EMERGENCY MEDICAL SERVICES FOR CHILDREN NEWSLETTER

news

VOLUME 14, NO.6, NOVEMBER/DECEMBER 2001

NDDP Cooperative Agreement Grants

Awarded To Four Sites Across U.S.

I

n an exciting milestone toward a key

objective of its new Five-Year Plan,

the Emergency Medical Services for

Children (EMSC) Program is pleased to

announce that four cooperative agreement grants have been awarded for the

Network Development Demonstration

Project (NDDP). The awards, which

together amount to $2.4 million, will

support regional pediatric EMS research

nodes in California, Michigan, New York,

and Washington, DC.

Each node, which consists of a

Regional Node Center and affiliated hospital emergency departments (see Figure

1), is charged with building a research

infrastructure to facilitate the collection

INSIDE THIS

ISSUE

Page 4

Oregon Passes EMSC 

Legislation

New Trauma/EMSC 

Program Moves Forward

Page 5

Grantees Provide Feedback 

on EMSC Resources

NHA Nominations Now 

Being Accepted

Page 6 

EMSC Identified Top 10 

Reasons Why Children 

Visit the ED

Page 8 

Pediatric Prehospital 

Continuing Education 

Guidelines to be Developed

Page 14 

Wisconsin Is “Ready with

BELSS On”

EMSC Sends In Teams of Experts to Help Pacific Islands

August 2001 marked the beginning of yet

another quantum leap of collaborative

support between the Emergency Medical Services for Children (EMSC) Program

and the U.S. Pacific territories. Teams of

EMSC experts were assembled and sent to

American Samoa, the Commonwealth of the

Northern Mariana Islands (CNMI), and Guam

to assist each in developing their grant application, drafting a multi-year strategic plan,

and strengthening collaborations among key

stakeholders. 

“This is the first time EMSC has deployed

a ‘team’ of experts to conduct a grantee site

continue on page 2

continue on page 3

visit,” said Cindy Doyle, RN, EMSC program

director for the Maternal and Child Health

Bureau. “The technical assistance needed by

these territories is drastically different from

what is provided to mainland programs. Their

culture; infrastructure; and political, geographical, and economical climates call for a

unique, more in-depth level of expertise.”

A team of experts was sent to each Island

(see sidebar on page 2). Team members were

selected based on their knowledge of the following: emergency medical services (EMS)

system development, pediatric emergency

medical care, project coordination, coalition

Figure 1.
EMSC Program Project Officer, MCHB

Cindy Doyle, RN, MS

Dan Kavanaugh, MSW, LCSW-C

Executive Director, 

EMSC National Resource Center

Jane Ball, RN, DrPH

Communications Director

Millree Williams

Managing Editor

Suzanne Sellman, MA

Editor

Donna Frassetto

Design 

Design Central, Inc.

EMSC News is a publication of the 

Emergency Medical Services for Children

(EMSC) Program, a federally funded initiative jointly administered by the Health

Resources and Services Administration’s

Maternal and Child Health Bureau

(MCHB) and the National Highway Traffic

Safety Administration. ISSN 1522-5275.

EMSC News is published six times a year

by the EMSC National Resource Center,

111 Michigan Avenue, NW, Washington,

DC 20010-2970; 202/884-4927 (phone);

202/884-6845 (fax); info@emscnrc.com 

(e-mail); www.ems-c.org (web). 

Subscriptions to EMSC News are free.

EMSC News welcomes articles on people,

programs, and procedures related to

emergency medical services for children.

All manuscripts, artwork, or photography

should be submitted to Suzanne Sellman

at the EMSC National Resource Center. 

© 2001 EMSC Program. All rights reserved.

Teams of Experts Sent to Help Pacific Islands, from page 1

building, political affairs, rural health

care, provider education, public safety, public health, data collection and

analysis, computer hardware and software, medical direction, grant writing,

and grant management.

American Samoa Team

David Boer, EMT-P, MBA, South

Dakota EMSC

Stephen Karl, MD, South Dakota

EMSC

Stacey Knight, MStat, National

EMSC Data Analysis Resource

Center

Bob Waddell, EMSC NRC

CNMI Team

Nels Sanddal, MS, REMT-B, Critical Illness and Trauma Foundation

Stacey Knight, MStat, National

EMSC Data Analysis Resource

Center

Bob Waddell, EMSC NRC

During each of the four-day site

visits, team members worked one-onone with EMSC project staff; toured

local hospitals and other medical systems; and met with hospital staff, fire

and EMS leaders, public safety officials, and maternal and child health

officers. America Samoa team members also met with senior administrators from the Governor’s Office, the

Department of Commerce, and the

Department of Social Services, while

CNMI team members met with senior

health department officials, including

Secretary of Health Joseph Villagomez.

After numerous meetings and

tours and countless hours of analysis

of EMS data, all three teams identified

each territory’s most immediate pediatric emergency medical need. In

addition, they provided each project

with a draft document outlining their

grant’s primary goals and objectives. 

For more information about the 

site visits or the primary goals of each

HHS Announces New Initiatives for Rural Health

I

n September, Health and Human

Services (HHS) Secretary Tommy

Thompson announced the creation

of a rural task force that will conduct

a department-wide examination of

how HHS programs can better serve

rural communities. The task force,

which is expected to reach across 12

divisions in HHS, will work to assess

how health care and social services in

rural areas can be improved and

expanded. Secretary Thompson

described this initiative as “a high

priority,” and charged the task force

with returning to him in three

months a report of findings, recommendations for improvement, and a

strategic plan to ensure a real change

in the way HHS does business. 

The report is expected to include

information about the development of

a “tool chest” to help improve the performance of small rural hospitals and

an examination of the use of Title XII

(Public Health Services Act) to keep

emergency medical technician personnel on the job in rural America, where

emergency medical service systems

are stretched thin.

2 EMSC News NOVEMBER/DECEMBER 2001 

project, contact Bob Waddell, EMS

systems specialist for the EMSC

National Resource Center (NRC), at

bwaddell@emscnrc.com.
NDDP Cooperative Agreement Grants Awarded To Four Sites Across U.S., from page 1

of high-quality data for the purposes of

expanding and improving the services

children receive in a medical emergency.

“Despite the many advances in

creating EMS systems that incorporate

a pediatric component, relatively little

data have been collected about how

these systems operate, whether they

are cost efficient, or whether the clinical procedures being provided within

these systems are effective in treating

the child at the scene of the emergency, in transit, or at the hospital,”

said Cindy Doyle, RN, EMSC program

director for the Health Resources and

Services Administration’s Maternal and

Child Health Bureau (MCHB). “In the

past, we have had trouble obtaining

these data because of the relatively

small incidence rates of pediatric

emergency events occurring at any

one site or state system. These grants

serve as the mechanism to gather the

data by pooling sites, systems, and

Principle Investigator: Nadine Levick, MD

Areas Affected by Project: New York City,

Buffalo, and Rochester, NY and 

Morristown, NJ

Regional Collaborators to Date: Bellevue

Hospital Center, Woodhull Hospital Center,

Strong Memorial Hospital, Children’s Hospital of New York, Children’s Hospital of Buffalo, Children’s Medical Center of Morristown,

Atlantic Health System, and the Rural Emergency Department Network of the Finger

Lakes Region

Project Title: EMSC Network Development

Demonstration Project 

Recipient: The Regents of the University of

California

Organization: University of California, Davis

Medical Center

Location: Sacramento, CA

Principle Investigator: Nathan Kuppermann, MD, MPH

Areas Affected by Project: Sacramento,

CA; Cincinnati, OH; Philadelphia, PA; St.

Project Title: Chesapeake Applied

Research Network for EMSC (CARN-EMSC)

Recipient: Children’s Research Institute 

Organization: Children’s National Medical

Center, Division of Emergency Medicine

Location: Washington, DC 

Principle Investigator: James Chamberlain,

MD

Areas Affected by Project: BaltimoreWashington Metropolitan Area

Regional Collaborators to Date: Johns

Hopkins Children’s Center, the Maryland

Institute for Emergency Medical Services

Systems, the DC Fire Department, and the

Maryland and DC Health Departments.

Project Title: EMSC NDDP North East

Regional Node (PEDNET)

Recipient: Columbia University and Harlem

Hospital Center

Organization: Columbia University, Department of Pediatrics

Location: New York City, NY

NDDP Cooperative Agreement Grant Awardees

Louis, MO; Salt Lake City, UT; and Wisconsin.

Regional Collaborators to Date: Children’s

hospitals from Cincinnati, Philadelphia, St.

Louis, and Salt Lake City, and state EMS and

county health agencies in the affected areas.

Project Title: Great Lakes Regional Node for

Pediatric EMS Research 

Recipient: The Regents of the University of

Michigan

Organization: University of Michigan,

Department of Emergency Medicine

Location: Ann Arbor, MI

Principle Investigator: Ronald Maio, DO, MS

Areas Affected by Project: Washtenaw,

Wayne, Genessee, Kent, and Marquette 

counties.

Regional Collaborators to Date:

Children’s Hospital of Michigan, 

Hurley Medical Center, the University of

Michigan, Spectrum-Butterworth, Marquette

General Hospital, and the Michigan Department of Consumer and Industry Services’

EMS Section.

treatment experiences.” The data,

standardized across sites, can now be

collected from a sample size large

enough to produce meaningful

research results.

To facilitate data sharing between

regions, representatives from each

node will serve on the Pediatric Emergency Care Applied Research Network

(PECARN). This collaborative group

will work with MCHB’s Division of

Research, Training and Education and

other federal agencies to conduct

multi-regional observational studies

and clinical trials (see Figure 2). Once

established, the research infrastructure created by the NDDP can be used

to conduct studies on a variety of

issues related to EMSC, including

processes involved in transferring

research results to treatment settings. 

For more information about this

project, contact Doyle at

cdoyle@hrsa.gov.

EMSC News NOVEMBER/DECEMBER 2001 3

Figure 2.
After more than a five-year hiatus, the trauma systems of this

country are seeing some much

needed federal support. As reported

in the July/August 2001 issue of EMSC

News, the Health Resources and Services Administration (HRSA) was

appropriated $3 million in fiscal year

(FY) 2001 to support trauma systems

as a critical component of a statewide

emergency medical services EMS

program. To help facilitate this new

effort, HRSA’s Maternal and Child

Health Bureau and it’s Office of Rural

Health Policy recently announced 

that they along with the National

Highway Traffic Safety Administration

(NHTSA), have awarded grants to all

50 states and three U.S. territories

(American Samoa, the Commonwealth

of Northern Mariana Islands and

Guam). Each grantee will use the

funding to convene a meeting of principal stakeholders to complete a 

standardized trauma needs survey. 

The results of this survey, due

December 31, 2001, will be analyzed

and published in a national report for

use by HRSA and NHTSA to raise

awareness about the status of trauma

systems and to establish priorities for

FY 2002 and beyond. 

In addition to completing the survey, grantees are required to assess

their current EMS system using the

SWOT (Strengths, Weaknesses,

Opportunities, and Threats) Analysis.

This assessment is also expected to

assist HRSA and NHTSA in identifying

system components that need to be

enhanced. More information about

this report will be featured in the next

issue of EMSC News.

New Trauma/EMS

••• PUBLIC POLICY NETWORK••• Program Moves Forward ••• PUBLIC POLICY NETWORK••• PUBLIC POLICY NETWORK

• Establish initial and continuing

professional education programs

for EMS personnel in the emergency care of infants and children;

• Conduct an education program to

inform the public about EMSC,

including how and when to access

emergency telephone numbers;

• Collect and analyze statewide pediatric emergency and critical care

medical services data for the purpose of quality improvement;

• Establish a cooperative interstate

relationship to facilitate the provision of appropriate care for pediatric patients who must cross state

borders to receive emergency and

critical care services; and

• Collaborate with other public and

private organizations interested or

involved in emergency and critical

care for children.

For more information about this

bill, visit the Oregon State Legislature

web site at www.leg.state.or.us. 

On August 2, 2001, Oregon

Governor John Kitzhaber,

MD, (D), signed into law S.B.

243, making Oregon the 20th state to

pass legislation mandating an Emergency Medical Services for Children

(EMSC)-related measure or program.

The law’s enactment was due largely

to the advocacy efforts of Michael

Howles, an Oregon resident whose

daughter was the victim of a bicycle

accident nearly two years ago.

The bill, sponsored by State Senator Peter Courtney (D-Salem/Keizer),

provides for the establishment of an

EMSC program within the state of

Oregon’s Health Division. Specifically,

it calls for the program to operate in

collaboration with the Emergency

Medical Services (EMS) and Trauma

Systems program to: 

• Provide technical assistance to the

State Trauma Advisory Board on

the integration of EMSC into the

statewide EMS and trauma system;

• Establish an EMSC Advisory 

Committee;

• Develop guidelines and protocols

for facility designation, prehospital

care, acute care, and rehabilitation

services;

4 EMSC News NOVEMBER/DECEMBER 2001

Oregon Passes EMSC Legislation
health and emergency medical services initiatives and to increase the

level of assistance the centers provide

on incorporating EMSC into larger

programs. 

In addition to collecting input

about the technical services provided

by the resource centers, EMSC solicited and received the following feedback

on the Program’s web site, listserv,

newsletter, clearinghouse, and National Congress on Childhood Emergencies.

EMSC Web Site

• Make the web site faster and easier

to navigate.

• Enhance customer-service orientation.

• Create scheduled, live interactions

among NEDARC, NRC, and grantees

to exchange information and

resources.

EMSC Listserv

• Tally queries submitted through the

listserv (e.g., high-frequency

queries), and make the results available to all interested parties.

• Promote the EMSC listserv to state

coordinators and others so that it is

more freely utilized.

EMSC News

• Advertise its on-line availability.

• Include more family-centered 

topics/issues.

• Expand information about state programs, and profile model programs.

• Include a section on alternative

funding opportunities.

EMSC Clearinghouse

• Improve the response time for

requested products and materials.

• Fine-tune the tracking system.

National Congress

• Create a venue to publicize and profile model programs.

During the 2001 Annual EMSC

Grantee Meeting, held June 3-

5, attendees participated in a

special, closed-door session to provide

critical input and feedback on the

EMSC Program and its resources and

services. Approximately 55 of the 250

attendees participated in the session.

The comments were far-reaching and

will be examined in detail by EMSC

National Resource Center (NRC) staff

and federal project officers.

Of primary interest to the EMSC

Program was how grantees viewed its

two resource centers: the NRC, located

in Washington, DC, and the National

EMSC Data Analysis Resource Center

(NEDARC), located in Salt Lake City,

UT. Overall, grantees felt that both

centers were doing an excellent job in

meeting the day-to-day needs of their

programs. They appreciated staff participation in regional meetings and

encouraged their continued and

expanded involvement. Several

grantees commented on the centers’

orientation procedures for new

grantees. 

“A common concern was that staff

need to spend more time orienting

grantees to each center’s functions and

services,” said Jane Ball, DrPH, RN,

NRC’s executive director. “Others referenced a need for new grantees (as

well as seasoned grantees) to receive

information about state programs that

can serve as national models for other

states to replicate.” NRC is looking to

address both concerns by developing

an enhanced New Grantee Orientation

Packet. Other outreach activities are

being considered to meet the educational needs of seasoned grantees. 

Two additional suggestions offered

at the meeting were to increase the

centers’ use of state expertise when

creating new maternal and child

• Continue to move the site of the

Congress around the country to

increase accessibility for all

grantees.

These suggestions are only a sampling

of the responses gathered at the evaluation sessions. The EMSC Program

appreciates and welcomes all feedback and input you may have as it

continues to address the growing

needs of its grantees.

Grantees Provide Valuable Feedback on EMSC Program Resources

EMSC News NOVEMBER/DECEMBER 2001 5

NHA Nominations Now

Being Accepted

Nominations are now being

accepted for the 2002 EMSC

National Heroes Award. Winners will be honored during an

Evening Gala at the Third National

Congress on Childhood Emergencies,

April 15-17, in Dallas, TX. Awards 

will be presented in the following 

categories.

• EMSC Project Coordinator of 

Distinction

• EMSC State Achievement Award

• Outstanding EMS Provider of 

the Year

• EMSC Parent Volunteer of the Year

• EMSC Community Partnership of

Excellence

• Innovation in EMSC Product or

Program Development

• Excellence in EMSC Research

• Sate EMSC Legislator/Governor 

of the Year

• EMSC Lifetime Achievement 

Forms and information about the criteria and application process can be

downloaded from the EMSC website,

www.ems-c.org, or call Leslie Green,

at 202.884.6879.
6 EMSC News NOVEMBER/DECEMBER 2001

EMSC Identifies Top 10 Reasons for Visits to EDs by

Children Aged 0-21

As reported in the September/

October 2001 issue of EMSC

News, the National Center for

Health Statistics (NCHS) recently

released the data from its 1999

National Hospital Ambulatory Medical

Care Survey (NHAMCS). Additional

analysis of the data by the EMSC Program has identified the 10 leading reasons why children aged 0 to 21 years

visit the emergency department (ED). 

Several years ago, a comprehensive report on these and related data

was drawn from the results of the

1994 NHAMCS and published in 1996

as the Child and Adolescent Emergency Department Visit Databook,

one of EMSC’s most popular and highly-regarded publications. The EMSC

Program will use the 1999 data to 

continue its progress toward updating

the Databook.

According to EMSC Research Specialist Isabelle Melese-d’Hospital, PhD,

preliminary analysis of the 1999

NHAMCS database revealed that fever

is the primary reason for ED visits

among children aged 0 to14 years,

while adolescents aged 15 to 21 years

visited the ED most often for abdominal pain and cramps (see Table 1,

page 7). Secondary and tertiary reasons for children aged 0 to 4 years to

visit the ED were vomiting and coughing, while children aged 5 to 9 and 15

to 19 years sought care for sore throat

and upper extremity lacerations.

Motor vehicle accidents were more

common reasons for visits among

older youth, particularly those

between 15 and 21 years of age. This

is probably due to the legal driving age

and increased likelihood of traveling with

driving peers, says Melese-d’Hospital. 

cut here

The editors of EMSC News want to

make sure you don’t miss a single

issue. If you have recently moved or

the contact person for your organization has changed, please let us

know by completing the below

EMSC News Subscription Update

Request and mailing it to: Leslie

Green, Communications Assistant,

EMSC National Resource Center,

111 Michigan Avenue, NW, 

Washington, DC 20010.

Have You Moved?

EMSC News 

Subscription

Update Request

Current Subscription 

Information

Name:

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Street Address:

City, State, and Zip:

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In 1999, 15% of school-age children (aged 6 to 17 years) visited the

ED within the past 12 months. Schoolage children living below the poverty

threshold were much more likely than

non-poor children to have had a

recent ED visit (21% compared to

14%). Unfortunately, the survey did

not address severity of symptoms. It is

therefore difficult to draw conclusions

about whether EDs are being used

appropriately by children and their

parents. In addition, EMSC has not yet

examined diagnosis data, which may

serve as a proxy for severity. 

NCHS began gathering, analyzing,

and disseminating information about

the care provided by hospital EDs and

outpatient departments in 1992. From

1992 to 1999, the volume of ED visits

increased by 14%. In fact, an estimated

102.8 million visits were made to hospital EDs in 1999, about 37.8 visits per

100 persons. However, reported ED

visits within the past 12 months

among all children aged 17 years and

younger have shown a decline, with

those having one or more ED visits

falling from 19.9% to 17.9%, and those

with two or more visits dropping from

7.1% to 5.5%. 

Acknowledgment: For assistance with

data processing and frequency runs,

EMSC would like to thank Lawrence

Cook, MStat, of the National EMSC

Data Analysis Resource Center in 

Salt Lake City, UT.
EMSC News NOVEMBER/DECEMBER 2001 7

Table 1: Top 10 Reasons for Visits to the ED by Children Aged 0-21

Child’s Age Infants Preschool Elementary Middle School High School Youth

Group (<12months) (1-4 yrs) (5-9 yrs) (10-14) (15-19) (20-21)

Total No. of 3,839,850 7,957,471 5,439,640 4,645,372 7,207,712 3,550,512

Visits

% of Total 13.33% 27.63% 18.89% 16.13% 25.03% 12.33%

ED Visits

Reason #1 Fever Fever Fever Fever Abdominal Abdominal

pain, Cramps pain, Cramps

Reason #2 Vomiting Cough Cough Earache Sore Laceration/

throat cut upper

extremities

(arm, hand)

Reason #3 Cough Vomiting Sore Abdominal Laceration/ MVA

throat pain, cramps cut upper injury**

extremities

(arm, hand)

Reason #4 Crying, Laceration/ Earache Injury - fall, headache Cough

fussy, cut in facial other accident

irritable area

Reason #5 Nasal Earache Vomiting Sore throat MVA Back pain

congestion injury**

Reason #6 Labored Skin Abdominal Hand/finger Laceration Chest

breathing rash pain, Cramps injury cut in facial pain

area

Reason #7 Head cold, Accident* Laceration/ Headache Chest Sore 

URI cut in facial pain throat 

area

Reason #8 Injury to Injury to Injury to Laceration/ Fever Injury to 

head/neck/ head/neck/ head/neck/ cut upper head/neck/

face, TBI face, TBI face, TBI extremities face, TBI

(arm, hand)

Reason #9 Skin Labored Injury - fall, MVA Back pain Laceration/

rash breathing other accident Injury** cut in facial

area

Reason #10 Diarrhea Nasal Laceration/ Ankle pain, Cough Uterine/

congestion cut lower ache vaginal

extremities bleeding

(ankle, foot) 

Source: 1999 NHAMCS Reasons for ED visits.

*Not otherwise specified

**Motor Vehicle Accidents
8 EMSC News NOVEMBER/DECEMBER 2001

3rd National 

Congress on 

Childhood 

Emergencies

April 15-17, 2002

Dallas, TX

Taking Action, Saving Lives

*To obtain a copy of the Exibitor

and Sponsorship Information

Guide call (202)884-4927.

NCSEMSTC to Develop Guidelines on Pediatric

Prehospital Continuing Education 

T

he Health Resources and

Services Administration’s

Maternal and Child Health

Bureau (MCHB) recently awarded

an EMS Partnership for Children

(PFC) contract to the National

Council of State Emergency Medical Services Training Coordinators (NCSEMSTC) to develop

guidelines for pediatric continuing

education as it relates to licensing

and certification of prehospital

providers. 

Under the contract’s scope of

work, NCSEMSTC will conduct an

analysis of available data and current literature on prehospital

provider skill retention/deterioration trends to assess the status of

national pediatric prehospital certificate and license renewal training requirements. NCSEMSTC will

distribute the findings from the

analysis at a consensus conference it will organize to help develop recommendations for future

pediatric continuing education

programs. These recommendations will be used to develop

guidelines, which are due to

MCHB in final form on April 30,

2002.

The PFC is a multidisciplinary consortium of 17 national

and professional organizations

contracted by MCHB to help

implement the EMSC Program’s

Five-Year Plan. In addition, PFC

representatives meet twice a year

to share information, discuss

common interests, and identify

opportunities for collaboration.

NCSEMSTC is the newest member of the consortium.

NCSEMSTC was established in

1977 to promote the training of

EMS personnel based on sound

educational principles, current

medical knowledge, and practice.

The Council seeks to standardize

nationwide training curricula, certification/recertification policies

and procedures, and the reciprocity of certification from state to

state.

For more information about

NCSEMSTC, visit www.ncsemstc.org.

On August 3, 2001, the U.S.

Senate confirmed Jeffrey

Runge, MD, as the 12th

administrator for the Department

of Transportation’s National Highway Traffic Safety Administration

(NHTSA). Dr. Runge is a nationally

recognized physician expert in the

area of motor vehicle injury care

and prevention. As NHTSA’s

administrator, Dr. Runge will lead

an agency of more than 600

employees with a $403 million

annual budget. 

NHTSA is primarily responsible for reducing deaths, injuries,

and economic losses resulting from

motor vehicle crashes and for

enhancing comprehensive emergency medical service systems.

NHTSA co-administers the EMSC

Program.

EMSC Welcomes New

NHTSA Administrator 
EMSC News NOVEMBER/DECEMBER 2001

Health and Human Services

(HHS) Secretary Tommy

Thompson recently announced

that HHS plans to award hundreds of

“micro-grants” to community organizations for activities that support the

goals of Healthy People 2010, the

nation’s public health agenda for the

next decade.

Worth up to $2,010 each, the

micro-grants represent a new, low-cost

approach to foster effective prevention

efforts at the community level. Each

grant will support efforts by local

groups to promote health education,

quality care, access to care, and other

projects that support the far-reaching

national health goals of Healthy People

2010. Faith-based organizations will be

among those eligible to apply for funding.

“This is a new idea for HHS, a

way to leverage very small grants into

very widespread action,” Secretary

Thompson said. “Though small in

size, these grants can have a large

impact by tapping the potential of

local organizations to make a difference in the lives of the people closest

to them.”

Healthy People 2010 has established a broad set of goals and specific

targets for improving the nation’s

health over the next 10 years and, for

the first time, has identified the Leading Health Indicators—10 high-priority public health challenges. The plan

is grouped into focus areas devoted to

a comprehensive array of diseases,

conditions, and public health challenges, such as promoting exercise,

reducing obesity, and discouraging

tobacco use.

HHS Announces New “Micro-Grants” to Enlist Community

Support for Health Goals

HHS will launch the new microgrant initiative with a two-year pilot

project. If successful, the approach

could be expanded nationally. HHS

will commit between $500,000 and

$700,000 to the pilot project this year.

“The application will be easy to

complete, so local groups can tap the

money quickly and then focus immediately on health promotion projects

in their communities,” HHS Acting

Assistant Secretary for Health Arthur

Lawrence said. “We anticipate that

much of the process will be handled

electronically.”

HHS will choose several not-forprofit organizations or groups of organizations to recruit, review, and

award grant applications in different

geographic areas. 

For more information, including

application procedures, go to

www.health.gov/healthypeople/

Implementation/Community/

default.htm.

9

What Do We Tell Our Kids?

Talking with Children After Tragedy

I

n the wake of the September 11,

2001, terrorist events, the EMSC

National Resource Center received

numerous telephone calls, faxes, and

e-mails from EMSC grantees, partners,

and friends asking the Program to post

general information and guidance on

how to help comfort children during

times of tragedy. 

Some of the information that was

collected in the days following the

events is summarized below.

Providers, parents, and teachers, as

well as all adults, are encouraged to

apply the information when speaking

to children and adolescents about loss

and disaster-related anxiety.

• Acknowledge their fear and take it

seriously. At the same time continuously reassure your children that

you will help to keep them safe. 

• Turn off the television. Overexposure to the media can be traumatizing. If your older children are

watching the news, be sure to watch

with them. 

• Be aware that your child’s age will

affect his or her response. Adolescents in particular may be hard hit

by these kinds of events. Obtaining

counseling for a child or adolescent

soon after a disaster may reduce

long-term effects. 

• Calmly express your emotions.

Remember that a composed

demeanor will provide a greater

sense of security for your child. 

• Let your children ask questions,

talk about what happened, and

express their feelings. 

• Answer their questions directly but

don’t give them more information

than they are asking for or that

they need. 

• Give your children extra time and

attention, and plan to spend more

time with your children in the following months. 

• Play with children who can’t talk

yet to help them work out their

fears and respond to the atmosphere around them. 

• Keep regular schedules for activities

such as eating, playing, and going to

bed to help restore a sense of security and normalcy. 

• Remind children of other national

tragedies (e.g., the bombing of Pearl

Harbor and the Challenger Space

Shuttle explosion) and explain that

life goes on and the United States

does overcome these tragedies. 

• Consider how you and your child

can help. Children are better able

to regain their sense of power and

security if they feel they can help

in some way.

continue on page 12
K

O

Florida

In July at the quarterly meeting of

the state’s EMS Advisory Council, the

Florida Department of Health’s EMS

Bureau awarded its first annual Emergency Medical Services for Children

(EMSC) Award to Lou Romig, MD. The

award is given to an individual or

organization demonstrating dedication

to the care of ill or injured children 18

years of age and younger in at least

one of the following areas: education,

clinical care, community service, or

disaster management. 

For more information, contact

Melia Jenkins at melia_jenkins@doh.

state.fl.us.

Guam

During this year’s celebration of

National EMS Week and National

EMSC Day, the Guam EMSC team 

visited child care centers and public

schools to present information on

injury prevention. Staff also participated in a mini-fair at the local mall, featuring fire-prevention

characters Smokey and

Sparkey. In addition,

EMSC staff helped

numerous other

state agencies to

celebrate the

observances by

working with

them to re-enact

an auto-collision

rescue effort, present water and boating safety information

to local elementary school

students, and promote Operation Buckle Down events and

key messages.

In appreciation for their participation, Guam’s EMSC program

would like to thank the Guam Fire

Department’s EMS and Rescue, the

Department of Agriculture’s Forestry

Division, the Department of Education’s Early Intervention Program and

Student Support Services Section, the

Guam International Airport Authority’s Aircraft Rescue Fire Fighting,

the Department of Public Works’

Office of Highway Safety, the U.S. Air

Force EMS, the Department of Parks

and Recreation’s Swimming Pool Division, the Guam Police Department’s

Highway Safety Patrol, the U.S. Coast

Guard Auxiliary, the Office of Civil

Defense, and Guam Memorial Hospital.

For more information, contact

Theresa Morrison-Quinata at

Taquinat@mail.gov.gu.

Illinois

Chicago Children’s Memorial Hospital and EMSC of Illinois have developed a training CD-ROM entitled

“Child Maltreatment Awareness.” The

CD is provided in PowerPoint format

and includes three levels of training:

EMS, teacher, and police. It also

includes slides and speaker notes with

a voice-over script to provide training

by lecture format or self-study. It is

approximately two hours in length.

Copies are available for $10 each from

Peter Lazzara at (773) 880-8262 or at

plazzara@childrensmemorial.org. 

For more information, contact

Patricia Sikorski at psikors@wpo.

it.luc.edu.

S

tate of the States

•

Gr

a

ntee Up ad oC et nr er

•

S

tate of the States

•

Gr

a

ntee Up ad oC et nr er

•

10 EMSC News NOVEMBER/DECEMBER 2001

Fire Prevention Characters Smokey and Sparky work with EMSC staff from Guam to distribute safety promotion

materials to children at a local mall during National EMSC Day 2001.
J

EMSC News NOVEMBER/DECEMBER 2001 11

y

www.ems-c.org

EMSC News is

available on-line,

free of charge, 

at www.ems-c.org

Once there, click on 

“What’s New” to access the 

current newsletter, as well as 

all back issues.

health units, child care

centers, clinics, hospitals,

ambulance services, and

the general public. The

brochure is divided into

four sections: When to

Call An Ambulance for A

Child, Calling for Help—

What You Will Need to

Provide, What to Do Until

Help Arrives, and Be Prepared Before An Emergency Occurs. 

For more information about the brochure, contact

Shelly Arnold at (701) 328-1026 or

sarnold@state.nd.us.

Washington, DC

Washington, DC’s EMS and Children with Special Health Care Needs

(CSHCN) project recently rolled out

their prehospital educational program, SCOPE (Special Children’s Outreach and Education Program). The

goal of the program is to increase prehospital providers’ awareness of

CSHCN, as well as their knowledge of

and comfort level with caring for

chronically ill and technology-dependent children in emergency situations. The SCOPE program includes a

self-study manual, lecture, three videoenhanced skill stations, and a post-test. 

For more information, contact

Betsy Smith, RN, at elsmith@cnmc.org.

Wisconsin

The Wisconsin EMSC program is

working with state officials on the Safe

Place For Newborns legislation, which

was enacted on April 3, 2001, to provide a safe place for unwanted newborn babies in lieu of abandonment,

injury, or death. The bill mandates the

provision of confidential protective

shelter, medical care, and treatment

in a hospital setting to babies reasonably believed to be up to 72 hours old.

The Wisconsin EMSC Advisory Board,

in collaboration with the Bureau 

of EMS and Injury Prevention, has

developed guidelines for EMS

providers and law enforcement personnel to accept and care for infants

who are abandoned. 

For more information, contact

Mary Jean Erschen, RN, BSN, at (608)

266-7457 or erschmj@dhfs.state.wi.us. 

a

j

Mississippi

On August 18, 2001, the Mississippi EMSC program participated in the

third annual celebration of “A Kid’s

World 2001: For Smart Parents & Cool

Kids” in Jackson, MS. More than

14,000 children and adults attend the

event each year to shop for the latest

“cool kids stuff” and to interact with

experts in children’s health care, education, and extracurricular activities.

The event featured the Scooby Doo

and friends back-to-school musical

revue, “Scooby’s School Daze.” Mississippi EMSC distributed child safety

information to parents, as well as

activity books, coloring books, and

stickers to the children. 

For more information, contact

Keith Parker, RN, at kparker@msdh.

state.ms.us. 

North Dakota

The North Dakota EMSC program

has completed a brochure entitled

“When to Call An Ambulance for A

Child.” Approximately 30,000

brochures of the 50,000 printed have

already been distributed to state public

As part of the EMSC Day Celebration, children

from Guam had the opportunity to get their 

picture taken with Sparky.
••••••••• ••••••••• •••••••••LATEST LIBRARY ADDITIONS DDITIONS DDITIONS••••••••• ••••••••• ••••••••• LATEST LIBRARY ADDITIONS

• Murphy, Rick and Siegle, Derek.

“Speaking the Same Language:

PSWN Works to Improve Communications in EMS.” EMS: The Journal

of Emergency Care, Rescue and

Transportation. 30, No. 8 (2001):

39-41.

• Phelan, Kieran; Khoury, Jane; Kalkwarf, Heidi; and Lanphear, Bruce.

“Trends and Patterns of Playground

Injuries in United States Children

and Adolescents.” Ambulatory

Pediatrics. 1, No. 4 (2001): 227-33.

• Ray, R. Mark and Senders, Craig.

“Airway Management in the Obese

Child.” Pediatric Clinics of North

America. 48, No. 4 (2001): 1055-63.

• Sheridan, Robert and Schnitzer,

Jay. “Management of the High-Risk

Pediatric Burn Patient.” Journal of

Pediatric Surgery. 36, No. 8 (2001):

1308-12.

If any interesting publication or product (written or produced within the

last 18 months) has crossed your desk

that you would like to share, please

contact the EMSC National Resource

Center Medical Librarian, Kathryn

Willis, at (202) 884-6835 or

kwillis@emscnrc.com.

12 EMSC News NOVEMBER/DECEMBER 2001

• Provide physical reassurance with

lots of hugs and touching. 

Immediately following the terrorist events, the EMSC Program posted a

fact sheet to its web site (www.emsc.org) entitled “After the Emergency Is

Over: Post-Traumatic Stress Disorder

in Children and Youth.” This two-page

sheet defines post-traumatic stress disorder, lists common symptoms, and

provides adults with tips on how to

help children and youth who have suffered a traumatic event. The fact

sheet, which is available free of

charge, also lists additional resources

to help children cope with disaster.

What Do We Tell Our Kids? from page 9

• Aitken, Mary; Rowlands, Leigh Ann;

and Wheeler, J. Gary. “Advocating

for Children’s Health at the State

Level: Lessons Learned.” Archives

of Pediatric and Adolescent Medicine. 155, No. 6 (2001): 877-80.

• American Academy of Pediatrics,

Committee on Injury and Poison

Control. “School Bus Transportation

of Children with Special Health

Care Needs.” Pediatrics. 108, No. 2

(2001): 516-18.

• Becknell, John. “Searching for Best

Practices.” EMS: The Journal of

Emergency Care, Rescue and 

Transportation. 30, No. 8 (2001): 32.

• Bernardo, Lisa Marie; Gardner,

Mary Jane; O’Dair, Joan; and

Cohen, Beth. “The PAWS Program:

Pediatric Animal Awareness and

Safety.” Journal of Emergency

Nursing. 27, No. 4 (2001): 387-90.

• Casaubon, Denise. “EMTALA: Practical Application with an Algorithm.” Journal of Emergency

Nursing. 27, No. 4 (2001): 364-68.

• Gallagher, Carolyn. “Before the

Call: How EMS Outreach Can Help

Kids.” EMS: The Journal of Emergency Care, Rescue and Transportation. 30, No. 8 (2001): 76-79.

• Hohenhaus, Susan McDaniel. “Pediatric Emergency Preparedness in

Schools: A Report From the 2001

Southeastern Regional EMSC Annual Meeting.” Journal of Emergency

Nursing. 27, No. 4 (2001): 353-56.

• Kincaid, Edward; Chang, Michael;

Letton, R.; Chen, John; and Meredith, J. Wayne. “Admission Base

Deficit in Pediatric Trauma: A

Study Using the National Trauma

Data Bank.” Journal of Trauma:

Injury, Infection, and Critical Care.

51, No. 2 (2001): 332-35.

• Lassman, Janet. “Pedestrian Safety–Teaching Points and Resources

for ED Nurses Educating the Community.” Journal of Emergency

Nursing. 27, No. 4 (2001): 360-363.

• Mercy, James; Kresnow, Marcie-jo;

O’Carroll, Patrick; Lee, Roberta;

Powell, Denneth; Potter, Lloyd;

Swann, Alan; Frankowski, Ralph;

and Bayer, Timothy. “Is Suicide

Contagious? A Study of the Relationship Between Exposures to the

Suicidal Behavior of Others and

Nearly Lethal Suicide Attempts.”

American Journal of Epidemiology.

154, No. 2 (2001): 120-127.
EMSC News NOVEMBER/DECEMBER 2001 13

NEDARC’s New QI Workshop Features . . . Catapults?

F

or many, the word “catapult”

might signify the threat of imminent warfare or the tossing of

small individuals. However, for the 25

attendees at the National EMSC Data

Analysis Resource Center’s (NEDARC)

Quality Improvement (QI) Workshop

on August 2-3, 2001, in Portland, OR,

the catapult was used as a unique tool

for statistical manipulation and team

strategy. 

NEDARC’s new QI Workshop featured a statistical exercise using statapults, small, wooden catapults

designed specifically for training students in statistical process control and

control charting. Racing against the

clock, attendees divided into teams

and took turns flinging a ball from

their statapult and recording its distance. Though performance was weak

on each team’s first sequence, a combination of statistical instruction,

chart development, group brainstorming, and team planning enabled EMSC

grantees to improve their performance

“All of the materials and concepts presented at this workshop can be transferred to

projects I am working on,

helping me to identify areas

to improve and streamline

the process.”

—Workshop attendee

The workshop also featured a

group QI analysis activity during

which teams of people were asked to

examine a common EMS problem

within their states, identify a data

request, and explore quality improvement ideas based on their data. Each

group was then asked to develop

posters to present their findings and

recommended solutions. Many groups

found that, just as in real life, the

data were more complicated to work

with than originally thought. 

“It was interesting to see how

tough it was for our group to try to

ask the right questions and find solutions based on the data we obtained,”

said Shelly Arnold, North Dakota’s

EMSC project coordinator. 

NEDARC provides technical

assistance to EMS providers and

EMSC grantees to help states develop

their own data collection and analysis

capabilities. To assist in this effort,

NEDARC hosts several one-day workshops each year to help educate

grantees on data issues, typically

through a series of presentations on

topics such as statistics, data collection, program evaluation, communicating data, or grant writing. The

August QI Workshop was the first

two-day, topic-specific workshop

NEDARC has offered, and the first to

be able to incorporate so much audience participation. 

“We get much more interaction

among participants when there’s just

one topic of discussion,” said Michael

Dean, principal investigator for

NEDARC and instructor at the conference. “I think people liked this format. We’ll be trying to have workshops more like this in the future.” 

Printed with permission from Steve Berry.

at a surprising rate by their second

try. The exercise was intended to

demonstrate the power of statistical

and quality improvement in a way

that attendees could see right before

their eyes.

“This was a unique way of giving

us a basic understanding of statistics

and showing how data can help with

quality improvement,” said Petra

Menzel, Virginia’s EMSC project 

coordinator. 
14 EMSC News NOVEMBER/DECEMBER 2001

Erschen, RN, BSN, of the Wisconsin

Department of Health and Family 

Services’ EMSC Program. “Plans are

under way to hold more workshops 

in 2002, especially in Wisconsin’s

rural areas.

“We hope to reach many educators, all of whom are responsible for

teaching basic lifesaving skills to meet

the recently revised Wisconsin Department of Public Instruction’s standards

of education,” said Erschen.

Wisconsin’s EMSC Program would

like to thank the University of Wisconsin’s Department of Health Education,

Children’s Hospital of Wisconsin, the

Northland Affiliate American Heart

Association, Children’s Health Education Center, the Department of Public

Instruction, and the Injury 

Prevention Section of the Division of

Public Health for helping to sponsor

this event.

For more information, contact

Erschen at (608) 266-7457 or

erschmj@dhfs.state.wi.us.

Wisconsin Is “Ready with BELSS On!”

On July 30-31, 2001, at the 

University of Wisconsin in

Madison, primary and secondary educators from throughout the

state gathered to learn about a new

and exciting comprehensive educational model designed to incorporate

basic emergency lifesaving skills training into the school curriculum. The

Basic Emergency Lifesaving Skills

(BELSS) model, developed by more

than 25 national organizations and

medical institutions, provides educators with a framework for teaching 

and reinforcing such topics as injury

prevention, first aid, and cardiopulmonary resuscitation (CPR). 

The framework is divided into

developmental, age-appropriate templates that are taught each year, beginning with kindergarten. Using the Wisconsin Comprehensive School Health

process, workshop participants

learned how to incorporate each template into the health, math, sciences,

and arts curriculums. The overall goal

is to ensure that students are proficient in lifesaving skills upon graduation from high school. 

In addition to BELSS, the two-day

workshop included information about

emergency planning and how to collaborate with community health and

safety partners, such as emergency

medical services, fire, law enforcement, public health, and emergency

management. It included a track for

those who were interested in becoming certified CPR and automatic

external defibrillation instructors. 

It also featured the National Fire 

Protection Association’s Risk Watch

Program for elementary educators,

the American Red Cross Community

First Aid Program for middle school

educators, the American Heart Association’s CPR in the Schools Program,

and the Children’s Hospital of Wisconsin’s public access defibrillation

program (known as Project ADAM) for

high school educators. Participants

received one complimentary copy of

each program’s

workbook to

take back to the

classroom.

“Participant

evaluations were

overwhelmingly

positive,” said

Mary Jean
EMSC News NOVEMBER/DECEMBER 2001 15

T

his high-energy clown is preparing for his next journey on

board the “Junglemobile,” a refurbished ambulance used by

Denver-area Kiwanis club members and EMS providers to

educate children, aged 5 to 11 years, about injury prevention.

Since May 2000, the colorful, eye-catching traveling road show has

visited 30 rural and frontier communities and provided more than

75 free car seats. 

The Junglemobile is a collaborative effort between the Colorado Department of Public Health and Environment’s Prehospital

Care Program, EMS for Children Program; the Kiwanis Pediatric

Trauma Institute; Children’s Hospital of Denver; and St. Anthony’s

Hospital of Denver.

Roving Reporter

What’s the biggest threat to a

child’s health? If you asked

the average parent with

school-age children this question,

what would their answer be? Probably

not car crashes. Most parents believe

their children are safe in their own

car. Yet, according to the National

Highway and Traffic Safety Administration (NHTSA), motor vehicle crashes are the leading cause of death for

children aged 6 to 14 years. “During

1999, an average of seven children

younger than 15 years of age were

killed and 872 were injured in motor

vehicle crashes every day in the United States,” says Laurie Flaherty,

NHTSA, “It’s a silent epidemic.”

That’s why February 10-16, 2002,

is National Child Passenger Safety

(CPS) Week. NHTSA wants to get the

word out that children need to be

properly restrained—every trip, every

time. More than half of children who

are fatally injured are completely

unrestrained. CPS Week is also a time

to teach parents and caregivers how

to properly restrain children. More

than half of all child seats are misused. Even more, it’s a week to take

action, to prevent children from being

killed or hurt in car crashes.

Participation in the observation

of CPS Week can take place at many

levels, such as: 

• Distributing free NHTSA brochures,

videos, posters, or reproducible

handouts to children and their 

parents within your community.

• Using “teachable moments” to ask

and counsel children and their parents about child seat use. Parents

and caregivers are most open to

receiving prevention and preparedness messages just after their child

has had an emergency.

• Referring parents and caregivers to

trained CPS technicians in your

community to have their car seat

checked. To identify local techniCelebrate National Child Passenger Safety Week

February 10-16

cians in your area, access NHSTA’s

web site at http://www.nhtsa.dot.gov/

people/injury/childps/Contacts/

index.cfm.

• Sponsoring or participating in a 

car seat check.

• Becoming an advocate for stronger

child passenger safety laws in your

state.

• Actively supporting the enforcement of CPS laws.

For more information about

becoming an advocate for or an

enforcer of CPS laws or to order free

materials, contact Laurie Flaherty in

NHTSA’s Office of Communication and

Outreach at (202) 366-2705 or lflaherty@nhtsa.dot.gov, or visit the NHTSA

web site at www.nhtsa.dot.gov. Once

there, click on “Child Passenger Safety.”
EMSC News NOVEMBER/DECEMBER 2001

EMSC National Resource Center

Children’s National Medical Center

111 Michigan Avenue, N.W.

Washington, DC 20010

2001

••••••••• IMPORTANT DATES TO REMEMBER ••••••••• ••••••••• IMPORTANT DATES TO REMEMBER ••••••••• ••••••••• IMPORTANT DATES TO REMEMBER •••••••••

n

PRSRT STD

Postage and

Fees

Paid HRSA

Permit No. G-286

16

November

National Family Caregivers Month

National Family Caregivers Association

Contact: Suzanne Mintz at 

(301) 942-6430 or

(800) 896-3650

November 7-9

National Association of Children’s 

Hospitals and Related Institutions

Annual Meeting

Arlington, VA

Contact: (703) 684-1355

November 7-11

American School Health Association

Annual Conference

Albuquerque, NM

Contact: (330) 678-1601

November 13-14

California EMSC

Annual Meeting

San Diego, CA

Contact: Michael Conley at

(916) 322-4336, ext. 461

November 28-29

Annual School Nurse Conference

North Charleston, SC

Contact: Susan Nichols at 

(803) 943-5052

December

Drunk and Drugged Driving 

Prevention Month

National Highway Traffic Safety

Administration

Contact: Evelyn Avant at 

(202) 366-2679

December

Safe Toys and Gifts Month

Prevent Blindness America

Contact: Betsy Zandee at 

(800) 331-2020

December 1

World AIDS Day

American Association for World Health

Contact: Emily Adams at 

(202) 466-5883

December 3-5

Centers for Disease Control 

and Prevention

Safe USA Conference

Atlanta, GA

Contact: (888) 252-7751

January 10-12

National Association of 

EMS Physicians

Annual Meeting

Tucson, AZ

Contact: (800) 228-3677

January 26-30

National Safe Kids Campaign

Leadership Conference

Washington, DC

Contact: (800) 662-0600

EMSC SALUTES

OUR HEROIC EMS

COMMUNITY