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 their anxiety stems from their lack of experience in responding to pediatric calls (very few EMS calls are for children) and their 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, however, the EMS community has initiated efforts to define pediatric and emergency care competencies and establish a national EMS education system, inclusive of pediatric emergency care, to ensure that practitioners receive the appropriate, uniform level of initial and continuing education necessary to achieve and maintain those competencies. This toolbox highlights these and other educational efforts.

HEALTHCARE PROVIDER RESOURCES

Center for Pediatric Emergency Medicine

• 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. (Accessed September 2008).

• Teaching Resource for Instructors in Prehospital Pediatrics (TRIPP). The Second Edition of the Teaching Resource for Instructors in Prehospital Pediatrics (TRIPP) 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 topic chapters, including cultural competence and family-centered care, as well as an expanded version of disaster management. (Accessed September 2008).

• 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. (2003).

Children's National Medical Center.

• S.C.O.P.E.: Special Children’s Outreach and Prehospital Education Instructor Manual. 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. (2006). Also available is a Student Manual and a modified version of SCOPE published by Jones and Bartlett.

American Academy of Pediatrics

• PEPP: Pediatric Education for Prehospital Professionals, 2nd Edition (DVD). This American Academy of Pediatrics course is a visual pediatric course for both basic and advanced life support providers with case-based lectures, live action videos, hands-on skill stations and small group scenarios. PEPP is specifically designed for First Responders, emergency medical technicians (EMTs), and Paramedics. The one-day basic course is geared toward the EMT Basic and the two-day advanced course is geared toward EMT-Intermediate and Paramedic providers. (Accessed September 2008).

American Heart Association

• Basic Life Support (BLS) for Healthcare Providers. The Basic Life Support (BLS) for Healthcare Providers teaches the skills for victims of all ages including ventilation with a barrier device, a bag-mask device, and oxygen, use of automated external defibrillators (AED) 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. (2005).

• 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 CPR, the use of automated external defibrillators (AEDs) and recommendations for advanced cardiovascular life support (ACLS) and pediatric advanced life support (PALS). (2005).

National Association of Emergency Medical Technicians

• Emergency Pediatric Care. The Emergency Pediatric Care (EPC) 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. (Accessed September 2008).

National Disaster Life Support Foundation

• Basic Disaster Life Supportre. BDLS® is targeted to multiple disciplines including emergency medical service (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 (WMD) disasters and public health emergencies. (Accessed September 2008).

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, the 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. (Accessed September 2008).

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 web site.  In 2008, Dr Romig released Kids In Disasters (DVD). This new resource contains updated information related to the JumpSTART Triage tool. The Kids In Disasters DVD is available for order through the EMSC National Resource Center.

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.

Selected Relevant Publications
“Triage” and “Prehospital Care” sections in the Executive Summary of the Pediatric Preparedness for Disasters and Terrorism, A National Consensus Conference, Mailman School of Public Health, Columbia University, 2004

“Disaster Management” chapter in Advanced Pediatric Life Support Course, 4th edition, American College of Emergency Physicians and American Academy of Pediatrics, 2004

“Pediatric Triage: A system to JumpSTART your triage of young patients at MCIs”, JEMS27(7):52-63, May 2002.

“Pediatric Issues in Disasters and Multi-casualty Incidents” in Teaching Resource for Instructors of Prehospital Pediatrics: Paramedic, G. Foltin, et.al. eds. Center for Pediatric Emergency Medicine, 2001.

“PREP for Peds”, JEMS (Journal of Emergency Medical Services) 26(5): 24-33, May 2001.

Other EMSC Leaders in EMS
Dr. Romig lists the following healthcare providers and researchers as key leaders in pediatric prehospital emergency care.

Jim Broselow, MD
Department of Emergency Medicine
Catawba County Medical Center
Hickory, NC

Arthur Cooper, MD, MS, FACS, FAAP, FCCM
Harlem Hospital Center
Columbia University College of Physicians & Surgeons
New York, NY

Ron Dieckmann, MD
Pediatric Emergency Medicine
San Francisco General Hospital
San Francisco, CA

George Foltin, MD, FAAP, FACEP
Center for Pediatric Emergency Medicine
New York University School of Medicine/Bellevue Hospital Center
New York, NY

Susan Fuchs, MD
Pediatric Emergency Medicine
Northwestern University’s Feinberg School of Medicine
Chicago, IL

Marianne Gausche-Hill, MD
Department of Emergency Medicine
David Geffen School of Medicine at UCLA Harbor-UCLA Medical Center
Torrance, CA

Nadine Levick, MD, MPH, DABFP, MBBS, FACEEM, FRACGP
Emergency Department
Maimonides Medical Center
Brooklyn, NY

Tommy Loyacano, MPA, NREMT
East Baton Rouge Parrish EMS
Baton Rouge, LA
Pediatric Committee Chair, NAEMT

Bob Luten, MD
University of Florida Emergency Medicine
Jacksonville, FL

David Markenson, MD
Center of Disaster Medicine
New York Medical College School of Public Health
Valhalla, NY

Bob Waddell II
Think Sharp Inc.
Executive Committee Chair, Pediatric Prehospital Care Course, NAEMT

Arno Zaritsky, MD
Department of Pediatrics
University of Florida College of Medicine
Gainesville, FL

Dr. Romig would also like to acknowledge the leadership and multitude of accomplishments of Jim Seidel, MD, one of the founding fathers of EMS for children. Dr. Seidel is no longer with us but his landmark work in EMS continues to inspire all who are passionate about children and those who care for them.

FAMILY AND CAREGIVER RESOURCES

American Heart Association

• Family & Friends CPR Anytime Personal Learning Program. The Family & Friends CPR Anytime Personal Learning Program 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. (Accessed September 2008)

• Heartsaver Family & Friends First Aid for Children. Designed for family members, including siblings, grandparents, new parents, and friends who care for children and infants and want to know first aid basics, this course is also available in Spanish. (Accessed September 2008)

• Infant CPR Anytime. Created for families, friends, grandparents, siblings and others caring for infants to learn the core skills of infant cardiopulmonary resuscitation (CPR) and relief of choking in just 22 minutes. Developed in coordination with the American Academy of Pediatrics (AAP) and using the learning technology of Laerdal Medical, the kit contains everything needed to learn infant CPR and relief of choking. (Accessed September 2008)

American Red Cross

• Babysitter Training Course. The Babysitter’s Training Course is designed to help 11- to 15-year-olds interview for a babysitting job; choose safe and age-appropriate toys and games; perform first aid; learn diapering and feeding techniques; and handle bedtime issues. (Accessed September 2008)