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Prehospital Education

The goal of prehospital pediatric education is to aid the emergency medical services (EMS) provider in developing the knowledge and skills necessary to efficiently and effectively manage critically ill or injured infants and children.

However, prehospital professionals – regardless of provider level – often state that pediatric emergency calls are very intimidating. Many providers have said that his or her anxiety stems from lack of experience in responding to pediatric calls (very few EMS calls are for children) and heightened emotional response when treating a child. The absence of a unified, accessible, comprehensive pediatric curriculum directed specifically toward out-of-hospital providers contributes to provider anxiety.

Recently, the EMS community has initiated efforts to define pediatric and emergency care competencies and establish a national EMS education system. The EMS education system is inclusive of pediatric emergency care to ensure that practitioners receive the appropriate, uniform level of initial and continuing education necessary to achieve as well as maintain those competencies. This toolbox highlights these and other educational efforts.

HEALTHCARE PROVIDER RESOURCES

American Academy of Pediatrics

• PEPP: Pediatric Education for Prehospital Professionals. This curriculum instructs prehospital providers such as first responders, emergency medical technicians (EMTs), and paramedics in how to better assess and manage ill or injured infants and children.  The one- and two-day courses are designed to meet the minimum standards related to the pediatric portion of the U.S. Department of Transportation’s National Standard Curriculum.  While the PEPP website includes links to full course materials available for purchase, interested parties have the opportunity to view sample course material through free online previews of initial and renewal PEPP courses. (March 2006)

American Heart Association

• Basic Life Support (BLS) for Healthcare Providers. The American Heart Association offers two courses on Basic Life Support for Healthcare Providers. These courses teach the skills for victims of all ages, including: ventilation with a barrier device, a bag-mask device, and oxygen; use of automated external defibrillators on adults and children; and relief of foreign body airway obstruction in responsive and nonresponsive victims. The course is designed for healthcare providers who provide care in and out of the hospital setting. (2010)

• Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Pediatric Basic Life Support. These guidelines provide recommendations for how lay rescuers and emergency healthcare providers should resuscitate victims of cardiovascular emergencies. Topics include prevention of cardiopulmonary arrest, BLS sequence for infants and children, CPR techniques, foreign-body airway obstruction, and special resuscitation situations. (2005)

Center for Pediatric Emergency Medicine

• Child Abuse and Neglect: A Prehospital Continuing Education and Teaching Resource. Based on a national survey of what EMS providers need to know about child abuse and neglect, this resource is designed to assist instructors of prehospital personnel in providing students with the information they need to sensitively and confidently attend to the needs of this vulnerable population. This resource focuses on such topics as risk factors associated between the child, parents, and society; role of pre-hospital medical providers; high risk families and situations; importance of documentation; and medicolegal issues. (2003)

• Teaching Resource for Instructors in Prehospital Pediatrics (TRIPP), Second Edition. This course supports instructors of prehospital personnel to provide comprehensive training in the assessment and treatment of critically ill and injured children. Second Edition TRIPP incorporates the most recent guidelines of the American Heart Association, and includes several new chapters addressing such topics as cultural competence and family-centered care, as well as expanded information on disaster management.  (2008)

• Teaching Resource for Instructors in Prehospital Pediatrics for Paramedics. A sequel to the Teaching Resource for Instructors in Prehospital Pediatrics (TRIPP), the paramedic version expands the scope of prehospital practice from basic to advanced life support procedures for children. Neither a course nor a curriculum, the Paramedic TRIPP is an encyclopedic resource that empowers instructors of ambulance personnel to provide comprehensive training in the assessment and treatment of critically ill and injured children. (2008)

• Pediatric Disaster Preparedness: A Resource for Planning, Management and Provision of Out-of-Hospital Emergency Care. This resource focuses on pediatric prehospital emergency care in EMS system planning for disasters and terrorism. It is designed for use by EMS agency and system medical directors and administrators, emergency managers, and other stakeholders who will be concerned with the functions and activities of EMS care providers during a disaster, terror event, or other public health emergency.  This resource can also be used by other pediatric health care providers, public health professionals, health administrators, and policy makers who are committed to ensuring that planning for terrorism and disasters includes the special needs of children. (2008)

Children’s National Medical Center

• SCOPE: Special Children’s Outreach and Prehospital Education. As children with special healthcare needs often present with uncommon medical conditions that are unfamiliar to emergency responders, the purpose of this program is to improve the prehospital care responder’s knowledge and comfort level with chronically ill and technology-dependent children. SCOPE provides basic information on chronic medical conditions that these children may have, as well as the technologies and equipment that may be necessary for their survival. Available for download is the SCOPE Instructor and Student handbooks originally created for the EMSC Program. (2006)

• Prehospital Protocols for Children with Special Health Care Needs. The Center for Prehospital Pediatrics at Children’s National Medical Center was tasked with revising the prehospital pediatric guidelines for the District of Columbia. However during the revision process, it became evident that although there are several training programs that highlight children with special health care needs (CSHCN), there are very few EMS jurisdictions that support training with specific protocols to treat CSHCN. Therefore, these prehospital protocol guidelines were developed by a review of the existing literature, focusing on evidence-based treatment modalities and through in-house expertise regarding prehospital treatment of CSHCN. (2002)

Illinois Emergency Medical Services for Children

• Pediatric Mild Traumatic Head Injury. This module targets all health care providers who care for children. The course addresses: principles and standards underlying safe and effective pediatric moderate sedation, reviews commonly used sedating/analgesic agents, reviews potential pediatric complications, and highlights adjuncts to sedation.(November 2009)

• Pediatric Moderate Sedation. This module highlights the principles and standards underlying safe and effective pediatric moderate sedation. The module targets all health care providers who care for children. The course contains 10 narrated chapters along with appendices that contain additional resources. Key areas of focus include recommendations for appropriate triage/management of mild traumatic head injuries, guidelines for neuroimaging, child maltreatment screening, patient education, and head injury prevention strategies. (2009)

National Association of Emergency Medical Technicians

• Emergency Pediatric Care. The program instructs prehospital providers in the approach of sick and injured children; affords a practical understanding of respiratory, cardiovascular, medical, and traumatic emergencies; and educates about the treatment of children with special health care requirements (such as tracheal ventilation, central venous line management, and gastric feeding tube maintenance).  The program is available in one or two-day educational formats for basic and advanced life support providers.  Its goal is to expand EMS knowledge of emergent pediatric health care through hands-on instruction using case-based scenarios, thus improving patient outcomes. Click here for the demo. (2008)

• Prehospital Trauma Life Support. This course promotes excellence in trauma patient management through global education of all providers involved in the delivery of prehospital care. It improves the quality of trauma care in your area and decrease mortality. The program is based on a prehospital trauma care philosophy, stressing the treatment of the multi-system trauma patient as a unique entity with specific needs. PHTLS is developed by the National Association of Emergency Medical Technicians in cooperation with the American College of Surgeons Committee on Trauma. (2008)

National Disaster Life Support Foundation

The Foundation promotes the importance of specialized training for all healthcare providers. The group works to encourage educational institutions and professional societies to provide curricular materials for broad-based and well-supervised training.

• Basic Disaster Life Support. BDLS® is targeted to multiple disciplines including EMS personnel, hazardous materials personnel, public health personnel, and health care providers. The goal of teaching multiple disciplines simultaneously is to develop a commonality of approach and language in the health care community, improving the care and coordination of response in weapon of mass destruction disasters and public health emergencies.  (2007)

• Advanced Disaster Life Support and Instructor Course. The ADLS course is an advanced practicum of the principles introduced in Basic Disaster Life Support. The ADLS course includes lectures on Mass Triage, community and hospital disaster planning; media and communications during disasters; mass fatality management. Also included are small group interactive sessions allowing students to work through a series of difficult questions of disaster management. The ADLS instructor course is provided for students of the ADLS course whom desire to become instructors. (2007)

• Core Disaster Life Support. This four-hour awareness level course is focused at the medical first responder, but is also useful for non-medical providers. The program is constructed around the DISASTER Paradigm™ and is designed to teach core concepts of disaster management. In addition, students are taught concepts that will allow them be more effective in the recognition and response to medical disasters. MASS Triage™ is taught to allow these providers to more effectively assist in the mitigation of the disaster and to assist in the process of triage. (2007)

• National Disaster Life Support - DECON. This program is designed to meet the need of having training and equipped personnel to decontaminate a large number of victims from a chemical or radiological event. After completing CDLS™ as the awareness level program, students complete an additional eight hours of instruction over two days. (2007)

• Electronic Basic Disaster Life Support. This course is the online version of the Basic Disaster Life Support and has been made for distance learning. The eBDLS™ course consists of nine lessons covering the standardized BDLS® curriculum. The presentation is interactive and employs text, slides, recorded lectures, and end-of-lesson examinations. (2007)

• Electronic Core Disaster Life Support.  The eCDLS™ course is the on-line version of Core Disaster Life Support® and has been made for distance learning.  The added advantage of the on-line approach is that the student may take the course in multiple sessions over a period of several days or weeks; it is self paced. (2007)

New York State Department of Public Health

• Prehospital Pediatric Care Curriculum. The New York State EMSC Prehospital Pediatric Care Course (PPCC), a continuing education course for EMTs, is designed to reinforce or enhance the knowledge and skills of all prehospital providers in assessing and treating children in the field. Developed under contract with the Fire Department of New York, EMS Training Division, PPCC provides EMS instructors and EMS agency training officers with a comprehensive curriculum that can be taught as a full-day course or in modular form by chapter depending on specific topic needs.  PPCC contains eight chapters. Each chapter includes instructor slides and notes in PowerPoint format and student guides in .pdf format. Most chapters include student handouts. In addition, the course includes case scenarios and a skills equipment list. (February 2009)

Tennessee Emergency Medical Services for Children

• Pediatric Disaster Online Courses. Tennessee developed six courses targeting healthcare professions – Children with Special Needs: Considerations for Healthcare Professionals; Disaster Preparedness for Schools; Preparing for Explosion and Blast injuries; Responding to Bioterrorism; Responding to Chemical Incidents; and Responding to Radiation Disasters – and two courses targeting the general public – Family Preparedness and Family Preparedness Supplement: Children with Special Needs. (August 2007)

University of New Mexico, Department of Pediatric Emergency Medicine

• EMSC Online Training Program. The University of New Mexico, Department of Pediatric Emergency Medicine has designed eight module courses as part of an online training: Pediatric Seizures (September 2004), Diabetes in Children (February 2005), Blunt Chest Trauma: Commotio Cordis (August 2005), Methamphetamine in Children (October 2005), CSHCN: Down Syndrome (January 2006), CSHCN: Technology Dependent Children (April 2006), Shaken Baby Syndrome (December 2006), and Poisoning: Toxic Exposure (2007)

• A Multi-Systems Approach to Pediatric Trauma Course. This six-module course targets all healthcare providers, and address trauma to different body systems in children: the head, neck, spine, abdomen, and chest. (Accessed February 2010)

• Pediatric Emergencies Course. This exciting virtual online course for all healthcare providers presents pediatric medical emergency scenarios and their emergency medical management. (Accessed February 2010)

• EMSC Partnership Course. This course primarily targets prehospital EMS personnel and includes eight modules: pediatric seizures, diabetes, blunt chest trauma, methamphetamine, child abuse/Down Syndrome, technological dependent, Shaken Baby Syndrome, and poisoning/toxic exposure. (Accessed February 2010)

IN THE SPOTLIGHT: AN INTERVIEW WITH DR. LOU ROMIG

Lou Romig, MD, FAAP, FACEP, is a board-certified subspecialist in Pediatric Emergency Medicine, working at the Miami (FL) Children’s Hospital since 1989, where she is also the hospital’s EMS Liaison. As a self-proclaimed “EMS groupie” of the Johnny and Roy “Emergency” era, Dr. Romig has worked with EMS agencies, first responders, EMTs, and paramedics for 20 years to help assure that these frontline emergency responders not only know how to take excellent care of kids and their families, but how to feel comfortable and confident while doing so. “Dr. Lou”, as she’s widely known, has served as the Pediatric Medical Advisor to the Miami Dade Fire Rescue Department for 13 years and worked within Florida’s EMS advisory and regulatory structure for 17 years. She is currently the Physician Consultant to the Florida EMS for Children (EMSC) program and the Florida Department of Health’s EMSC Advisory Committee. She is also the Medical Director for the National Association of Emergency Medical Technicians’ (NAEMT) Pediatric Prehospital Care course and serves as that organization’s pediatric advisor. Dr. Romig has served on numerous working groups and committees at the national level, working with and/or representing such organizations as the American College of Emergency Physicians, the American Academy of Pediatrics, and NAEMT.

In 2000, and again in 2001, the Florida EMS Bureau recognized Dr. Romig’s work with the state’s EMS for Children Award. In 2004, Dr. Romig received the Federal EMSC Program’s National Heroes Award for EMS Provider Leadership.
As a result of her involvement with EMS and having lived through such disasters as Hurricane Andrew, Dr. Romig developed a special interest in pediatric disaster medicine. She is now considered a national expert in pediatric disaster planning and response, with experience gained not only through serving her own community after hurricanes, but also as a member of the National Disaster Medical System.

Dr. Romig’s greatest claim to fame is as the inventor of the JumpSTART Pediatric MCI Triage Tool. Developed in 1995 and continuously refined, JumpSTART (JS) was developed to meet the need for a disaster-style primary triage tool suited to the wide range of normal physiology in children of different ages. Until its development no objective pediatric MCI triage tool existed for EMS or hospital use. JumpSTART is now approaching "gold standard" status for EMS use throughout North America and is gaining in popularity around the world. Emergency departments are also acknowledging the need for MCI (multi-casualty incident) triage capabilities and training their staff members in the use of JS. All of Dr. Romig’s JumpSTART materials are available as free downloadable files from her website.
Dr. Romig started Team Life Support Inc. as a vehicle to distribute information about JumpSTART and to share her experience and ideas about caring for children and families in their times of greatest vulnerability. The name of the company is meant to evoke the image of emergency responders and other medical care providers working together seamlessly as a team, regardless of differences in practice setting, training level, or experience. The company’s motto, “Promoting better outcomes for children, families, and responders,” is a reflection of Dr. Romig’s dedication to serving not only our potential patients, but also our greater EMS family.

FAMILY AND CAREGIVER RESOURCES

Children's Hospital of Philadelphia

• AftertheInjury.org.  This website has been designed to help parents learn what to expect and what they can do to help their child recover from an injury. This online parent resource provides healthcare professionals an alternative way to communicate to parents who, at the time of injury, may not be able to absorb all that there is to know. (2009)

American Heart Association

• Family & Friends CPR Anytime Personal Learning Program. This resource allows families, friends, and the general public – those who most likely would never attend a traditional cardiopulmonary resuscitation (CPR) course – to learn the core skills of CPR in just 22 minutes using their own personal kit. The kit contains everything needed to learn basic CPR, and skills can be learned anywhere, from the comfort of a family home to a large community group setting. This kit does not provide certification in CPR.  (2005) A companion Infant CPR Anytime is also available. (2007)

American Red Cross

• Babysitter Training Course. The Babysitter Training Course is designed to help 11- to 15-year-olds care for children and infants; interview for a babysitting job; choose safe and age-appropriate toys and games; handle emergencies such as injuries, illnesses, and household accidents; perform first aid; learn diapering and feeding techniques; and handle bedtime issues. (2010)

EMSC National Resource Center

• Emergency Care Plans for Children with Special Needs. This fact sheet helps family and caregivers on developing a proper emergency care plan. It provides useful information that should be included in the plan to help prehospital providers provide proper care in the case of an emergency with a sick or injured child. (1998)

• How to Get Help for A Sick or Injured Child (English) (Spanish). This resource helps families and caregivers learn the importance of knowing how to handle an emergency situation dealing with a sick or injured child. In this fact sheet, you will find information on types of emergencies, what are not emergencies, whether to dial local emergency number or 911, and other useful information. This document is also available in Spanish. (2006)

• What to Do Until Help Arrives for A Child Medical Emergency (English) (Spanish). This fact sheet provides you with basic steps that could help save a child’s life. It includes information on what you should do and what you should not do in several types of emergencies, such as choking, eating or drinking a poison, severe bleeding, breathing problems, burns, seizures, loss of consciousness, falls, and crashes. (2006).

Florida Emergency Medical Services for Children

• How to Prevent and Handle Childhood Emergencies: A Handbook for Parents and People Who Care for Children. This handbook has been prepared to assist the family or caregiver in helping a child if an emergency occurs. It provides useful information about children of all ages, from newborns to teens. Through this handbook you will learn how to get help for a sick or injured child, what to do until help arrives, how to prevent childhood emergencies, and other additional information and safety tips. (1997)

Tennessee Emergency Medical Services for Children

• Family Preparedness Online Course. This course has been designed to help families in understanding why a family preparedness plan is vital by walking through the items needed for your family disaster supply kit. The course will assist in recognizing the significance of a pre-plan evacuation route and will even identify disaster preparedness concerns for your family pets. (August 2007)

• Family Preparedness Supplement for Children with Special Needs. This course will assist you in understanding what necessities are beyond your family’s disaster preparedness plan. It will aid you in pre-planning for both evacuation and staying at home during a disaster event. (August 2007)

NRC is funded by the Health Resources and Services Administration, Maternal and Child Health Bureau, Cooperative agreement number U07MC09174.

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