Emergency Medical Services for Children Evaluation of Readiness and Outcomes (EMSC-HERO)

紧急医疗服务(EMS)是一种基本的公共资源，运行在第一线的 在美国人最脆弱的时候为他们提供医疗保健系统。超过180万的儿童 在美国，每年通过EMS运送到急诊部(ED)，大约需要90,000 EMS提供者的即时干预和稳定。然而，在以下方面存在重大缺陷： 安全和护理质量。我们发现危重儿科患者有严重的不良安全事件 23%的电话。呼吸衰竭需要气管插管的儿童和心脏骤停的儿童， 可以说，这两个风险最高和复杂的医疗条件，经历了严重的不良安全事件 到60%的时间。农村地区在高质量的儿科院前护理方面面临更大的挑战。它是 对我们的EMS系统来说至关重要的是对儿科紧急情况有高度的准备，尽管存在严重的差距 留下来。一个主要的差距是，目前没有经过验证的方法来评估EMS机构对 儿科急诊。这样的衡量标准将提供有关我们系统当前状态的重要数据，同时 向领导人和政策制定者提供指导资源分配所需的信息。最新研究 已经发现，就绪性评分最高的医院急救人员的死亡率降低了三倍以上 患有危重疾病和创伤的儿童的比率高于准备最差的急救人员。有儿科急救护理 协调员也已成为教育部门准备就绪的关键要素之一。近日，首份技术报告 关于EMS中的儿科准备情况的出版，这为科学研究创造了一个起点， 将加强政策制定者的努力。我们的总体目标是提高安全和高质量的交付 对儿童的院前护理，以最大限度地提高结果。这项研究将扩展以前使用的方法 测量以医院为基础的急诊室的准备情况，以严格评估改善儿科准备情况的因素 EMS机构和儿童健康结果。我们将纳入一个积极的偏差框架，以确保 我们从现场供应商的角度对就绪性有了广泛的理解。特定的健康 我们将评估的结果包括EMS护理期间不良安全事件的发生以及医院 我们将评估特定于疾病的结果。EMS系统定位于改善以下方面的结果 需要立即稳定的医疗状况，如癫痫发作、创伤、心脏骤停和 呼吸衰竭，这是我们关注的领域。这项研究的具体目的是1)得出一个分数， 反映EMS机构已准备好使用改进的Delphi流程照顾危重儿童 主题专家，2)使用经验性的真实世界数据和 患者结果，包括来自城市和农村地区的不良安全事件，以及3)使用定性 在积极偏离框架中进行面谈，以确定机构的具体活动和属性 城市和农村地区业绩最好和最差的EMS机构。

Emergency Medical Services (EMS) are an essential public resource that operates at the front lines of the healthcare system for Americans during their most vulnerable times. More than 1.8 million children are transported to an Emergency Department (ED) by EMS each year in the US, and approximately 90,000 need immediate intervention and stabilization by EMS providers. However, there are significant deficiencies in the safety and quality of care. We have found that critical pediatric patients have severe adverse safety events in 23% of calls. Children with respiratory failure requiring endotracheal intubation and children with cardiac arrest, arguably two of the highest risk and complex medical conditions, experience severe adverse safety events up to 60% of the time. Rural areas experience even greater challenges to quality pediatric prehospital care. It is vital for our EMS system to have a high level of readiness for pediatric emergencies, though serious gaps remain. One major gap is that there is currently no validated means to evaluate EMS agency readiness for pediatric emergencies. Such a metric would provide vital data on the current status of our system while empowering leaders and policymakers with information needed to guide resource allocation. Recent studies have found that hospital-based EDs with the highest readiness scores have more than threefold lower mortality rates for children with critical illness and trauma than the least ready EDs. Having a pediatric emergency care coordinator has also emerged as one of the key elements of ED readiness. Recently, the first technical report on pediatric readiness in EMS was published, which has created a starting point for scientific investigation that will enhance policymakers' efforts. Our overall goal is to improve the delivery of safe and high-quality prehospital care for children that maximizes outcomes. This study will expand on the previous methods used to measure readiness in hospital-based EDs to rigorously evaluate factors that improve pediatric readiness for EMS agencies and health outcomes for children. We will incorporate a positive deviance framework to ensure we develop a broad understanding of readiness from the perspective of field providers. The specific health outcomes we will evaluate include occurrence of adverse safety events during EMS care, as well as hospital outcomes specific to the diseases we will evaluate. The EMS system is positioned to improve outcomes for medical conditions that require immediate stabilization, such as seizures, trauma, cardiac arrest, and respiratory failure, which are our areas of focus. The specific aims of the study are to 1) derive a score that reflects the readiness of an EMS agency to care for critically ill children using a modified Delphi process among subject matter experts, 2) evaluate and refine the score developed in Aim 1 using empiric real-world data and patient outcomes including adverse safety events from both urban and rural areas, and 3) use qualitative interviews in a positive deviance framework to identify specific agency activities and attributes among the highest and lowest performing EMS agencies, in both urban and rural areas.