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TM Pre-hospital care providers: The following pages outline a plan to identify and become prepared to more efficiently care for special needs children in your district in an emergency. These children include, but are not limited to, those with chronic physical, developmental, behavioral or emotional conditions who are at a higher risk of requiring health-related services to a degree not typical of normally developing children. The plan is designed to include infants through 21 years of age, however, if your individual department wishes to extend the age limit to those who may be at risk without an action plan, you may do so as you see fit. Emergency care of children with special health care needs is frequently complicated by the lack of a concise summary of their medical condition, precautions needed and special management plan. Emergency hospital and pre-hospital care is believed to be negatively affected by a frequent lack of accurate timely information about the children s special needs and particular histories. *pedicatrics.aappublications.org, vol. 104 No. 4. This quote by the American Academy of Pediatrics relates directly to us as pre-hospital providers. You may already be aware of some children in your district that could benefit from this program. All of our participating departments have done a phenomenal job implementing and have been using it to its full potential. Thank you, Patricia Casey, Paramedic Coordinator/EMS Liaison for Missouri Physician Services Phone 314-422-6383 Fax 314-268-2766 patricia_casey@ssmhc.com Joshua Dugal RN, Paramedic Coordinator/EMS Liaison for Illinois Physician Services Phone 573-631-7218 Fax 314-268-2766 joshua_dugal@ssmhc.com
TM OVERVIEW Emergency Preparedness for Children with Special Needs The following are reasons that we should track and have an action plan for special needs pediatric patients in our community: >> Many EMS protocols specifically state that children with special healthcare needs should be tracked, and that EMS departments should become familiar with both the child and his or her anticipated needs. (see enclosure) >> Introducing ourselves to the caregivers of these children and explaining our capabilities as well as our limitations can help alleviate anxiety if there is a clear understanding and plan in place. For example, if a family is aware that in extreme cases, you may have to transport to your closest facility, and that their child will be transferred by specialty transport when stabilized, the tension of explaining that and arguing during an already tense event can be eliminated. >> The pediatric emergency form that was developed by FACEP and the AAP for emergency care givers to review includes the child s baseline vital signs and assessment findings. Many chronically ill children have a baseline that while perfectly normal for them, would be a critical finding in a healthy child. The form also includes interventions to be avoided. These two pieces of information alone are vital to properly assess and treat these children. If a caregiver is not on scene to relay this information, the form will become an invaluable tool. has taken information from this form that is of immediate value to EMS providers and developed our own, simplified version. >> Public Relations idea: After your tracking system is in place, many departments choose to publish articles in their local papers or posting on social media pages explaining how the program works. Not only will this shed a positive light on your department, but it can help bring families forward who may benefit from having an action plan in place.
TM IMPLEMENTING 1. Identify pediatric patients in need: >> You may already be aware of and have contact information for candidates. Contact the guardians of these patients and explain the reason for and invite them to enroll their child. >> Other patients can be identified through special school districts, day care centers, pediatricians offices, community support groups and upon referral from SSM Health Cardinal Glennon Children s Hospital and Ranken Jordan Pediatric Bridge Hospital. >> Many patients will be discovered as you run calls on them and recognize the need. Crews can then forward the patient s guardian contact information for your department coordinator. 2. Contact parents or guardians to set up a home visit: >> Schedule a home visit if possible to fill out the form, HIPAA form and to educate the families about the program. At this time, families can ask questions and you can explain you re your capabilities and limitations are. Details such as the fact that the system will only work within the response zone of your district until a data base is in place should be explained. You can also allow families to tour the ambulance at this time. >> The patient will be assigned a STAR number. The guardian s will be informed of what their number is and the importance of knowing their number for dispatch in the case of an emergency. Two or more brightly colored key chains with their STAR number will be given to them as a reminder. It will be suggested that one key chain be kept with the guardian and one sent with the child on a diaper bag or school bag whenever the child is not in the care of the guardian. Other items to serve as identifiers such as bracelets, luggage tags, seat belt covers and small tote bags may also be used. 3. Forward the information to your 911 dispatch center: >> The information will be forwarded to your dispatch center where the number and the child s address will both be flagged. The importance of the child having a number as well as the address being flagged is so that they can be tracked when not in the home. When dispatch is notified by the caller that they have a child, dispatch will then relay the number to the responding ambulance crew who can reference the sheet to prepare.
IMPLEMENTING 4. Schedule training as needed: >> In the instance that a child with an atypical syndrome, disease or medical equipment is identified, training needs to be held to familiarize crews with that child s needs. 5. File the forms in numerical number in each ambulance: >> The forms will be in a folder in each ambulance for reference. The forms will be printed front and back, kept in plastic sheets in a three ring binder as our current maps are. The folder will be brightly colored for quick recognition. 6. Follow Up: >> Schedule follow up calls every six months to update the forms as needed. 7. Schedule a yearly in house event for families: >> Invite the families out to your district house for an annual tour and get-together. Invite representatives from your local hospitals and SSM Health Cardinal Glennon to also attend. At this time, families can ask questions and the medics can get acquainted.
The following is an excerpt from page 26 of the St. Anthony s Medical Center 2014 EMS Guidelines (page 26) and the recommendation from the SSM Health Pre-hospital Guidelines. St. Anthony s Medical Center serves as the medical direction for Rock Township Ambulance District in Arnold, MO. Rock Township was the first district to pilot in July of 2014 and continues to run a successful program. Considerations for Children with Special Healthcare Needs 1. Track children with special healthcare needs in your service community, and become familiar with both the child and his/her anticipated emergency care needs. 2. Refer to the child s emergency care plan formulated by his/her medical providers, if available. Understanding the child s baseline will assist in determining the significance of altered physical findings. Parents/caregivers are the best source of information on medications, baseline vitals, functional level/normal mentation, likely medical complications, equipment operation and troubleshooting, emergency procedures. 3. Regardless of underlying condition, assess in a systematic and thorough manner. Use parents/ caregivers/home health nurses as medical resources. 4. Be prepared for differences in airway anatomy, physical development, cognitive development and possibly existing surgical alterations or mechanical adjuncts. Common home therapies include respiratory support (oxygen, apnea monitors, pulse oximeters, tracheostomies, mechanical ventilators), nutrition therapy (nasogastric or gastrostomy feeding tubes), intravenous therapy (central venous catheters), urinary catheterization or dialysis (continuous ambulatory peritoneal dialysis), biotelemetry, ostomy care, orthotic devices, communication or mobility devices, or hospice care. SSM Health Recommendation: Medical technology, changes in the healthcare industry, and increased home health have created a special population of patients that interface with the EMS system. It is important for EMS to understand and provide quality care to patients with special health care needs.