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EMERGENCY MEDICAL SERVICES FOR CHILDREN

Goal: Improve Access to Quality Health Care and Services

Sub-Goal: Strengthen health systems to support the delivery of quality health services

Measure FY Target Result

14.1: Mortality rate for children with an injury severity score (ISS) greater than 15. (Baseline – FY 2005: 9.1%)

(Outcome)

Out-Year

Target 8.1% (FY 2014) July 31, 2016 2012 8.4% July 31, 2014

2011 8.5% July 31, 2013

2010 8.6% July 31, 2012

2009 8.7% July 31, 2011

14.V.B.1: Increase the number of awardees that demonstrate the operational capacity to provide pediatric emergency care, including all core capacity elements related to: (a) on- line and off-line medical direction at the scene of an emergency for Basic Life Support (BLS) and Advanced Life Support providers, (b) essential pediatric equipment and supplies, (c) designation of pediatric specialty care hospitals, and inter-facility transfer agreements. (Baseline – FY 2005: 20) (Output) 2012 30 July 31, 2013 2011 28 July 31, 2012 2010 26 July 31, 2011 2009 24 26 (Target Exceeded) 2008 21 23 (Target Exceeded) 2007 28 22

(Target Not Met but Improved)

14.V.B.2: Increase the number of awardees that have adopted requirements for pediatric emergency education for the re-certification of paramedics. (Output) 2012 39 July 31, 2013 2011 373 July 31, 2012 2010 27 July 31, 2011 2009 25 37 (Target Exceeded) 2008 22 24 (Target Exceeded) 2007 43 23

(Target Not Met but Improved) 14.V.B.3: Transfer rate for children with an

injury severity score (ISS) of 15 or more.4

2012 (Developmental) (Output) TBD TBD 2011 N/A N/A 2010 N/A N/A 2009 N/A TBD (Baseline)

3 _{Target differs from that shown in the FY 2011 Congressional Justification to reflect most recent performance.}

4 _{This developmental measure does not currently have annual targets. Baseline data for FY 2009 will be available in 2011 when the 2012 target}

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Efficiency Measure FY Target Result

14.E: Decrease the application and reporting time burden of grantees.

(Efficiency) 2012 70 hours July 31, 2013 2011 75 hours July 31, 2012 2010 80 hours July 31, 2011 2009 85 hours 85 hours (Target Met) 2008 90 hours 90 hours (Target Met) 2007 90 hours 90 hours (Target Met)

Measure Data Source Data Validation

14.E 14.V.B.1 14.V.B.2

Grantee reports. Data confirmed by project officers.

14.1 14.V.B.3

Grantee reports; Healthcare Cost and Utilization Project (HCUP) Data confirmed by project officers.

INTRODUCTION

The performance measures of the Emergency Medical Services for Children (EMSC) Program are linked to HRSA’s Strategic Plan goal of improving access to quality health care and services. These performance measures are designed to assist State EMS programs to measure progress toward achieving high quality services for children’s emergencies. The measures help States to focus their resources on pediatric program components in greatest need. Tracking progress also helps the Federal program implement its strategies to target technical assistance and fiscal resources to States needing help, and to identify successful State programs which then are used as models to assist States that need to improve.

DISCUSSION OF RESULTS AND TARGETS

Goal: Improve Access to Quality Health Care and Services

Sub-Goal: Strengthen health systems to support the delivery of quality health services 14.1. Mortality rate for children with an injury severity score (ISS) greater than 15. The EMSC program is designed to ensure state-of-the-art emergency medical care for ill or injured children and adolescents. It covers the entire spectrum of emergency medical care. This measure was selected as a measure of performance because the right emergency care should result in reduced mortality. The FY 2012 target is 8.4%

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14.V.B.1. Increase the number of awardees that demonstrate the operational capacity to provide pediatric emergency care, including all core capacity elements related to: (a) on- line and off-line medical direction at the scene of an emergency for Basic Life Support (BLS) and Advanced Life Support providers, (b) essential pediatric equipment and supplies, (c) designation of pediatric specialty care hospitals, and inter-facility transfer agreements.

The EMS System was originally designed to address the needs of adults. The purpose of this program is to increase awareness of the specific needs of children in emergency situations, and increase EMS capacity to address them. The number of States that demonstrate the operational capacity to provide pediatric emergency care provides a critical indicator of the degree to which the appropriate care for children has been integrated into the EMS system.

In FY 2007, 22 States were considered to have met the operational capacity to provide pediatric emergency care, based upon reports from individual States. This was an increase over FY 2006 but did not meet the FY 2007 target. The fact that the FY 2007 target was not met is due to a change that occurred in 2006 in the definition of what is required to meet the performance standard. The current definition and method of data collection are more rigorous than when the target was established. As a result, many States that reported meeting all components in FY 2005 did not meet the requirements for FY 2006 and FY 2007 reporting. In areas such as "essential pediatric equipment and supplies," for example, some States may be missing only one piece of equipment, but these States are now considered as not meeting the essential pediatric equipment requirement. States must completely meet all three categories of core elements in order to be considered as demonstrating the operational capacity to provide pediatric emergency care. Collection of the data is a requirement of the State Partnership grant program. In FY 2008, 23 States were considered to have met the operational capacity to provide pediatric emergency care, slightly exceeding the target of 21 and exceeding the FY 2007 actual by one. In FY 2009, 26 States were considered to have met the operational capacity to provide pediatric emergency care, exceeding the target of 24. The target for FY 2012 is 30.

14.V.B.2. Increase the number of awardees that have adopted requirements for pediatric emergency education for the re-certification of paramedics.

The adoption of guidelines for pediatric emergency care training/education for pre-hospital providers is an integral component of the EMSC Program and helps to ensure the provision of appropriate pediatric emergency care across the continuum of care. In FY 2007, the number of awardees that met this goal was 23, and is expected to increase annually. This was an increase over FY 2006 but did not meet the FY 2007 target (43 states). The target was not met because the requirements for pediatric emergency education for the re-certification of paramedics were made more rigorous based on feedback from national stakeholders to add the specification that the requirement for recertification be State-mandated through statute, rules, or regulations. This change resulted in fewer states being able to meet the performance standard. However, the amount of pediatric emergency education within States did not diminish. Rather, training in some States is not yet mandated through State statutes, rules or regulations. In FY 2009, 37 awardees adopted requirements for pediatric emergency education for pre-hospital providers, exceeding the target of 25. The target for FY 2012 is 39.

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14.V.B.3. Transfer rate for children with an injury severity score (ISS) of 15 or more. (Developmental)

The EMSC program seeks to improve the inter-facility transfer rate to hospitals that have the special expertise to care for critically ill or injured children. By improving the inter-facility transfer rate, it is expected that mortality rates for critically ill and injured children will improve. Baseline data for FY 2009 will be available in 2011 when the 2012 target will be established. 14.E. Decrease the application and reporting time burden of grantees by 5% per year A new on-line application and reporting system was implemented in FY 2005 and became fully implemented in FY 2006 through Grants.gov and HRSA’s Electronic Handbook. This system provides grantees with information from previous years, including budget and service data. This alleviates the grantees from having to supply information that was previously provided. Also, the system pre-populates figures into subsequent forms so that grantees do not have to enter the same data more than once. Reporting is also easier on the on-line system and provides program management with performance data that are far more reliable and valid, with a shorter lag time. In FY 2009 the number of hours was 85, meeting the target. This was down from125 hours in FY 2006. The target for FY 2012 is 70 hours.

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