Kathleen Adelgais

INTRODUCTIONConducting impactful research on time-critical illnesses requires standard human subjects’ protection review and occasionally a waiver of informed consent. In 1996, the United States (U...

INTRODUCTIONSince the initial development of emergency medical services (EMS) agencies in the mid-1960’s, modern EMS organizations have implemented standards designed to enhance organizational perf...

Pediatric patients represent a high-risk, low frequency population in emergency medical services (EMS) systems. Quality improvement (QI) is the backbone of high-quality care delivered in EMS and engagement in pediatric-specific QI work is a core domain of the National Prehospital Pediatric Readiness Project (PPRP). There is no widely accepted set of quality measures that focus on the full scope of pediatric prehospital care. Our objective was to establish core PPRP Quality Measures for a National EMS Information System (NEMSIS)-derived pediatric prehospital dashboard to support pediatric QI initiatives. We convened a 16-member technical expert panel (TEP) from national professional societies and federal entities. The TEP included physicians, nurses, EMS clinicians, federal partners, state EMS officials, and NEMSIS staff. Candidate measures were identified through a review of national resources and a survey of TEP members. The TEP employed a modified Delphi process to establish consensus priorities and scored measures based on the National Quality Forum Measure Evaluation Criteria. Candidate measures were prioritized based on scientific acceptability, importance to patient outcomes, utility in driving improvements, and feasibility of collection. Candidate measures were scored on a scale of 1 (lowest priority) to 5 (highest priority). Consensus was defined as 75% of the TEP rating a measure ≥ 4. The TEP identified 65 candidate measures. After three rounds of voting, consensus was achieved on 24 measures addressing a range of common pediatric prehospital conditions, including airway management (5 measures), trauma (4), pain control (3), respiratory emergencies (3), cardiac arrest (2), anaphylaxis (1), shock (1), seizures (1), hypoglycemia (1), newborn emergencies (1), non-transport (1), and safe transport (1). Thirteen (54%) of these measures apply to basic life support (BLS) teams. Common reasons for excluding measures included: limited scientific evidence, measure complexity, and redundancy. A TEP identified 24 quality measures in pediatric EMS that emphasize foundational practice and relevance across a range of volumes and service models. Future validation of these measures with NEMSIS data are needed to establish benchmarks of care across variably resourced EMS agencies and develop effective strategies to support adherence to high-quality pediatric prehospital emergency care.

Background: Seizures are one of the most common reasons for emergency medical services (EMS) activation for children, and current EMS practice results in underdosing and delayed delivery of anti-seizure medication. A prehospital evidence-based guideline recommends using intranasal or intramuscular midazolam as first-line treatment for pediatric seizures. Despite attempts to implement these guidelines, one-third of children having a paramedic-witnessed seizure have ongoing seizures on emergency department (ED) arrival; this may be due to inadequate or delayed midazolam dosing. Replacing the error-prone, sequential calculations with age-based midazolam dosing may be simpler, faster, and more effective without compromising safety. The objective of this manuscript is to describe the methodology of the Pediatric Dose Optimization for Seizures in EMS (PediDOSE) study, a clinical trial designed to compare the effectiveness and safety of an EMS protocol with four age-based categories for midazolam dosing relative to the current weight-based dosing. Methods: We are conducting a large EMS-based stepped wedge trial in the Pediatric Emergency Care Applied Research Network (PECARN) by implementing midazolam dosing based on four age categories in seizure protocols in EMS systems in 20 cities. We believe that this implementation will stop more seizures before ED arrival without increasing respiratory failure rates. The primary aim of this study is to compare the effectiveness of age-based EMS midazolam dosing compared to the current weight-based dosing on seizure cessation upon ED arrival. The secondary aim is to determine the frequency of respiratory failure in children after the implementation of EMS midazolam dosing based on these age categories. Conclusion: If this study demonstrates that an EMS patient care protocol with age-based midazolam dosing is safe and more effective than current practice, the potential impact of this study is a paradigm shift in the treatment of pediatric seizures that can be easily implemented in EMS systems across the country. Beyond seizures, the concept of age-based dosing may also be applicable to other commonly encountered pediatric prehospital conditions for which medication may be indicated.

Background: Community consultation (CC) is crucial for exception from informed consent (EFIC) trials. Digital marketing platforms offer a novel and efficient way to gather community input through surveys. This study aimed to determine if the demographics of digital CC survey respondents align with those of their targeted communities. Methods: We deployed an EFIC CC digital survey for Pedi‐PART, a multicenter study on paramedic airway management in critically ill children. A seven‐item survey, developed to gauge community perspectives on emergency care research and the trial, was disseminated through a digital marketing platform (Qualtrics Inc.). The survey targeted adults aged 18–65 residing within the geographic service areas of 10 participating EMS agencies. We determined community demographic data from the 2022 American Community Survey (ACS) for the dominant county in each service area. We compared survey respondent demographics (age, sex, race, ethnicity, household income, education) with those of the corresponding communities. Results: We received 6630 completed surveys (528 to 913 per community). The proportion of individuals over 35 years old was similar between survey and community populations (67.1% vs. 66.5%). Survey respondents were more likely to be female (60.0% vs. 50.9%) and report household incomes < $100,000 (77.5% vs. 60.2%). Survey respondents were less likely to be Black, American Indian, Pacific Islander, or other race (33.9% vs. 52.1%), Hispanic ethnicity (15.3% vs. 34.9%), or have at least a high school education (23.2% vs. 34.9%). Demographic differences between survey respondents and communities varied across the 10 communities. Conclusions: Demographic differences may exist between digital survey respondents and their targeted communities. Study teams should account for these factors when utilizing such platforms for EFIC CC.

Effective communication is critical for emergency medical teams, especially when distributed providers must collaborate under high-stakes conditions to deliver timely, life-saving care. Traditional communication tools such as radios and phones, while commonly used, are limited to audio-only exchanges-often resulting in misunderstandings, communication breakdowns, and delays in treatment. This study explores the use of smart glasses as an alternative communication tool in prehospital emergency care and examines how their use influences communication dynamics between prehospital providers (e.g., paramedics) and remote emergency physicians, compared to traditional methods (radio and phone). Through simulation-based testing, we found that smart glasses reduced communication breakdowns and facilitated more in-depth, context-rich discussions about patient care. Both EMS providers and physicians viewed the smart glass technology as a promising solution for enabling multimodal communication (e.g., visual, auditory, gestures, text). However, we also identified several challenges associated with its use in near-realistic simulation environments, including the need for overhearing capabilities, issues with visual alignment and motion-induced discomfort, extended interaction times, and concerns around autonomy and privacy. We conclude with a discussion of the design and practical implications of these findings.

Background Unmet social needs can increase the risk of adverse health outcomes in children. Emergency medical services (EMS) utilization is higher among families facing challenges with certain social determinants of health (SDoH). Understanding service needs among families seeking emergency care may inform interventions designed to support better health outcomes. Methods We conducted a cross-sectional survey of caregivers and EMS clinicians presenting to a pediatric emergency department (ED) via EMS or private vehicle (POV). Participants completed a survey reporting access to transportation, food, housing, healthcare, mental healthcare, and financial support. We evaluated differences in self-reported SDoH and service needs by arrival mode and differences in caregiver-reported needs with those perceived by EMS clinicians using Pearson’s chi-squared and Fisher’s exact tests. Results A total of 159 caregivers (111 POV, 48 EMS) and 17 EMS clinicians were enrolled. Caregiver demographics were similar between groups. Overall, 67 (42%) caregivers reported at least one service need with few differences between groups. Difficulty seeking healthcare, childcare, and mental health support were most frequently reported. EMS arrivals were more likely to report difficulty seeking child healthcare (p=.02); POV arrivals were more likely to report personal mental health needs (p<.01). There was no difference in requests for child mental health treatment (p>.90). Conclusions Service needs are common in pediatric emergency care. Difficulty accessing child healthcare and mental healthcare were common in our population. Screening pediatric caregivers during emergency care including during EMS activations may identify families in need of support services. KEY MESSAGE STATEMENT Social Determinants of Health (SDoH) have important health implications in children. In pediatric emergency care, caregivers and children arriving via Emergency Medical Services (EMS) are more likely to have social needs. There is a paucity of research on the specific needs of this population compared to private vehicle arrives and if EMS clinicians are aware of these needs. This study compares the SDoH of caregivers in the ED between arrival type and assesses if EMS clinicians recognize the needs of the people they transport. These results may be useful in improving EMS clinician curricula and addressing SDoH in families with young children.