Justine Ropp RRT
PPC Capstone
January 25, 2011

Why this topic?
• Identify family knowledge of EMS

Identify EMS knowledge for transporting children with special health care needs

Identify outside facilities knowledge of activating
CHETA

Goal 4: Provide regional and national continuing education…based on identified needs

Process

Develop Questionnaire/Needs assessment

EMS

Families

Contact surrounding EMS to distribute questionnaires

Contact Families

Parent member of PPC Family involvement

Face to Face interview

EMT Levels
• EMT-Basic
• EMT -Paramedic

EMT- Basic (EMT-B)
• Represents the first level of the EMS System
• Receive 120-150 hours of training
• Basic Life Support (BLS) skills
• Assess a patients condition and manage respiratory, cardiac, and trauma situations
• Usually restricted to using oxygen, glucose, inhalers, small volume nebulizers, and auto injectors

EMT-Paramedic
• Receive 1,200-1,800 hours of training
• Advanced Life Support (ALS) skills
• All skills in EMT-Basic
• Provide the most extensive pre-hospital care
• administer drugs orally or intravenously
• interpret EKG
• perform endotracheal intubations
• use complex equipment

EMT/Paramedic Questionnaire
• Madison Fire Department
• Rockford Fire Department
• Waunakee
• Deer Grove
Did not hear back from:
• Green Bay
• Racine
• Middleton
• Merrimac

EMT/Paramedic Response
• 88% of responses were EMT-Paramedics
• 18% of responses were EMT-Basics

EMT/Paramedic Age Comfort
20
15
10
5
0
50
45
40
35
30
25 infant-15yr 15-18 yrs All None
EMT/Paramedic

50
45
40
35
30
25
20
15
10
5
0
PALS
Pediatric Experience
Limited Zero
EMT/Paramedic

EMS Response-Family
• Family/child visit station or obtain information prior to initiating call
• Knowledgeable care provider able to ride in ambulance to assist with care/questions
• Written instructions and medical information

EMS Response-PPC
• Education
• Seminars
• In-services
• Case Studies
• Lectures from experts
• Organize a peds bag
• BiPAP training
• Information on specialized equipment

EMS Response-Limitations
• Lack of equipment options
– BiPAP unavailable on ambulance
– Cough machine
• Lack or Pure Sine Wave Inverter to power
Cough machine and BiPAP

Local families of SMA website
0 response
Interviewed families in clinic and inpatient setting
12 responses

Family Questionnaire-Response
33% use EMS to transport to local hospital
100% used own equipment
66% feel they can transport faster and safer
33% notified EMS of their child’s needs and residence
25% notified EMS of their child’s equipment
EMS unable to support technology on rig

Family Questionnaire-Response
• 50% of families are willing to provide in-services
• 100% of families would like to be transferred to
AFCH
• 66% of families have heard of CHETA
• 33% Feel they would be comfortable advising the outside facility how to activate CHETA
• 16.7% of family believe their outside facility has knowledge of CHETA

Family Response-EMS
Things families feel EMS should be knowledgeable on
• Cough machine
• Suction
• BiPAP
• Bag mask ventilation
• Willingness to take advice from families

Families perception of EMS weakness
• No Knowledge of child's disease process
• EMT’s afraid to touch and handle children
• The ones that did, didn’t realize the lack of muscle strength

Moving Forward-PPC
PPC Provide education for local EMS
• In-services and other forms of education opportunities for local EMS providers
• Collaborate with other resources such as
CHETA and MATC to provide simulation with scenarios and equipment
• Provide Case Studies
Encourage EMS on Equipment recommendations
• Pure Sine Wave inverter

Moving Forward-PPC
Update discharge process to include contacting patients local EMS providers with pertinent information standardize form
Meet with access center to understand each others needs in the process of transporting to AFCH patients diagnosis safest way to transport initiate CHETA at point of transporting to local hospital

Moving Forward-Families
Encourage families to:
Educate local community providers
Local care providers
Schools
Make contacts with their local EMS
Identify child’s needs
Review equipment

Outside Facilities
• CHETA- outreach for medical training and technical assistance
• Target regions with high census of children with special health care needs
• Create a quick reference for families to give to outside facilities for initiating a transport.
• Initiating CHETA at point of transport to local hospital

CHETA: Children’s Hospital Emergency Transport
Ambulance
• A critical care team with life support skills to bridge care between health care facilities
• A vehicle equipped with state of the art technology and equipment designed specifically for pediatric patients
• Transport services available 24/7
• 24/7Consultation with:
• Pediatric critical care physician
• Pediatric pulmonologist
How to activate CHETA:
To arrange transport or to speak to a pediatric critical care physician, call the Access Center at
1-800-472-0111 .
Bringing pediatric critical care to the bedside of children in a community or a referring hospital

Why Wait
How can we relay importance of a specialized Pediatric
Critical Care team (CHETA) to outside facilities
• Pediatric Nurse
• Pediatric Respiratory Therapist
• CHETA RTs know neuromuscular protocol and how to care for these children

Moving Forward-CHETA
PPC Collaborate with CHETA to identify areas of improvement
CHETA makes connections with patients and families when they are in clinic or inpatient
CHETA reviews process for implementing with family
CHETA provides follow up with local hospital/EMT after transport

Questions