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

紧急医疗服务（EMS）是一种重要的公共资源，在前线运作， 在美国人最脆弱的时候，医疗保健系统。超过180万儿童 在美国，每年通过EMS运送到急诊室（艾德），并且大约90，000人需要 EMS供应商的立即干预和稳定。然而，在这方面存在重大缺陷。 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。需要气管插管的呼吸衰竭儿童和心脏骤停儿童， 可以说是两个最高风险和复杂的医疗条件，经历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。是 对于我们的EMS系统来说，尽管存在严重的差距，但对儿科急诊的高水平准备至关重要 保持。一个主要的差距是，目前没有有效的手段来评估环境管理体系机构的准备情况， 儿科急诊这样的指标将提供有关我们系统当前状态的重要数据，同时 向领导人和决策者提供指导资源分配所需的信息。最近的研究 他们发现，准备得分最高的医院急诊室的死亡率要低三倍以上 患有危重病和创伤的儿童的死亡率高于准备最不充分的急诊科医生。儿科急诊护理 协调员也已成为艾德准备的关键要素之一。近日，第一份技术报告 发表了关于EMS中儿科准备情况的研究报告，这为科学调查创造了一个起点， 将加强决策者的努力。我们的总体目标是提高交付的安全性和高质量 为儿童提供院前护理，最大限度地提高结果。本研究将扩展以前使用的方法， 测量医院急诊科的准备情况，以严格评估提高儿科准备情况的因素， EMS机构和儿童健康结果。我们将纳入积极的异常框架，以确保 我们从现场供应商的角度对准备情况有了广泛的了解。的具体卫生 我们将评估的结局包括EMS护理期间不良安全事件的发生率，以及医院 我们将评估的疾病的具体结果。EMS系统的定位是改善结果， 需要立即稳定的医疗状况，如癫痫发作、创伤、心脏骤停，以及 呼吸衰竭，这是我们关注的领域该研究的具体目的是：1）得出一个分数， 反映了EMS机构准备使用修改后的德尔菲过程照顾重症儿童， 主题专家，2）使用经验性的真实世界数据评估和改进目标1中开发的分数， 患者结局，包括城市和农村地区的不良安全事件，以及3）使用定性 在积极的偏差框架中进行访谈，以确定机构的具体活动和属性， 城市和农村地区表现最好和最差的环管系统机构。

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.