics

How many pediatric emergency visits did you have in 2007? How many arrived by private vehicle? How many ED RN staff are trained in PALS/APLS or ENPC? How many ED MD’s are trained in PALS/APLS?

Our hospital defines pediatric patient as beginning at age_____ and ending at age_____. Y N Do you have pediatric inpatient or outpatient services at your facility? Pediatric general care beds PICU beds Newborn Nursery beds NICU beds Pediatric Clinics (general care or specialty) Do you admit pediatric patients to your adult floors? What facilities do you transfer pediatric patients to? Please provide a complete list


What pediatric prevention community activities or programs does your hospital or ED participate in? Please list and attach additional information if needed. Y N Would your ED be interested in joint ED/Prehospital resuscitation training using

a Pediatric Patient Simulator? Y N Have you heard about the new AHA and AAP National Standard in Pediatric

Emergency Assessment, Recognition and Stabilization? (Known as Assess Categorize Decide Act for ACDA). This new standard is currently being taught in PALS and the new AHA course focused on Pediatric Emergency Assessment called PEARS (Pediatric Emergency Assessment, Recognition and Stabilization).

Y N Would you be interested in a staff training 1-2 hours on this new assessment approach?

How can Contra Costa EMS Agency support your ED efforts to improve in the care of children? This survey was completed by: (name/title) Contra Costa County EMS thanks you for your participation in this survey. Results will be compiled and shared with our facilities as blinded data. Recommendations for improvement of pediatric prehospital care is always welcome and should be directed to Pat Frost at [email protected].

Con

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ta C

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y 20

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1

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2008

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Em

erge

ncy

Dep

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mar

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C: JMMC-WC

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Em

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Dep

artm

ent A

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t Sum

mar

y*

A: CCRMC

B: Doctors-SP

C: JMMC-WC

D: Kaiser- R

E: Kaiser-WC

F: JMMC-C

G: Sutter Delta

H: SRVRMC

I: Kaiser: A

POLI

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PR

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ts 2

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ited

but

shou

ld i

nclu

de:

Y Y

Y Y

Y Y

Y Y

Y

Ill

ness

and

inju

ry tr

iage

Y

Y

Y

Y

Y

Y

Y

Y

Y

Pedi

atric

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ent

Y Y

Y Y

Y Y

Y Y

Y

Phys

ical

or c

hem

ical

rest

rain

t of p

atie

nts

Y Y

Y

Y

Y

Y

Y

Y

Y

Chi

ld m

altre

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ent

Y Y

Y Y

Y Y

Y Y

Y

Saf

e su

rrend

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chi

ld a

band

onm

ent

Y

Y

Y

Y

Y

Y

Y

Y

Y

C

onse

nt (i

nclu

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situ

atio

ns in

whi

ch a

par

ent i

s no

t im

med

iate

ly a

vaila

ble)

Y

Y

Y

Y

Y

Y

Y

Y

Y

DN

R o

rder

s Y

Y1Y

Y Y

Y1Y

Y Y

P

roce

dura

l sed

atio

n Y

Y Y

Y Y

Y Y

Y Y

D

eath

in E

D to

incl

ude

SID

S &

car

e of

the

grie

ving

fam

ily

N5

N5

Y Y

Y N

5N

5Y

N5

R

adia

tions

dos

age

prot

ocol

Y

Y Y

Y Y

Y Y

Y Y

S

ched

uled

resu

scita

tion

med

ical

and

sup

ply

inve

ntor

y ch

eck

Y

Y

Y

Y

Y

Y

Y

Y

Y

Im

mun

izat

ion

stat

us

Y Y

Y Y

Y Y

Y Y

Y

Men

tal h

ealth

em

erge

ncie

s Y

Y

Y

Y

Y

Y

Y

Y

4Y

Fa

mily

Cen

tere

d C

are

incl

udin

g: p

atie

nt ,

fam

ily a

nd c

areg

iver

edu

catio

n, D

isch

arge

pl

anni

ng a

nd in

stru

ctio

n, fa

mily

pre

senc

e du

ring

care

. Y

Y Y

Y Y

Y Y

Y Y

C

omm

unic

atio

n w

ith p

atie

nt’s

prim

ary

heal

th c

are

prov

ider

. Y

5Y

Y Y

Y Y2

Y Y

Y

Pai

n as

sess

men

t and

trea

tmen

t Y

Y

Y

Y

Y

Y

Y

Y

Y

Dis

aste

r pre

pare

dnes

s pl

an a

ddre

ssin

g pe

diat

ric is

sues

: par

ent c

hild

sep

arat

ion

and

reun

ifica

tion,

ped

iatri

c su

rge

capa

city

, dis

aste

r med

ical

, men

tal &

soc

ial s

ervi

ces

for

child

ren,

dis

aste

r dril

ls in

clud

e pe

diat

ric m

ass

casu

alty

inci

dent

one

eve

ry 2

yea

rs &

de

cont

amin

atio

n.

Y3Y3

Y2,3

Y3Y3

Y1,4

Y3Y4

Y3

M

edic

atio

n sa

fety

: rec

ord

all w

eigh

ts in

kg,

med

ical

err

or re

porti

ng, f

amily

invo

lvem

ent i

n m

edic

atio

n sa

fety

pro

cess

, med

icat

ion

orde

rs c

lear

& u

nam

bigu

ous.

Y

Y Y

Y Y

Y Y

Y Y

Foot

note

s:

1 Thi

s lis

t was

exp

ande

d w

ith 2

008

upda

te o

f Sta

te E

MS

C g

uide

lines

. Ped

iatri

c po

licie

s, p

roce

dure

s or

pro

toco

ls m

ay b

e a

com

pone

nt o

f ED

or h

ospi

tal p

olic

y &

pro

cedu

re o

r may

be

addr

esse

d as

sep

arat

e pe

diat

ric s

peci

fic d

ocum

ents

. 2 P

lan

to d

evel

op

3 Has

gen

eric

dis

aste

r pla

n w

ith s

ome

or li

mite

d pe

diat

ric a

spec

ts

4 Add

ition

al p

edi a

nd a

dole

scen

t asp

ects

pla

nned

to e

nhan

ce c

urre

nt p

olic

ies,

pro

toco

ls &

gui

delin

es

5 E

stab

lishe

d in

form

al p

roce

sses

in p

lace

with

no

form

al p

edia

tric

polic

y

Page

3

12

/24/

2008

Con

tra

Cos

ta C

ount

y 20

08 E

MSC

Em

erge

ncy

Dep

artm

ent A

sses

smen

t Sum

mar

y*

A: CCRMC

B: Doctors-SP

C: JMMC-WC

D: Kaiser-R

E: Kaiser-WC

F: JMMC-C

G: Sutter Delta

H: SRVRMC

I: Kaiser-A

An

Inte

rfac

ility

Con

sulta

tion

and

tran

sfer

Pla

n fo

r ter

tiary

or s

peci

aliz

ed c

are

shou

ld in

clud

e at

a m

inim

um th

e fo

llow

ing

in li

ne w

ith 2

008

EMSA

gui

delin

es.

Pla

n fo

r sub

-spe

cial

ty c

onsu

ltatio

n (te

leph

one

or re

al-ti

me

tele

med

icin

e 24

/hrs

per

day

) Y

Y

Y

Y

Y

Y

Y

Y

Y

Id

entif

icat

ion

of tr

ansf

errin

g an

d re

ceiv

ing

faci

litie

s re

spon

sibi

litie

s in

com

plia

nce

with

EM

TALA

Y

Y

3Y

Y Y

Y Y

Y Y

Est

ablis

hmen

t of i

nter

-faci

lity

trans

fer a

gree

men

ts (i

nclu

ding

repa

triat

ion

of th

e ch

ild b

ack

to h

is/h

er

com

mun

ity a

s ap

prop

riate

) sho

uld

incl

ude

the

follo

win

g pe

diat

ric s

peci

alty

refe

rral

reso

urce

s:

M

edic

al a

nd s

urgi

cal p

edia

tric

inte

nsiv

e ca

re

Tr

aum

a

Re-

impl

anta

tion

(rep

lace

men

t of s

ever

ed d

igits

or l

imbs

)

Bur

ns

P

sych

iatri

c em

erge

ncie

s

Obs

tetri

c an

d pe

rinat

al e

mer

genc

ies

C

hild

mal

treat

men

t

Y2Y2

Y2Y2

Y2Y2

Y2Y2

Y2

Gui

delin

es fo

r Sup

port

Ser

vice

s fo

r the

ED

in li

ne w

ith 2

008

EMSA

gui

delin

es.

R

espi

rato

ry C

are

Prac

titio

ners

(who

resp

ond

to th

e E

D) s

houl

d in

clud

e qu

alifi

ed s

taff

and

nece

ssar

y eq

uipm

ent a

nd s

uppl

ies

to c

are

for c

hild

ren

in th

e E

D

Y Y

Y Y

Y Y

Y Y

Y

Res

pira

tory

Car

e S

taffi

ng

Y Y

Y Y

Y Y

Y Y

Y

At l

east

one

resp

irato

ry c

are

or e

quiv

alen

t pra

ctiti

oner

in h

ouse

24

hrs/

day

Y

Y

Y

Y

Y

Y

Y

Y

Y

C

ompl

ete

pedi

atric

com

pete

ncy

eval

uatio

ns th

at a

re a

ge s

peci

fic a

nd in

clud

e ne

onat

es,

infa

nts,

chi

ldre

n an

d ad

oles

cent

s as

requ

ired

by lo

cal c

rede

ntia

ling.

Y

Y Y

Y Y

Y Y

Y Y

Rad

iolo

gy S

ervi

ces

shou

ld in

clud

e qu

alifi

ed s

taff

& n

eces

sary

equ

ipm

ent &

sup

plie

s to

pro

vide

im

agin

g st

udie

s of

chi

ldre

n in

clud

ing:

Pro

toco

ls th

at in

clud

e m

odifi

catio

n of

radi

atio

n ex

posu

re o

f chi

ldre

n ba

sed

on a

ge a

nd

wei

ght,

pedi

atric

radi

atio

n do

sing

and

pro

tect

ive

shie

ldin

g of

chi

ldre

n fo

r pla

in ra

diog

raph

y an

d C

T

Y Y

Y Y

Y Y2

Y Y

Y

Clin

ical

Lab

orat

ory

Serv

ices

wou

ld in

clud

e qu

alifi

ed s

taff

and

nece

ssar

y eq

uipm

ent &

sup

plie

s to

pr

ovid

e la

bora

tory

ser

vice

s an

d te

stin

g/an

alys

is in

clud

ing

but n

ot li

mite

d to

:

Obt

aini

ng s

ampl

es fr

om c

hild

ren

of a

ll ag

es

M

icro

-cap

abilit

ies

Y Y

Y Y

Y Y

Y Y

Y

Foot

note

: 1 P

lan

is in

dev

elop

men

t 2 S

ome

com

pone

nts

liste

d m

ay n

ot b

e m

et

3 Info

rmal

agr

eem

ents

in p

lace

Page

4

12

/24/

2008

Con

tra

Cos

ta C

ount

y 20

08 E

MSC

Em

erge

ncy

Dep

artm

ent A

sses

smen

t Sum

mar

y*

A: CCRMC

B: Doctors-SP

C: JMMC-WC

D:Kaiser-R

E:Kaiser-WC

F: JMMC-C

G: Sutter Delta

H: SRVRMC

I: Kaiser-A

Equi

pmen

t, Su

pplie

s &

Med

iatio

ns fo

r the

Car

e of

Ped

i Pat

ient

s in

the

ED in

line

with

200

8 EM

SA g

uide

lines

.

Ped

iatri

c eq

uipm

ent,

supp

lies

& m

edic

atio

ns s

houl

d be

eas

ily a

cces

sibl

e, la

bele

d an

d lo

gica

lly

orga

nize

d Y

Y Y

Y Y

Y Y

YY

ED

sta

ff sh

ould

be

appr

opria

tely

edu

cate

d to

loca

tion

of a

ll ite

ms

Y

Y

Y

Y

Y

Y

Y

YY

Mob

ile p

edia

tric

cras

h ca

rt re

com

men

ded

in E

D

Y Y

Y Y

Y Y

Y Y

Y

Leng

th b

ased

ped

iatri

c w

eigh

t mea

sure

men

t sys

tem

use

d fo

r in

an e

mer

genc

y (e

g: B

rose

low

) Y

Y

Y

Y

Y

Y

Y

Y

Y

Ped

iatri

c m

edic

atio

n ch

art,

tape

or m

edic

al s

oftw

are

or o

ther

sys

tem

in p

lace

to a

ssur

e re

ady

acce

ss

to p

rope

r siz

ing

of re

susc

itatio

n eq

uipm

ent a

nd p

rope

r dos

ing

of m

edic

atio

n sh

ould

be

easi

ly

acce

ssib

le

Y Y

Y Y

Y Y

Y Y

Y

Res

usci

tatio

n m

edic

atio

n as

per

200

5 AH

A P

ALS

gui

delin

es a

vaila

ble

Y

Y

Y

Y

Y

Y

Y

YY

Res

usci

tatio

n eq

uipm

ent (

reco

mm

enda

tions

per

Sta

te E

MS

C g

uide

lines

) and

sup

plie

s sh

ould

be

loca

ted

in th

e ED

.

Tray

s &

oth

er it

ems

may

be

hous

ed in

oth

er d

epar

tmen

ts e

g: N

ewbo

rn n

urse

ry o

r cen

tral

supp

ly im

med

iate

ly a

cces

sibl

e if

need

ed.

Y Y

Y Y

Y Y

Y Y

Y

Con

clus

ions

Fa

cilit

ies

have

met

or e

xcee

ded

Con

tra C

osta

EM

SC

Pla

n 20

00 g

oals

and

exp

ecta

tions

. P

edia

tric

inpa

tient

bed

cap

acity

has

bee

n su

bsta

ntia

lly re

duce

d to

1 b

ed fo

r eve

ry 5

000

child

ren

< 14

yea

rs in

the

EM

S s

yste

m s

ince

200

0. T

his

is th

e re

sult

of e

limin

atio

n of

ped

iatri

c be

ds a

t Doc

tors

San

Pab

lo, C

CR

MC

& J

MM

C-C

onco

rd a

nd in

crea

sing

refe

rral

of s

ick

child

ren

to d

efin

itive

ped

iatri

c ca

re.

As

of J

anua

ry 1

, 200

9 th

ere

are

44 g

ener

al p

edia

tric

beds

, 47

new

born

nur

sery

bed

s an

d 48

NIC

U b

eds

in th

e C

ontra

Cos

ta E

MS

sys

tem

. O

ppor

tuni

ties

exis

t to

impr

ove

Con

tra C

osta

EM

SC

Pro

gram

in th

e fo

llow

ing

area

s:

P

edia

tric

CQ

I pro

cess

es.

P

olic

y an

d pr

otoc

ols

for m

anag

ing

pedi

atric

dea

th in

the

ED

incl

udin

g si

tuat

iona

l sup

port

for h

ealth

car

e pr

ovid

ers.

Enh

ance

d ed

ucat

ion

and

train

ing

in th

e ea

rly re

cogn

ition

and

inte

rven

tion

of th

e pe

diat

ric p

re-a

rres

t sta

te to

impr

ove

outc

omes

.

Dev

elop

men

t of c

riter

ia fo

r ped

iatri

c in

patie

nt c

onsu

ltatio

n w

ithin

eac

h fa

cilit

y.

P

edia

tric

disa

ster

pre

pare

dnes

s in

clud

ing

the

pedi

atric

sur

ge c

apab

ility

Enh

ance

d pr

ehos

pita

l and

em

erge

ncy

depa

rtmen

t col

labo

ratio

n on

ped

iatri

c em

erge

ncy

care

issu

es in

clud

ing

inju

ry p

reve

ntio

n Pa

ge 5

12/2

4/20

08

Con

tra

Cos

ta 2

008

EMSC

Sur

vey

Emer

genc

y D

epar

tmen

t Cha

ract

eris

tics

A: CCRMC

B: Doctors-SP

C: JMMC-WC

D: Kaiser-R

E: Kaiser-WC

F: JMMC-C

G: Sutter Delta

H: SRVRMC

I: Kaiser-A opened 11/07

Pedi

atric

Em

erge

ncy

Visi

ts in

200

7 6,

316

7,20

0

23%

of

ED

vis

its

6,42

3 6,

000

5,78

4 8,

024

18.2

% o

f E

D v

isits

15,0

006

25%

of E

D

visi

ts

2,89

5 23

% o

f E

D v

isits

4821

% A

rrivi

ng b

y pr

ivat

e ve

hicl

e 95

%

80%

?

? 90

.5%

55

2 ?

90%

?

90.4

%

4361

98%

10

0%

100%

410

0%

100%

10

0%

100%

10

0%

100%

%

ED

RN

sta

ff tra

ined

in P

ALS

/EN

PC

or

equi

vale

nt

100%

10

0%2

100%

10

0%

100%

10

0%2

100%

10

0%

100%

%

ED

MD

s tra

ined

in P

ALS

/AP

LS o

r eq

uiva

lent

P

edia

tric

patie

nt d

efin

ed a

s (a

ges)

0-

13 y

r 0-

18 y

r 0-

13 y

r 1d

–18

yr

0-18

yr

0-18

yr

0-18

yr

1d-1

8 yr

0-

18 y

r

Do

you

have

ded

icat

ed p

edia

tric

inpa

tient

or

out

patie

nt s

ervi

ces

Y

N

Y

N

Y

Y

Y

Y

Y

Do

you

have

ped

iatri

c ge

nera

l car

e be

ds

N

N

Y

17

bed

s N

Y

12

bed

s N

5Y

7

beds

Y

5

8 be

ds

N

PIC

U b

eds

N

N

N

N

N

N

N

N

N

New

born

Nur

sery

bed

s Y

6 be

ds

N

Y

19

-20

beds

N

Y

ro

om in

N

Y

ro

om in

Y

15

bed

s Y

6 be

ds

NIC

U b

eds

N

N

Y

4

beds

N

Y

28

bed

s N

Y

4

beds

Y

2

beds

Y

10 b

eds

Ped

iatri

c cl

inic

s: g

ener

al/s

peci

alty

car

e Y

N

Y

N

Y

N

N

N

Y

Adm

it pe

diat

ric p

atie

nts

to a

dult

units

? N

Y5

pts

>14

N

N

Y

pts

> 14

Y

5

pts

> 6

N

Y

Y

pts

> 14

W

hat f

acilit

ies

do y

ou tr

ansf

er p

edia

tric

patie

nts

to

CH

O

JMM

C-W

C

CH

O

KP

-OA

K

CC

RM

C3

CH

O

UC

SF

LPC

H

UC

Dav

is

Shr

iner

s S

t Fra

ncis

C

PM

D

JMH

-Pav

CH

O

KP

-OK

K

P-O

K

KP

-SA

C

KP

-SC

C

HO

U

CS

F LP

CH

CH

O

JMM

C-W

C

CC

RM

C3

LPC

H

UC

Dav

is

UC

SF

Kai

ser

CH

O

JMM

C-W

C

JMM

C-C

LP

CH

CH

O

JMH

-Pav

K

aise

r JM

MC

-C

Her

rick

LPC

H

CH

O

KP

-OK

U

CS

F

S

t Fra

ncis

Frem

ont

Hos

p

Page

6

12

/24/

2008

A: CCRMC

B: Doctors-SP

C: JMMC-WC

D: K/Richmond

E: K/Walnut Crk

F: JMMC-C

G: Sutter Delta

H: SRVRMC

I: K/Antioch opened 11/07

Invo

lved

in p

edia

tric

prev

entio

n ac

tiviti

es

Y

Y

Y

Y

Y

Y

Y

Y

Y

Inte

rest

ed in

Joi

nt E

D/P

reho

spita

l tra

inin

g us

ing

pedi

atric

pat

ient

sim

ulat

or

Y

Y

Y

Y

Y

Y

Y

N

Y

Hea

rd a

bout

new

AC

DA

ped

i em

erge

ncy

asse

ssm

ent m

odel

taug

ht in

PA

LS/P

EA

RS

N

N

Y

Y

Y

N

N

Y

Y

Y

Y

Y

Y

Y

Y

Y

N

Y

Inte

rest

ed in

a s

taff

train

ing

on th

is n

ew

appr

oach

Fo

otno

tes:

1 F

acili

ty o

pene

d in

Nov

200

8 2 A

ll M

Ds

train

ed in

itial

ly b

ut u

nkno

wn

how

man

y cu

rren

t 3 C

CR

MC

ped

iatri

c un

it cl

osed

in 2

008

4 With

in 6

mon

ths

of h

ire

5 Lic

ense

d as

med

/sur

g be

ds n

ot d

edic

ated

ped

iatri

c un

it 6 E

stim

ated

vol

umes

of p

edia

tric

patie

nts

Rec

omm

enda

tions

/com

men

ts fr

om fa

cilit

ies

to s

uppo

rt fo

r ED

effo

rts

to im

prov

e th

e ca

re o

f chi

ldre

n:

Ass

ist i

n pr

ovid

ing

EN

PC c

lass

es in

Con

tra C

osta

Cou

nty

Bet

ter p

reho

spita

l com

mun

icat

ion

Bet

ter r

espo

nse

to c

ritic

al c

are

trans

fers

B

y gi

ving

the

hosp

itals

add

ition

al a

ssis

tanc

e fo

r tra

inin

g an

d su

pplie

s th

roug

h m

oney

reso

urce

s an

d co

llabo

rativ

e pa

rtner

ship

s in

ord

er to

impr

ove

care

to p

edia

tric

patie

nts.

B

e aw

are

of li

mita

tions

O

pen

com

mun

icat

ion

betw

een

ED

& E

MS

. C

onst

ruct

ive

feed

back

onc

e cr

itica

l ped

iatri

c pa

tient

has

bee

n tra

nspo

rted

to th

e E

D.

Use

eve

ry o

ppor

tuni

ty to

lear

n fro

m o

ur c

ases

to c

ontin

uous

ly im

prov

e th

e ca

re d

eliv

ered

.

Page

7

12

/24/

2008

Appendix G

Contra Costa EMSC Injury Prevention

Resource List

PFro

st C

ontra

Cos

ta E

MSC

Coo

rdin

ator

12.

24.0

8

Con

tra

Cos

ta E

mer

genc

y M

edic

al S

ervi

ces

EM

S fo

r C

hild

ren

In

jury

Pre

vent

ion

Res

ourc

e L

ist

C

ontr

a C

osta

Cou

nty

has n

umer

ous l

ocal

res

ourc

es d

edic

ated

to in

jury

pre

vent

ion.

Thi

s lis

t is m

eant

to h

ighl

ight

s som

e of

the

reso

urce

s rea

dily

ava

ilabl

e in

the

com

mun

ity. T

he m

ajor

ity o

f the

se r

esou

rces

are

web

bas

ed p

rovi

ding

acc

ess t

o in

jury

pre

vent

ion

educ

atio

nal m

ater

ials

, res

ourc

es a

nd p

rogr

ams a

t any

time.

E

MS

Stak

ehol

ders

are

enc

oura

ged

to u

se th

ese

reso

urce

s. C

onta

ct C

ontr

a C

osta

EM

S to

add

you

r pr

ogra

m to

this

list

. N

ame

of O

rgan

izat

ion

Mis

sion

, Des

crip

tion

or P

urpo

se

Web

site

/Con

tact

Info

rmat

ion

Eas

t Bay

Chi

ld In

jury

Pr

even

tion

Net

wor

k (E

BC

IPN

)

Form

erly

Con

tra C

osta

Inju

ry P

reve

ntio

n C

oalit

ion.

Thi

s gr

oup

prov

ides

net

wor

king

opp

ortu

nitie

s to

inju

ry p

reve

ntio

n sp

ecia

lists

and

gro

ups t

o pr

omot

e ch

ild in

jury

pre

vent

ion

in

thei

r com

mun

ities

. Th

e vi

sion

of t

he E

BC

IPN

will

cre

ate

a sa

fer w

orld

for a

ll ch

ildre

n by

redu

cing

pre

vent

able

inju

ries.

Cha

ir Ja

ckW

alsh

39@

aol.c

om

Con

tra

Cos

ta H

ealth

Se

rvic

es In

jury

Pre

vent

ion

Proj

ect

Con

duct

cla

ssro

om b

icyc

le a

nd p

edes

trian

safe

ty

pres

enta

tions

, wal

king

eve

nts,

helm

et d

istri

butio

n an

d bi

ke

rode

os. W

orki

ng to

cre

ate

a sa

fer s

treet

and

com

mun

ity

envi

ronm

ent f

or w

alki

ng a

nd b

icyc

ling.

ww

w.c

chea

lth.o

rg/g

roup

s/pr

even

tion/

Kee

ping

Bab

ies S

afe

Kee

ping

Bab

ies S

afe

exis

ts to

pro

vide

lead

ersh

ip in

kee

ping

ba

bies

safe

from

pre

vent

able

inju

ries a

nd d

eath

s ass

ocia

ted

with

uns

afe

crib

s, da

nger

ous c

hild

ren'

s pro

duct

s and

uns

afe

slee

p en

viro

nmen

ts.

ww

w.k

eepi

ngba

bies

safe

.org

Chi

ldre

n’s H

ospi

tal &

R

esea

rch

Cen

ter

Oak

land

H

ere

to h

elp

if a

child

is in

jure

d. B

ut a

lso

focu

sed

on

prev

entin

g th

e in

jury

in th

e fir

st p

lace

. By

som

e es

timat

es,

90 p

erce

nt o

f uni

nten

tiona

l inj

urie

s can

be

avoi

ded.

The

w

ebsi

te p

rovi

des i

nfor

mat

ion

to k

eep

child

ren

out o

f har

m's

way

.

ww

w.c

hild

rens

hosp

italo

akla

nd.o

rg/h

ealth

car

e/de

pts/

keep

ings

afe.

asp

Safe

Kid

s A

nat

iona

l and

glo

bal n

etw

ork

of o

rgan

izat

ions

who

se

mis

sion

is to

pre

vent

acc

iden

tal c

hild

hood

inju

ry, a

lead

ing

kille

r of c

hild

ren

14 a

nd u

nder

.

ww

w.u

sa.sa

feki

ds.o

rgLo

cal C

oalit

ion

SA

FE K

IDS

Ala

med

a C

ount

y

510-

618-

2048

mailto:[email protected]

http://www.cchealth.org/groups/prevention/

http://www.keepingbabiessafe.org/

http://www.childrenshospitaloakland.org/healthcare/depts/keepingsafe.asp

http://www.childrenshospitaloakland.org/healthcare/depts/keepingsafe.asp

http://www.usa.safekids.org/

PFro

st C

ontra

Cos

ta E

MSC

Coo

rdin

ator

12.

24.0

8

Con

tra

Cos

ta E

mer

genc

y M

edic

al S

ervi

ces

EM

S fo

r C

hild

ren

In

jury

Pre

vent

ion

Res

ourc

e L

ist

Nam

e of

Org

aniz

atio

n M

issi

on, D

escr

iptio

n or

Pur

pose

W

ebsi

te/C

onta

ct In

form

atio

n D

row

ning

Pre

vent

ion

Foun

datio

n To

pre

vent

the

trage

dy o

f dro

wni

ngs t

hrou

gh p

ublic

info

rmat

ion,

ed

ucat

ion

and

polic

y ch

ange

w

ww

.dro

wni

ngpr

even

tionf

ound

atio

n.us

Con

tra

Cos

ta H

ealth

Se

rvic

es B

icyc

le &

Pe

dest

rian

Saf

ety

Proj

ect

Educ

atio

nal m

ater

ials

, hel

met

s; b

icyc

le ro

deo

equi

pmen

t; di

vers

ion

prog

ram

w

ww

.cch

ealth

.org

/topi

cs/c

hild

_saf

ety/

reso

urce

s.php

Con

tra

Cos

ta H

ealth

Se

rvic

es C

hild

Saf

ety

Res

ourc

es

Sour

ce fo

r web

site

s with

det

aile

d ho

me

safe

ty c

heck

lists

and

pr

even

tion

info

rmat

ion

ww

w.c

chea

lth.o

rg/to

pics

/chi

ld_s

afet

y/re

sour

ces.p

hp

Firs

t 5 C

ontr

a C

osta

Fi

rst 5

Con

tra C

osta

mak

es a

diff

eren

ce in

the

lives

of c

hild

ren

ages

0 to

5 a

nd th

eir f

amili

es b

y in

vest

ing

in lo

cal p

rogr

ams a

nd

serv

ices

des

igne

d to

hel

p ch

ildre

n re

ach

thei

r gre

ates

t pot

entia

l in

scho

ol a

nd li

fe. O

ur m

issi

on is

to h

elp

child

ren

grow

up

heal

thy,

re

ady

to le

arn,

and

supp

orte

d in

safe

, nur

turin

g fa

mili

es a

nd

com

mun

ities

.

ww

w.fi

rstfi

vecc

.org

Stre

et S

mar

ts

Cre

ated

in 2

004

this

inju

ry p

reve

ntio

n pr

ogra

m fo

cuse

s on

child

in

jury

pre

vent

ion

and

com

mun

ity e

duca

tion

by a

ddre

ssin

g tra

ffic

sa

fety

pro

blem

s at i

ts so

urce

: in

the

min

ds o

f driv

ers,

pede

stria

ns

and

cycl

ists

.

ww

w.st

reet

smar

ts-s

rv.c

om

Con

tra

Cos

ta H

ealth

Se

rvic

es V

iole

nce

Prev

entio

n

A v

arie

ty o

f pro

gram

s car

ried

out b

y C

CH

S, o

ften

in p

artn

ersh

ip

or in

con

junc

tion

with

com

mun

ity p

rovi

ders

to d

ecre

ase

and

prev

ent y

outh

vio

lenc

e an

d it’

s con

sequ

ence

s.

ww

w.c

chea

lth.o

rg/to

pics

/vio

lenc

e/

Con

tra

Cos

ta C

risi

s Cen

ter

To

kee

p pe

ople

in C

ontra

Cos

ta C

ount

y, C

alifo

rnia

aliv

e an

d sa

fe,

help

them

thro

ugh

cris

es, a

nd c

onne

ct th

em w

ith c

ultu

rally

re

leva

nt re

sour

ces i

n th

e co

mm

unity

to c

hild

ren

and

fam

ilies

. In

clud

es S

IDS

supp

ort,

yout

h vi

olen

ce &

suic

ide

prev

entio

n an

d ho

mel

ess s

ervi

ces.

ww

w.c

risis

-cen

ter.o

rg

http://www.drowningpreventionfoundation.us/

http://www.cchealth.org/topics/child_safety/resources.php




http://www.firstfivecc.org/

http://www.streetsmarts-srv.com/

http://www.cchealth.org/topics/violence/

http://www.crisis-center.org/

PFro

st C

ontra

Cos

ta E

MSC

Coo

rdin

ator

12.

24.0

8

Con

tra

Cos

ta E

mer

genc

y M

edic

al S

ervi

ces

EM

S fo

r C

hild

ren

In

jury

Pre

vent

ion

Res

ourc

e L

ist

Nam

e of

Org

aniz

atio

n M

issi

on, D

escr

iptio

n or

Pur

pose

W

ebsi

te/C

onta

ct In

form

atio

n C

hild

Abu

se P

reve

ntio

n C

ounc

il of

Con

tra

Cos

ta

Cou

nty

Mis

sion

is to

pro

mot

e th

e sa

fety

of o

ur c

hild

ren,

rais

e co

mm

unity

aw

aren

ess,

influ

ence

pub

lic p

olic

y, e

duca

te o

ur c

omm

unity

and

fa

mili

es, p

rovi

de re

sour

ces a

nd su

ppor

t fam

ilies

ww

w.c

apc-

coco

.org

/pre

vent

ion-

inte

rven

tion.

htm

l

Cal

iforn

ia P

oiso

n C

ontr

ol

The

Cal

iforn

ia P

oiso

n C

ontro

l Sys

tem

(CPC

S) is

the

stat

ewid

e pr

ovid

er o

f im

med

iate

, fre

e an

d ex

pert

treat

men

t adv

ice

and

assi

stan

ce o

ver t

he te

leph

one

in c

ase

of e

xpos

ure

to p

oiso

nous

, ha

zard

ous o

r tox

ic su

bsta

nces

. Ava

ilabl

e to

ll-fr

ee, 2

4 ho

urs a

day

, 7

days

a w

eek,

365

day

s a y

ear

ww

w.c

alpo

ison

.org

Pois

on A

ctio

n Li

ne

1-80

0-22

2-12

22

Con

tra

Cos

ta C

ount

y O

ffic

e of

E

duca

tion

Con

tra C

osta

Cou

nty

Off

ice

of E

duca

tion

emer

genc

y pr

epar

edne

ss

Web

pag

e go

al is

to p

rovi

de c

hild

care

pro

vide

rs a

nd p

aren

ts w

ith

easy

acc

ess t

o pe

rtine

nt e

mer

genc

y pr

epar

edne

ss in

form

atio

n an

d re

sour

ces a

s the

y re

late

to sc

hool

s thr

ough

out t

he c

ount

y.

ww

w.c

ccoe

.k12

.ca.

us/a

bout

/reso

urce

s_em

erge

ncy.

htm

l

San

Ram

on V

alle

y Fi

re

Prot

ectio

n D

istr

ict

Fred

die

the

Fire

truc

k an

imat

ed w

ebsi

te h

elps

kid

s and

thei

r fa

mili

es le

arn

to st

ay sa

fe. H

elps

chi

ldre

n de

term

ine

thei

r saf

ety

awar

enes

s. A

dditi

onal

pre

vent

ion

prog

ram

s foc

us o

n fir

e an

d bu

rn

prev

entio

n, h

ome

haza

rds,

elec

trica

l saf

ety,

cho

king

haz

ards

, bas

ic

first

aid

, fal

ls p

reve

ntio

n, d

row

ning

pre

vent

ion,

poi

son

prev

entio

n,

holid

ay sa

fety

and

veh

icle

safe

ty. T

hese

pre

vent

ion

activ

ities

im

pact

ove

r 25,

000

child

ren

a ye

ar.

ww

w.sr

vfpd

.dst

.ca.

us/k

ids/

inde

x.ht

m

Eve

ry 1

5 m

inut

es

Supp

orte

d by

John

Mui

r Wal

nut C

reek

Tra

uma

Cen

ter i

n co

llabo

ratio

n w

ith m

any

EMS

agen

cies

thro

ugho

ut C

ontra

Cos

ta

Cou

nty

Eve

ry 1

5 M

inut

es is

a tw

o-da

y pr

ogra

m th

at fo

cuse

s on

high

scho

ol ju

nior

s and

seni

ors.

It ch

alle

nges

teen

s to

thin

k ab

out

the

resp

onsi

bilit

y of

mak

ing

mat

ure

deci

sion

s abo

ut d

rinki

ng a

nd

driv

ing

and

the

impa

ct th

at th

eir d

ecis

ions

hav

e on

fam

ily, f

riend

s an

d ot

her m

embe

rs o

f the

ir co

mm

unity

. Thi

s em

otio

nally

cha

rged

w

orks

hop

feat

ures

sim

ulat

ions

, ree

nact

men

ts, g

uest

spea

kers

and

di

scus

sion

gro

ups.

ww

w.e

very

15m

inut

es.c

om/e

nter

/ent

er.h

tml

ww

w.jo

hnm

uirh

ealth

.com

/inde

x.ph

p/jm

mdh

s_al

lianc

e_ou

r_pr

ogra

ms_

broa

der1

.htm

l

http://www.capc-coco.org/prevention-intervention.html

http://www.capc-coco.org/prevention-intervention.html

http://www.calpoison.org/

http://www.cccoe.k12.ca.us/about/resources_emergency.html

http://www.cccoe.k12.ca.us/about/resources_emergency.html

http://www.srvfpd.dst.ca.us/kids/index.htm

http://www.every15minutes.com/enter/enter.html

http://www.johnmuirhealth.com/index.php/jmmdhs_alliance_our_programs_broader1.html


PFro

st C

ontra

Cos

ta E

MSC

Coo

rdin

ator

12.

24.0

8

Con

tra

Cos

ta E

mer

genc

y M

edic

al S

ervi

ces

EM

S fo

r C

hild

ren

In

jury

Pre

vent

ion

Res

ourc

e L

ist

Nam

e of

Org

aniz

atio

n M

issi

on, D

escr

iptio

n or

Pur

pose

W

ebsi

te/C

onta

ct In

form

atio

n Jo

hn M

uir

Com

mun

ity H

ealth

A

llian

ce

Obj

ectiv

es o

f the

pro

gram

incl

ude:

Uni

nsur

ed, u

nder

serv

ed a

nd

vuln

erab

le p

opul

atio

ns in

the

serv

ice

area

hav

e ac

cess

to h

ealth

ca

re. H

ealth

edu

catio

n, p

reve

ntio

n an

d ea

rly d

etec

tion

serv

ices

are

av

aila

ble

to re

side

nts w

ith p

hysi

cal,

men

tal a

nd d

enta

l hea

lth

cond

ition

s. C

hild

hood

supp

ort s

ervi

ces a

re a

vaila

ble

to p

aren

ts a

nd

scho

ols.

Res

iden

ts a

re sa

fe fr

om in

tent

iona

l and

uni

nten

tiona

l in

jurie

s.

ww

w.jo

hnm

uirh

ealth

.com

/inde

x.ph

p/jm

mdh

s_al

lianc

e_ou

r_pr

ogra

ms_

broa

der1

.htm

l

Kai

ser

Perm

anen

te C

ontr

a C

osta

Cou

nty

This

web

site

pro

vide

s a w

ealth

of h

ealth

pro

mot

ion

and

inju

ry

prev

entio

n m

ater

ials

for K

aise

r and

non

-Kai

ser m

embe

rs in

our

co

mm

unity

.

ww

w.m

embe

rs.k

aise

rper

man

ente

.org

/kpw

eb/c

lus

terQ

uery

.do?

clus

ter=

liveh

ealth

y

Con

tra

Cos

ta F

ire

Prev

entio

n D

istr

ict

CC

FPD

Pub

lic E

duca

tion

Uni

t goa

l is t

hat a

ll of

our

citi

zens

, fro

m

pres

choo

lers

to se

nior

citi

zens

, will

lear

n th

e pr

oper

act

ion

to ta

ke

in a

sudd

en fi

re o

r life

em

erge

ncy.

We

have

a n

umbe

r of p

rogr

ams

and

tool

s to

acco

mpl

ish

this

goa

l. O

ur v

isio

n is

a F

ire D

istri

ct

whe

re n

o on

e su

ffer

s fire

inju

ry o

r dea

th d

ue to

lack

of k

now

ledg

e or

pre

para

tion.

Web

site

pro

vide

s a w

ealth

of r

esou

rces

and

link

s to

inju

ry p

reve

ntio

n an

d di

sast

er p

repa

redn

ess r

esou

rces

.

http

://w

ww

.ccc

fpd.

org/

PubE

d/In

tro.h

tml

Ric

hmon

d E

mer

genc

y A

ctio

n C

omm

unity

Tea

ms (

RE

AC

T)

This

pro

gram

pro

vide

s fre

e tra

inin

g fo

r the

com

mun

ity to

“re

act”

an

d ke

ep sa

fe w

hen

emer

genc

ies a

rise.

w

ww

.poi

ntric

hmon

d.co

m/R

EAC

T/

Pino

le F

ire

Dep

artm

ent

Prov

ides

a n

umbe

r of l

ocal

pro

gram

s and

web

reso

urce

s to

prot

ect

child

ren

from

inju

ry.

ww

w.c

i.pin

ole.

ca.u

s/fir

e/pr

ogra

ms.h

tml

C

ontr

a C

osta

Chi

ld C

are

Cou

ncil

Prov

ides

supp

ort a

nd a

ssis

tanc

e fo

r par

ents

to p

rom

ote

heal

thy

child

-saf

e en

viro

nmen

ts. A

lso

prov

ides

info

rmat

ion

and

supp

ort

for c

hild

ren

with

spec

ial n

eeds

. Web

site

has

a la

rge

num

ber o

f re

sour

ces a

nd e

duca

tiona

l mat

eria

ls to

supp

ort i

njur

y pr

even

tion.

ww

w.c

ocok

ids.o

rg/



http://www.members.kaiserpermanente.org/kpweb/clusterQuery.do?cluster=livehealthy

http://www.members.kaiserpermanente.org/kpweb/clusterQuery.do?cluster=livehealthy

http://www.cccfpd.org/PubEd/Intro.html

http://www.pointrichmond.com/REACT/

http://www.ci.pinole.ca.us/fire/programs.html

http://www.cocokids.org/

Appendix H

Contra Costa EMSC Pediatric Emergency Training Programs

Course Comparison Resource

Con

tra

Cos

ta E

MSC

Pe

diat

ric

Em

erge

ncy

Tra

inin

g Pr

ogra

m C

ompa

riso

n

Prog

ram

Ta

rget

A

udie

nce

Leng

th

Cre

ated

by

Pu

rpos

e Sk

ills

Test

ed

Com

plet

ion

Req

uire

men

ts

Inst

ruct

or

Req

uire

men

ts

ENPC

E

mer

genc

y N

urse

P

edia

tric

Cou

rse

Dire

cted

to

Em

erge

ncy

Roo

m N

urse

s.

Initi

al

cour

se

16 h

ours

w

ith 8

ho

ur

rene

wal

co

urse

. H

as

inst

ruct

or

cour

se

com

pone

nt

Em

erge

ncy

Nur

ses

Asso

ciat

ion

in

coop

erat

ion

with

AH

A

and

AA

P.

Inte

rnat

ion

ally

ap

prov

ed

curr

icul

um

from

the

EN

A

Pre

sent

s co

re le

vel

know

ledg

e to

and

ps

ycho

mot

er s

kills

as

soci

ated

with

nur

sing

ca

re fo

r chi

ldre

n in

the

emer

genc

y de

partm

ent.

Inco

rpor

ates

AH

A

stan

dard

s bu

t no

long

er h

as P

ALS

re

new

al o

ptio

n

Con

tent

incl

udes

: The

P

edia

tric

Pat

ient

Initi

al

Ass

essm

ent a

nd T

riage

R

espi

rato

ry D

istre

ss a

nd

Failu

re C

ardi

ovas

cula

r Em

erge

ncie

s M

edic

al

Emer

genc

ies

Chi

ld

Mal

treat

men

t To

xico

logi

c E

mer

genc

ies

Ped

iatri

c Tr

aum

a C

risis

Inte

rven

tion

The

Neo

nate

Sta

biliz

atio

n an

d Tr

ansp

ort

Ped

iatri

c C

onsi

dera

tions

: R

espi

rato

ry

Inte

rven

tions

, V

ascu

lar A

cces

s,

Pain

M

anag

emen

t an

d M

edic

atio

n A

dmin

istra

tion

and

Posi

tioni

ng

and

Imm

obiliz

atio

n Te

chni

ques

P

edia

tric

Mul

tiple

Tr

aum

a Pe

diat

ric

Res

usci

tatio

n

Eval

uatio

n M

etho

ds

Suc

cess

ful c

ompl

etio

n of

the

cour

se in

clud

es

scor

ing

a m

inim

um o

f 80

% o

n th

e 50

item

m

ultip

le c

hoic

e ex

amin

atio

n an

d de

mon

stra

ting

all

criti

cal s

teps

and

70%

of

the

tota

l poi

nts

in

the

eval

uate

d sk

ill st

atio

ns. P

artic

ipan

ts

have

the

abili

ty to

re

peat

the

writ

ten

exam

inat

ion

or a

ps

ycho

mot

or s

kill

stat

ion

if ne

eded

.

ENPC

Ver

ifica

tion

Ver

ifica

tion

will

be

issu

ed fr

om E

NA

with

su

cces

sful

com

plet

ion

of th

e co

urse

. V

erifi

catio

n re

mai

ns

curre

nt fo

r fou

r yea

rs.

EN

PC

app

rove

d co

urse

dire

ctor

, fa

culty

per

E

NP

C

Adm

inis

trativ

e G

uide

lines

. In

stru

ctor

s m

ust

com

plet

e in

stru

ctor

co

urse

and

be

mon

itore

d (m

uch

like

AH

A

prog

ram

facu

lty)

This

com

paris

on w

as c

ompi

led

afte

r rev

iew

of e

ach

cour

ses c

onte

nt a

nd w

eb si

te in

form

atio

n as

of M

arch

200

8

Con

tra

Cos

ta E

MSC

Pe

diat

ric

Em

erge

ncy

Tra

inin

g Pr

ogra

m C

ompa

riso

n

PEPP

P

edia

tric

Edu

catio

n fo

r the

P

reho

spita

l P

rofe

ssio

nal

Dire

cted

at

EM

T In

term

edia

te

and

EM

T-P

pr

ovid

ers.

Any

he

alth

pr

ofes

sion

al

who

is

resp

onsi

ble

for

the

emer

gent

ca

re o

f chi

ldre

n m

ay fi

nd th

is

cour

se

bene

ficia

l N

atio

nal

Sta

ndar

d fo

r pr

ehos

pita

l pe

diat

rics

Initi

al

cour

se 2

da

ys

ALS

or 1

da

y B

LS

clas

s R

enew

al

cour

se 1

da

y

Am

eric

an

Aca

dem

y of

P

edia

trics

&

EM

SC

M

uti-

disc

iplin

ary

orga

niza

tions

Goa

l to

enha

nce

know

ledg

e &

ski

lls o

f pr

ehos

pita

l pro

vide

rs

carin

g fo

r ill

and

inju

red

child

ren.

Inco

rpor

ates

A

HA

sta

ndar

ds a

nd

has

PALS

rene

wal

op

tion

cove

rs

Res

pira

tory

, Spe

cial

ne

eds,

chi

ld fa

mily

in

tera

ctio

n, M

edic

al

emer

genc

ies,

trau

ma,

ch

ild m

altre

atm

ent,

CV

em

erge

ncie

s, D

eliv

ery

and

New

born

st

abiliz

atio

n

BLS

Ski

lls:

Airw

ay

Imm

obiliz

atio

n A

LS S

kills

: A

irway

ad

junc

ts, B

VM

, Tr

ach,

ETT

IO,

Spi

nal

Imm

obiliz

atio

n S

cena

rio

cont

ent

incl

udes

ne

utro

peni

c ch

ild, s

peci

al

need

s, s

ickl

e ce

ll, n

ewbo

rn.

Spe

cific

di

seas

e st

ates

.

Atte

ndan

ce

Writ

ten

exam

S

kills

sta

tions

S

cena

rio te

stin

g

PE

PP

Cou

rse

coor

dina

tor,

Med

ical

adv

isor

an

d P

EP

P

Facu

lty.

Inst

ruct

or to

st

uden

t rat

io 1

:6

Prog

ram

Ta

rget

A

udie

nce

Leng

th

Cre

ated

by

Pu

rpos

e Sk

ills

Test

ed

Com

plet

ion

Req

uire

men

ts

Inst

ruct

or

Req

uire

men

ts

This

com

paris

on w

as c

ompi

led

afte

r rev

iew

of e

ach

cour

ses c

onte

nt a

nd w

eb si

te in

form

atio

n as

of M

arch

200

8

Con

tra

Cos

ta E

MSC

Pe

diat

ric

Em

erge

ncy

Tra

inin

g Pr

ogra

m C

ompa

riso

n

PEA

RS

Ped

iatri

c E

mer

genc

y A

sses

smen

t, R

ecog

nitio

n an

d S

tabi

lizat

ion

Dire

cted

at a

ll pr

ehos

ptia

l pe

diat

ric c

are

prov

ider

s, a

ll he

alth

car

e pr

ovid

ers

who

ar

e no

t tra

ined

in

ped

iatri

cs.

Prer

equi

site

be

pro

ficie

nt in

C

PR

and

read

an

d st

udy

the

PEAR

S pr

ovid

er

man

ual a

nd

stud

ent C

D

Initi

al

cour

se 1

da

y

AH

A a

nd

Am

eric

an

Aca

dem

y of

P

edia

trics

.

Focu

s is

on

the

rapi

d as

sess

men

t and

ear

ly

inte

rven

tion

of th

e pr

e-ar

rest

sta

te to

ef

fect

ivel

y PR

EVEN

T pe

diat

ric a

rres

t. N

ew

natio

nal s

tand

ard

for

pedi

atric

ass

essm

ent

and

reco

gniti

on

trai

ning

. Ta

kes

PALS

Ass

ess,

C

ateg

oriz

e, D

ecid

e &

A

ct M

odel

with

PA

T (P

edia

tric

A

sses

smen

t Tria

ngle

as

com

pone

nt o

f A

sses

s).

Use

s Pr

imar

y A

sses

smen

t, Se

cond

ary

Ass

essm

ent a

nd

Tert

iatr

y A

sses

smen

t ap

proa

ch to

car

e C

ateg

oriz

e ill

ness

by

type

and

sev

erity

(R

ecog

nitio

n) a

nd th

e im

plem

enta

tion

of

appr

opria

te

inte

rven

tions

Ski

lls: P

edia

tric

asse

ssm

ent,

resp

irato

ry

skills

sta

tion,

ci

rcul

ator

y ag

ency

, re

susc

itatio

n te

am c

once

pt,

Asse

ssm

ent

and

reco

gniti

on

key

skill

s ta

ught

Bef

ore

cour

se:

revi

ew te

xt a

nd

PE

AR

S s

tude

nt C

D

activ

ities

. Dur

ing

cour

se a

ctiv

ely

parti

cipa

te p

ract

ice,

&

com

plet

e al

l ski

lls

stat

ions

and

le

arni

ng s

tatio

ns.

Pas

s sk

ills

test

s in

ch

ild 1

resc

uer a

nd

infa

nt 1

& 2

resc

uer

CP

R/A

ED

. Pas

s a

vide

o-ba

sed

writ

ten

test

with

a m

inim

um

scor

e of

84%

PALS

In

stru

ctor

s P

ALS

Reg

iona

l Fa

culty

on

site

A

ppro

pria

te

pedi

atric

sp

ecia

lists

B

LS In

stru

ctor

In

stru

ctor

S

tude

nt R

atio

1:

8

Prog

ram

Ta

rget

A

udie

nce

Leng

th

Cre

ated

by

Pu

rpos

e Sk

ills

Test

ed

Com

plet

ion

Req

uire

men

ts

Inst

ruct

or

Req

uire

men

ts

This

com

paris

on w

as c

ompi

led

afte

r rev

iew

of e

ach

cour

ses c

onte

nt a

nd w

eb si

te in

form

atio

n as

of M

arch

200

8

Con

tra

Cos

ta E

MSC

Pe

diat

ric

Em

erge

ncy

Tra

inin

g Pr

ogra

m C

ompa

riso

n

PALS

P

edia

tric

Adv

ance

d Li

fe S

uppo

rt

Cur

rent

BLS

he

alth

car

e pr

ovid

er.

Dire

cted

for

pedi

atric

hea

lth

care

pro

vide

rs

(ped

iatri

cian

s,

pedi

atric

MD

sp

ecia

lists

, pe

diat

ric

inte

rns

resi

dent

s,

nurs

es) a

nd

emer

genc

y pe

rson

nel w

ho

treat

ped

iatri

c pa

tient

s in

clud

ing

preh

ospi

tal

prov

ider

s.

Con

tent

can

be

prio

ritiz

ed to

m

eet a

pa

rticu

lar t

arge

t au

dien

ce b

y co

urse

dire

ctor

.

Initi

al

cour

se 2

da

ys

Ren

ewal

co

urse

1

day

Lect

ures

de

liver

ed

via

vide

o fo

rmat

to

assu

re

all

cont

ent

deliv

ered

AH

A a

nd

Am

eric

an

Aca

dem

y of

P

edia

trics

Focu

s is

on

ALL

as

pect

s of

ped

iatri

c re

susc

itatio

n. N

atio

nal

stan

dard

for p

edia

tric

re

susc

itatio

n tr

aini

ng.

Cov

ers

Ove

rvie

w o

f PA

LS s

cien

ce.

CP

R/A

ED

, Ped

iatri

c A

sses

smen

t Tria

ngle

, M

anag

emen

t of

Res

pira

tory

E

mer

genc

ies,

Rhy

thm

di

stur

banc

es, C

ardi

ac

Arre

st, S

hock

and

R

espi

rato

ry C

ase

sim

ulat

ions

Ski

lls: H

igh

qual

ity C

PR

, S

yste

mat

ic

App

roac

h to

th

e pa

tient

. R

espi

rato

ry

skills

, Rhy

thm

di

stur

banc

es/E

lec

trica

l Th

erap

y,

Vas

cula

r ac

cess

, re

susc

itatio

n co

re

sim

ulat

ions

Fo

cus

is

com

preh

ensi

ve

reco

gniti

on a

nd

man

agem

ent o

f th

e ch

ild w

ith

mor

e em

phas

is

on re

susc

itatio

n an

d le

ss

emph

asis

on

reco

gniti

on a

nd

asse

ssm

ent

than

in y

ears

pa

st. S

trong

ho

spita

l bas

ed

emph

asis

.

Bef

ore

cour

se:

PALS

sel

f as

sess

men

t CD

. P

artic

ipat

ion

in

cour

se. P

ass

skills

ch

ild/in

fant

CP

R

and

AE

D. W

ritte

n ex

am p

ass

of 8

4%.

Pas

s 2

PA

LS c

ore

case

test

s as

team

le

ader

(ped

i cod

es)

AH

A F

acul

ty

Cou

rse

Dire

ctor

, M

D P

ALS

in

stru

ctor

, Lea

d P

ALS

inst

ruct

or,

Oth

er P

ALS

in

stru

ctor

s,

BLS

inst

ruct

or

optio

nal;

Spe

cial

ty

Facu

lty

Inst

ruct

or

Stu

dent

Rat

io

max

1:8

M

ust b

e af

filia

ted

with

A

HA

trai

ning

ce

nter

.

Prog

ram

Ta

rget

A

udie

nce

Leng

th

Cre

ated

by

Pu

rpos

e Sk

ills

Test

ed

Com

plet

ion

Req

uire

men

ts

Inst

ruct

or

Req

uire

men

ts

This

com

paris

on w

as c

ompi

led

afte

r rev

iew

of e

ach

cour

ses c

onte

nt a

nd w

eb si

te in

form

atio

n as

of M

arch

200

8

Con

tra

Cos

ta E

MSC

Pe

diat

ric

Em

erge

ncy

Tra

inin

g Pr

ogra

m C

ompa

riso

n

APL

S A

dvan

ced

Ped

iatri

c Li

fe S

uppo

rt

Dire

cted

to E

D

Phy

sici

ans

who

se

e pe

diat

ric

patie

nts.

ED

re

side

nts

and

inte

rns

phys

icia

n as

sist

ants

or

nurs

es. A

ny

phys

icia

n w

ho

treat

s pe

diat

ric

patie

nts

Any

phys

icia

n w

ho p

rovi

des

med

ical

se

rvic

es to

sp

ecia

l po

pula

tions

Any

phys

icia

n w

ho is

in

tere

sted

in

beco

min

g an

A

PLS

Cou

rse

Dire

ctor

or

Facu

lty

mem

ber.

2 da

y co

urse

in

itial

but

ha

s a

1 da

y co

urse

op

tion

with

on

line

self

stud

y AP

LS

cour

se

Am

eric

an

Col

lege

of

Em

erge

ncy

Phy

sici

ans

and

Am

eric

an

Aca

dem

y of

P

edia

trics

Con

cent

ratio

n on

the

initi

al m

anag

emen

t of

spec

ific

illne

sses

and

in

jurie

s th

at if

left

untre

ated

cou

ld le

ad to

lif

e-th

reat

enin

g pe

diat

ric c

ondi

tions

re

quiri

ng re

susc

itatio

n.

Con

sist

ent w

ith A

HA

st

anda

rds

and

has

PALS

rene

wal

opt

ion.

Airw

ay

proc

edur

es

skills

C

V p

roce

dure

s sk

ills

Con

tent

robu

st

focu

s in

ped

iatri

c em

erge

ncy

med

icin

e an

d ca

n be

ada

pted

with

di

ffere

nt fo

cuse

s by

co

urse

dire

ctor

1

day

cour

se

Ped

i ass

essm

ent

Ped

i airw

ay in

he

alth

and

dis

ease

G

roup

dis

cuss

ions

C

NS

, Med

ical

em

erge

ncie

s an

d C

V d

isea

se

Ped

i Tra

uma

2 da

y co

urse

in

clud

es

Non

traum

atic

su

rgic

al

emer

genc

ies

spec

ial c

are

need

s

met

abol

ic d

isea

se

toxi

colo

gy, c

hild

m

altre

atm

ent,

othe

r op

tions

per

cou

rse

dire

ctor

1 AP

LS F

acul

ty

to 8

stu

dent

s m

ax. A

t lea

st

one

boar

d-ce

rtifie

d pe

diat

ricia

n an

d on

e bo

ard-

certi

fied

emer

genc

y ph

ysic

ian.

A

pedi

ED

ph

ysic

ian

can

fill

both

role

s.

Sub

boar

ded

MD

s in

ped

i em

erge

ncy

med

icin

e an

d/or

du

ally

cer

tifie

d in

ped

iatri

cs a

nd

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genc

y m

edic

ine.

If

optio

nal

Adv

ance

d Tr

aum

a S

kill

Sta

tion

done

th

en F

acul

ty

mus

t hav

e ex

perie

nce

perfo

rmin

g th

e pr

oced

ures

, and

at

leas

t one

pe

diat

ric

surg

eon

shou

ld

be in

clud

ed a

s Fa

culty

. Pr

ogra

m

Targ

et

Aud

ienc

e Le

ngth

C

reat

ed b

y

Purp

ose

Skill

s Te

sted

C

ompl

etio

n R

equi

rem

ents

In

stru

ctor

R

equi

rem

ents

This

com

paris

on w

as c

ompi

led

afte

r rev

iew

of e

ach

cour

ses c

onte

nt a

nd w

eb si

te in

form

atio

n as

of M

arch

200

8

emergency medical services for children plan program evaluation

Documents