P3A217: A Comparison of Various EMS Pediatric Disaster Issues Among FEMA Region V States

Purpose/Objectives: The 2006 Institute of Medicine publication entitled “Emergency Medical Services for Children: Growing Pains” found that the emergency and trauma care systems were unequally and inadequately prepared to care for children. It made recommendations for the improvement of pediatric care and for the readiness of emergency care systems for children in a disaster. While first-line care will be provided by prehospital providers, previous research has shown that emergency medical services (EMS) agencies may not be well prepared to treat pediatric disaster victims. Few position statements regarding mass casualty incidents (MCIs) address pediatric victims. Several organizations have developed resources for EMS agencies to incorporate children into disaster preparedness plans. This project intends to add to the resources available by comparing and contrasting various disaster-related domains in EMS among states within Federal Emergency Management Agency (FEMA) Region V.

Design/Methods: The U.S. Administration for Strategic Preparedness and Response (ASPR) awarded a grant to create the Eastern Great Lakes Pediatric Consortium for Disaster Response (EGLPCDR) that evolved into the Region V for Kids Pediatric Center of Excellence. An EMS workgroup was one of several created and was comprised of EMS professionals from all six states within Region V. Members analyzed similarities and differences among the states in several disaster-related EMS domains: disaster triage; pediatric transport assets location; pediatric training requirements; state pediatric equipment requirements; state pediatric protocol requirements; and legal issues.

Results: Most states, but not all, utilize an evidence-based disaster triage tool, such as Sort, Assess, Lifesaving Interventions, Treatment/Transport (SALT) or JumpSTART. All but two states utilize EM Resource (i.e., Juvare) for tracking transport assets and bed boards; one state implemented this program post-analysis. There is large variation across all six states for initial certification and ongoing education. Several states have no pediatric-specific education requirement and others vary from 6 to 18 hours of pediatric education. All states have pediatric protocols with some being state approved, but most are approved by the local EMS medical director. There are no standardized pediatric equipment requirements across all states. There is no legal reciprocity for EMS providers across the region.

Conclusion/Discussion: Based on the variations in the prehospital pediatric care that were identified in this regional analysis, significant differences are also likely to exist across the country. These differences present challenges in interstate mutual aid for major pediatric disasters/surges. Recommendations include creating a national common operating guide. This would improve alignment of prehospital pediatric disaster care if common coordination among prehospital procedures, protocols, and assets existed among neighboring states. Furthermore, legal regulations should be implemented that facilitate the interoperability of prehospital providers and agencies in case there is a need for mutual aid from neighboring states to respond to a significant pediatric MCI.