Reducing Disparities for Children in Rural Emergency Resuscitation (RESCU-ER)

总结 农村社区的婴儿死亡率几乎高出2倍，儿童死亡率高出2.6倍， 与城市环境;很少有人知道这些儿童的哪一部分与紧急医疗 服务（EMS）系统。农村健康差距的数据目前来自生命统计，并表明， 许多农村死亡率过高的情况下发生的紧急医疗的常见原因， 服务（EMS）调度。EMS提供商提供现场响应，复苏，稳定和运输， 一系列危及生命的疾病及其提供的护理是生存链中的关键环节。我们 对城市地区EMS护理的研究发现，超过一半的医院外儿童急诊 不良安全事件（ASE），发生率最高的是儿童， 心肺骤停、创伤、呼吸窘迫、癫痫发作和分娩。目前尚不清楚， EMS护理期间发生的潜在可改变因素在多大程度上导致死亡率差异。这 该项目建议通过以下目标来解决这一知识差距：目标1：开展全面的 对农村儿童生命威胁后果差异的流行病学比较调查 紧急情况，以确定与改善结果和生存相关的因素;目标2：确定和表征 在EMS护理期间发生的ASE，并了解可修改和不可修改的因素如何放大 或减弱ASES对结果的影响;目标3：测试一种新的认知辅助工具的线性方法， 错误和促进高质量的EMS复苏的儿童。这项研究将是一个实质性的出发点 通过利用大数据方法超越高水平结果频率， 通过卫生保健提供系统找到可以预防的源头。错误被认为 这是可预防伤害和潜在死亡的重要来源。本项目完成后将产生：（一）a 关于农村和城市环境中儿童死亡率和发病率以及环管系统应对措施的新的基于人口的流行病学调查; (ii)错误如何导致农村和城市可预防的发病率和死亡率的概念框架 儿童;以及（iii）关于线性认知辅助工具有效性的试点数据，以提高EMS护理的安全性，以及 有可能缩小城乡儿童发病率和死亡率的差距。

Summary Mortality for infants is almost 2 times higher and for children 2.6 times higher in rural communities compared with urban settings; little is known about what portion of these children interact with the Emergency Medical Services (EMS) system. Data for rural health disparities currently come from vital statistics and suggest that much of the excess rural mortality occurs in conditions that are common reasons for Emergency Medical Services (EMS) dispatch. EMS providers provide scene response, resuscitation, stabilization, and transport for a range of life-threatening conditions and the care they deliver is a critical link in the chain of survival. Our research on EMS care in urban areas finds that more than half of out of hospital children's emergencies have an adverse safety event (ASE) during the delivery of care, and the highest rates are seen in children with cardiopulmonary arrest, trauma, respiratory distress, seizures, and births. Currently, it is not known if and to what extent potentially modifiable factors occurring during EMS care contribute to disparities in mortality. This project proposes to address this knowledge gap through the following aims: Aim 1: Conduct a comprehensive comparative investigation into the epidemiology of disparities in rural child outcomes from life-threatening emergencies to identify factors associated with improved outcomes & survival; Aim 2: Identify and characterize ASEs that occur during EMS care and understand how modifiable and nonmodifiable factors magnify or attenuate the effect of ASEs on outcomes; Aim 3: Test a new linear approach to cognitive aids to reduce errors and promote high-quality EMS resuscitation for children. This research will be a substantive departure from the status quo by leveraging big data approaches to move beyond high level outcome frequencies and get to the source of what might be preventable through the health care delivery system. Errors are considered an important source of preventable harm and potentially death. Completion of this project will result in: (i) a novel population-based epistry on child mortality and morbidity and EMS response in rural and urban settings; (ii) a conceptual framework of how errors contribute to preventable morbidity and mortality for rural and urban children; and (iii) pilot data on the effectiveness of linear cognitive aids to improve the safety of EMS care and potentially reduce disparities in rural and urban child morbidity and mortality.