Volume 15 | Number 2 | Spring 2002

Pediatric

Disaster

Preparedness: 

EMSCnews

Emergency Medical Services for Children Newsletter

inside this

ISSUE

Pages 2-7

Disaster Preparedness

Special Section

Page 8

Six Targeted Issue

Grants Awarded

Page 9 

Seven EMSC

Symposium

Supplemental Grants

Awarded

Page 10 

State of the States

Page 11 

CPEM Releases

Paramedic TRIPP

Tools and

Information 

for the EMS

Provider

Pediatric

Disaster

Preparedness:

Tools and

Information 

for the EMS

Provider
Preparing EMS for Acts

of Violence/Terrorism

Involving Children

by Richard Aghababian, MD

Acts of terrorism are horrible events aimed at

innocent and unsuspecting victims that are

intended to create fear, insecurity, panic, and

chaos within a society. Some of these acts are identifiable

immediately, bombings and hijackings for example.

Others are more insidious, such as those involving biological, chemical, or radioactive agents. 

Unfortunately, individuals who are inclined to plan terrorist activities are just as likely

to include children as victims. It might even be argued that the most vicious terrorist

groups could intentionally target children. It is therefore critical that emergency/disaster

medical professionals play a pivotal role in detecting, planning, and managing the 

consequences of terrorism.

One such tool already available to the emergency response community is the

Pediatric Disaster Life Support (PDLS) course, which was developed to enable physicians, nurses, and emergency medical technicians (EMTs) to better care for children 

victimized by disaster. 

History of PDLS

The impetus for the PDLS course was a workshop sponsored by the Emergency

Medical Services for Children (EMSC) Program in September 1995. The workshop

focused on the problems of managing children during disasters. A set of recommendations developed by the attendees included the need for a course that would heighten

awareness that children require different medical care and emotional support during and

after experiencing a disaster. 

For the inexperienced responder it was felt that children are difficult to accurately

assess because they respond differently than do adults to the types of injuries and illness

associated with catastrophic events. While the PDLS course focuses heavily on the

impact of natural disasters on children, a portion of the course is devoted to school 

violence and intentional disasters. For example, the Columbine School shootings serve

as a case study in one of the course workshops. Several of the lectures also addressed

the injuries and the psychological impact that the bombing of the federal building in

Oklahoma City had on the children who were in day care centers in and around the 

building. Like the Oklahoma City tragedy, the events of September 11 have once again

heightened our awareness of the vulnerability of children to acts of terrorism.

Future Directions for PDLS

Future directions for the PDLS course and other training activities sponsored by

EMSC must take into consideration the heightened risk of terrorist activity. The U.S.

emergency/disaster response network must be better trained and supplied to handle 

pediatric needs, because an inadequate response to an event involving large numbers 

of children will produce the panic and chaos sought by the terrorist perpetrators. 

EMSC Program Project Officers,

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 quarterly 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. 

Cover photos courtesy of FEMA.

© 2002 EMSC Program. All rights reserved.

EMSCnews

2

disaster pr
Specifically, the PDLS course should be

revised to include greater emphasis not only

on the physical impact of terrorism on children

but on the psychological impact as well. Many

new lessons have been learned from the

events of September 11, and old lessons

revisited. As with the Oklahoma City bombing,

many children in New York City and

Washington, DC, lost a parent. The children

had no opportunity to prepare for their loss, or

the mammoth publicity surrounding these

events during which many parents perished. 

Disasters affect a child’s psychological

well being in a number of ways. I personally

learned new lessons while assisting with the

care of postal workers in New York City who

had been exposed to anthrax spores. As we

counseled the individuals who were at risk for

exposure in the use of the antibiotics, I began

asking if they truly intended to use the medication. Some parents said that they intended

to give the antibiotic, which was Cipro in most

cases, to their children to protect them from

anthrax. Clearly antibiotics were not indicated

for the children of the postal workers, nor was

the use of Cipro well advised for their children. Some workers also feared hugging or

touching their children when they returned

from work for fear of transmitting the anthrax.

Contact avoidance by a parent would clearly

have a psychological impact on a child unable

to understand the reasoning behind the parent’s behavior.

Revisions for School

Disaster Plans

Greater emphasis should also be

placed on revising school disaster

plans to make them more adaptable to

any situation that involves mass illness

or injury, including acts of violence or

terrorism. For example, we must pay

particular attention to the early identification and management of biological

attacks, such as the use of salmonella,

E. coli 0157:H7, or other hazardous

agents that could be used to contaminate the school food supply. Release 

of a nerve gas in or near a school would put 

a sudden strain on the emergency medical

system. Airway equipment, pediatric intensive

care beds, and pediatric doses of the antidotes 2-PAM and atropine would be rapidly

depleted at the local level. 

School plans should include mutual aid

arrangements, interfacing with fire, law

enforcement, and public health agencies.

Crisis response teams should also be available to manage the psychological needs of

the victims and rescuers. 

Clearly much work remains to be done in

preparing our country to adequately respond

to deliberate attacks by terrorists as well as 

all other potential disaster scenarios. Perhaps

EMSC should plan another workshop to

assess the adequacy of our preparedness to

handle the needs of children in disaster now

as compared with 1995. I would be happy to

see the PDLS course revised to address the

deficiencies in our knowledge or preparedness

that would be identified through such a meeting.

• • • 

About the Author: Richard Aghababian, MD, is

the chairman of the Department of Emergency

Medicine for the University of Massachusetts

Medical School (UMMS) in Worchester, MA. 

He also is the former president of the American

College of Emergency Physicians. For information about Dr. Aghababian’s two-day PDLS

course, contact UMMS at (508)856-4101.

JumpSTART: 

A Disaster

Preparedness Tool

for the Times

by Lou Romig, MD

Disasters are on our minds more than

ever these days. The events of the

past year have made us very aware

of our national, organizational, and personal

vulnerabilities. Any tool that can help us deal

with any aspect of natural, industrial, or intentional disasters is a hot commodity, not only 

in street-based emergency medical services

(EMS) but also in all areas where EMS may

have to be rendered. 

One such tool is JumpSTART, a system

modeled after the widely recognized START

(Simple Triage and Rapid Treatment) program,

which is designed to help rescuers quickly

and accurately categorize pediatric patients

into treatment groups. The program was

developed to assist in maximizing outcomes

for the greatest number of multicasualty 

incident patients by addressing the unique

anatomy and physiology of children. By providing age-specific guidelines, JumpSTART

also helps to counter the negative emotional

aspects of pediatric triage decision-making. 

Current Progress of

JumpSTART

The JumpSTART program was progressing well and garnering significant support

before September 2001; now it’s hard to keep

up with the requests for information. By year’s

end, JumpSTART will have been presented at

six national conferences and at multiple

regional and statewide conferences. At least

three states have mandated or strongly recommended that their EMS constituents use

JumpSTART, and interested agencies in five

EMSC NEWS SPRING 2002 3

Continue on page 4

eparedness
• Pediatric-sized protective equipment 

for personnel;

• Child care for the children of disaster

response workers;

• Plans for the decontamination of

pediatric patients;

• Training for the triage of pediatric

patients in mass-casualty events; and

• Disaster shelters for children with 

special health care needs.

The Rhode Island EMSC program is

devoting approximately 25% of its effort to

developing disaster preparedness plans for

pediatric issues. 

Following Lawrence’s presentation,

Lou Romig, MD, medical director for the

South Florida Regional DMAT, presented

on pediatric issues in terrorism. Dr. Romig

informed workshop participants that children are often found in large groups, such

as in child care centers, which are frequently located in or close to places of

business. According to Dr. Romig, children

are at an increased risk of injury in case of

a terrorist attack because they may not

understand what’s happening and may be

physically or developmentally unable to

rescue or protect themselves. In addition,

the extreme emotional responses of the

public and rescuers to an attack involving

children may affect the ability of rescuers

to do their jobs. Dr. Romig also provided an

overview of the JumpSTART Rapid

Pediatric Training System. This triage tool

is designed for use in multicasualty disasters that include large numbers of children.

The tool is applicable to children aged 1 to

8 years.

During the next presentation, entitled

“Addressing the Diverse Needs of Families

During Disasters,” Florida Institute for Family

Involvement Executive Director Connie Wells

provided valuable information on how the

EMS community can effectively integrate 

disaster pr

4 EMSC NEWS SPRING 2002

other states have requested information about

the program. 

JumpSTART is also included in the curriculum for the Pediatric Disaster Life Support

course and a soon-to-be-released National

Association of School Nurses school emergency course. A year ago, it was made into a

video by the Virginia EMSC program. In addition, it is our hope that JumpSTART will be

distributed with the color-coded pediatric disaster medication guide currently being developed by Jim Broselow, Bob Luten, and others. 

Future Challenges to

JumpSTART

Like many new concepts it is only through

validation that we can ensure a program’s

impact and usefulness at the local and national

levels. An effort must be made to validate the

techniques used in JumpSTART—a most difficult task in the triage arena where there is no

“gold standard.” We must also look at skills

and knowledge acquisition and retention.

In addition, in the face of chemical and

biological terrorism, can/should JumpSTART

(and START) include agent-specific triage systems for incidents involving weapons of mass

effect? 

In conclusion, let us remember that disasters are equal-opportunity destroyers, with

effects reaching far beyond any Ground Zero.

To believe that our children will not be affected

is simple ignorance and denial. Indeed, our

children may be more vulnerable and more

tempting as targets than any of us want to

think. We no longer have any excuse to

ignore children’s issues in disasters, not on

organizational levels and certainly not within

our own families.

• • • 

About the Author: Lou Romig, MD, is 

the medical director for the South Florida

Regional Disaster Medical Assistance Team.

For more information about her JumpSTART

program, contact Dr. Romig at louromig@

bellsouth.net.

On January 31, 2002, the Maternal

and Child Health Bureau’s (MCHB)

EMSC Program and the Florida

Department of Health’s EMSC project sponsored Pediatric Disasters, a preconference

workshop to the 23rd Annual International

Disaster Management Conference (IDMC), at

the Rosen Plaza Hotel in Orlando, FL. More

than 45 participants attended the conference

to learn about the unique needs of children

who are involved in natural or intentional disasters. An overview of each speaker’s presentation is provided below.

Dan Kavanaugh, MSW, EMSC project

officer for MCHB, and Phyllis Stenklyft, MD,

principal investigator for the Florida EMSC

project, opened the workshop and provided

an overview of the Program’s most recent

EMSC disaster-related initiatives. These

include the Pediatric Disaster Life Support

course, “After the Emergency Is Over: Posttraumatic Stress Disorder in Children and

Youth” fact sheet, the 1998 Consensus

Statement on Children’s Emergencies in

Disasters, and the recently funded targeted

issue grant, “Model Pediatric Component for

State Disaster Plans.” 

Tom Lawrence, NREMT-P, EMSC project

coordinator for Rhode Island and deputy

team leader for the Rhode Island Disaster

Medical Assistance Team (DMAT), provided 

a summary of the new Rhode Island Disaster

Initiative, a well-funded state initiative to

improve overall state disaster preparedness.

As both the EMSC coordinator and deputy

commander for DMAT, Lawrence is able to

ensure that the needs of children are integrated into state disaster planning. 

According to Lawrence, the following

pediatric needs should be addressed in a

state’s disaster preparedness plan:

• Pediatric-sized equipment and 

medication doses;

EMSC Sponsors IDMC Preconference

on Pediatric Disasters

JumpSTART...(cont.)
eparedness

families into disaster planning. According to

Wells, to help prepare families for a disaster

EMS professionals must be able to:

• recognize and understand the factors that

contribute to family diversity, 

• learn how to strengthen a family’s knowledge of and reaction to disasters, despite

diversity; and 

• identify necessary approaches to successfully engage diverse familes. 

Her presentation segued nicely into a

discussion of family-centered care by

Tommy Loyacano, MPA, NREMT-P, chief of

operations for the East Baton Rouge EMS

Department. Loyacano took a lead role in

helping the National Association of EMTs to

develop recommendations for implementing

family-centered care within the prehospital

environment. For more information about

these recommendations, read “NAEMT

Develops Recommendations for Familycentered Prehospital Care,” published in

the January/February 2001 issue of EMSC

News or visit www.ems-c.org.

The Pediatric Disasters Workshop also

included a presentation on a unique EMS

outreach program for children with special

health care needs (CSHCN) based at

Children’s National Medical Center (CNMC).

Betsy Smith, RN, NREMT-P, said the purpose of the CNMC program is to keep EMS

providers informed about the unique medical needs of CSHCN. “Informed EMS

providers are much more capable of

responding to children with chronic illnesses

or physical disabilities,” said Smith. 

The closing workshop speaker was

Cheryl Gurley, LCMH, NCC, from the

Devereux Mental Health Services for

Children in Orlando, FL. Gurley discussed

the impact disasters have on a child’s mental health and the common signs and symptoms associated with development of mental health issues in children.

EMSC Comrades

Help NYC Victims:

Reflections on the

9/11 Disaster

Daniel Kavanaugh, MSW, LCSW-C

EMSC Program Project Officer, MCHB

On September 16, Lieutenant Commander

Daniel Kavanaugh was deployed to New York

City to provide mental health support to federal

personnel responding to the World Trade Center

(WTC) disaster.

Kavanaugh is a member of the Department

of Health and Human Services’ Commissioned

Corps Readiness Force (CCRF), a cadre of

United States Public Health Service (USPHS)

officers who can be mobilized in times of disaster or other public health emergency. 

Upon arrival in New York City (NYC),

Kavanaugh was detailed to the USNS Comfort

and worked alongside the Navy’s Special

Psychiatric Rapid Intervention Team (SPRINT).

The mission of the USNS Comfort was to provide logistical support and services to emergency relief personnel. 

Following are some of Kavanaugh’s thoughts

and reflections about his 15-day experience.

“Every day, hundreds of police officers,

firefighters, and government workers came

aboard the ship for meals, a place to sleep,

and, most importantly, support. The 11-member

SPRINT team showed great flexibility, changing

from what they thought would be the initial

focus of their mission—caring for the wounded

from the WTC attack—to caring for the needs

of the relief workers who were working at

Ground Zero. The USNS Comfort became a

place where the relief workers could get physical and emotional nourishment in the midst of

their very difficult work.

“On day four a need was identified for

mental health support at the Office of the Chief

Medical Examiner, where approximately 150

members of the Disaster Mortuary Operational

Response Team (DMORT) had been deployed

to assist the city in its efforts to rapidly identify

the victims of the disaster. DMORT is a federal-level response team consisting of medical examiners, forensic pathologists, mental

health specialists, funeral directors, dental

assistants, and DNA specialists. 

“As one can imagine, the activity level

at the Medical Examiner’s office had

increased dramatically as a result of the

WTC disaster. DMORT personnel were

divided into two groups, each covering a 12-

hour shift. I covered the day shift (7:00 a.m.–

7:00 p.m.) while a colleague, Lieutenant Beth

Henson, covered the night shift (7:00 p.m. –

7:00 a.m.). With this arrangement, a mental

health specialist was available around the

clock for consultation or support. 

“The provision of mental health services within this environment takes on a very

different form than what is traditionally provided within an office or hospital. Those

working in this environment are typically

well-functioning people who may be struggling with the disruption and stress caused

by the disaster. It is important not to pathologize their feelings, but rather to help them

see that the stress they are experiencing is

a normal reaction to a traumatic event. I

saw my role as three-pronged: to provide a

safe place for personnel to talk about the

events; to “cruise the halls” to see if people

were getting sufficient sleep, food, and

break time; and to assist in problem solving

any areas of concern. We were also available to provide debriefings for those who

were returning home. 

“This is the first time that I have worked

on the victim identification side of a disaster.

I was impressed by the DMORT’s teamwork,

camaraderie, and willingness to take on any

tasks needed to assist the people of New

York City. I learned that the task of victim

identification is one that does not get a lot 

of press, but it is a critical need in a mass

casualty event. Through identification of 

victims, families who have experienced a

horrible loss can gain some sense of closure

and lessen the uncertainty that they may

have felt when they were living in the state

of not knowing.” 

EMSC NEWS SPRING 2002 5

Continue on page 6
disaster pr

6 EMSC NEWS SPRING 2002

people pushed their way in the opposite

direction trying to escape the fire and dust

inferno that had engulfed the Island.

“Once the triage center location was

established, countless ambulances arrived,

providing much-needed medical supplies.

Conference tables served as makeshift treatment and surgical suites. The triage center

remained active until late into the night. At

one point, the center was quickly evacuated

as the dust plume rising from the collapse of

World Trade Center building #7 pushed past

the volunteer medical team.

“PAD investigators remained at the

Brooklyn Marriott Hotel for several days following the terrorist attack offering first aid,

food, and shelter to displaced Manhattan residents in a large ballroom provided by the

hotel. When a window of opportunity opened

up for attendees to finally leave New York

City, most chose to drive home rather than

face the apprehension of flying. 

“Among the most heroic PAD attendees

was Thomas Holohan, an organizer of the

New York PAD meeting and a New York firefighter who gave his life in service to his city

on that day. It is our hope that this life-changing experience (and our memories of it) will

honor the heroic men and women of the New

York Fire Department and Police Department

who willingly sacrificed all to protect the citizens of New York City on that day.”

Tom Lawrence, NREMT-P, I/C

EMSC State Coordinator for Rhode

Island and Deputy Team Leader for

the Rhode Island Disaster Medical

Assistance Team

“My day on September 11 began as any

other, but like all other Americans, it changed

suddenly at 8:48 a.m. Within one hour of the

first attack on the World Trade Center, I along

with other members of the Rhode Island

Disaster Medical Assistance Team (RI-1

DMAT) was placed on high alert. We immediately began activating other team members,

ordering vans and trucks to transport the

team and its equipment, and looking after all

will never forget. 

“A month later, on October 22, I was

deployed to DC General Hospital in

Washington, DC, to help test individuals for

anthrax. The testing consisted of swabbing

both nostrils, recording contact information

and potential location of exposure, and education. From the swabbing station, the participant was then sent to an onsite pharmacist to receive a 10-day supply of the appropriate antibiotic and/or to an onsite physician for further evaluation, if desired. This

too was a remarkable experience that made

me appreciate how so many people, who

once seemed to have such different functions, could come together in a time of

great difficulty.” 

N. Clay Mann, PhD, MS

National EMS Data Analysis

Resource Center

On September 11, 2001, approximately 86 investigators associated with the

Public Access Defibrillation (PAD) Trial

gathered at the Brooklyn Marriott Hotel in

New York City for a PAD Steering

Committee Meeting. Clay Mann was one of

those who attended the meeting. Below is a

description of what he saw and did to help

the victims of the World Trade Center.

“When the strike happened the meeting attendees were evacuated into the

streets of Brooklyn. We all witnessed the

burning and eventual collapse of the WTC

Towers from the Brooklyn promenade. 

“In terror and grief, the physicians,

nurses, and other meeting participants

sprang into action, demonstrating fearless

control and true humanity as they attempted to respond to the enormity of the disaster. Within the hour, local fire personnel

attending the conference commandeered a

city bus and requested that conference

attendees travel to Manhattan Island to set

up an initial treatment center near Ground

Zero through which patients could be

triaged to local hospitals. As the bus began

its journey toward Ground Zero, countless

Betty Hastings, MSW

Traumatic Brain Injury Program

Director, MCHB

On September 22, Lieutenant Betty

Hastings was deployed by the Office of

Emergency Preparedness (OEP) to provide

mental health and emergency medical treatment at Ground Zero in New York City.

Hastings is a member of the USPHS’s Public

Health Service-1 Disaster Medical Assistance

Team (PHS-1 DMAT). Following her eightday tour of duty, Hastings submitted a report

to her superiors. The following excerpts are

from that report. 

“Being deployed to Ground Zero was

the saddest and the greatest honor ever

bestowed upon me. Words, photographs, and

television cameras will never capture what it

was like to have stood in the wreckage. The

smell, endless billowing smoke, noise, and

immeasurable human spirit I witnessed will

stay with me forever. 

“Some days I still can’t believe this really

happened. The magnitude of this event forbids me from being able to wrap my heart

and mind around it, as I believe we are not

built to process this type of devastation all 

at once. 

“As I stood in the temporary West Street

Morgue, waiting to give emergency workers a

good-will basket of Vicks Vapor Rub and

Hall’s cough drops—which was to help with

the smell and prevent nausea—word came

from the ‘pile’ that the bodies of 15 firefighters had just been uncovered. The bodies

were being brought up one-by-one. It was at

that moment, when I saw the first stretcher

with a body wrapped in the American flag

being carried by five or so firefighters, that I

realized I was standing in the presence of the

spirit of America’s bravest and most courageous public servants. To have served my

country as a public health service officer,

among such great heroes, is an honor that I

EMSC Comrades...(cont.)
eparedness

EMSC NEWS SPRING 2002 7

of the details of a major mobilization.

“DMATs are part of the National

Disaster Medical System (NDMS). Twentyfour level one DMAT teams currently exist in

the federal system. Level one status is

reserved for those teams that are staffed,

equipped, and ready to deploy with 6 to 12

hours notice. A deployed DMAT team is

composed of 35 physicians, nurses, paramedics, EMTs, other health care providers,

and support personnel, and is able to provide health care in an austere environment

for up to 72 hours without resupply.

“By 10:30 p.m. on September 11, 

57 members of the RI-1 DMAT left our sponsoring Rhode Island Hospital in 11 vans and

two large trucks for Stewart Air Force Base

(AFB) in Newburgh, NY. We were escorted

by state police cars at the front and rear of

the convoy due to the tight restriction on

travel into New York City. We arrived at

Stewart AFB at 5:00 a.m. and were directed

to a very large airplane hanger that would

be home for several days. We were quartered with other DMATs, military personnel,

and other responding agencies.

“The next morning, 120 members from

four DMAT teams left Stewart in another

escorted convoy, this time to Ground Zero.

During the next two days, we set up five

field hospitals around the ‘pile,’ and treated

nearly 8,000 disaster workers during the

next two weeks. 

“Field hospitals were set up in the

courtyard at Manhattan Community College,

a delicatessen on Liberty Street, tents at

Church Street and One World Financial

Plaza, and the lobby of the American

Express Building. Injuries involved those to

the eyes, soft tissue, respiratory system, and

musculoskeletal system. About 180 patients

were treated in a typical 8- to 12-hour shift. 

“The first teams in to Ground Zero were

rotated out and replaced with other teams

after 15 days. The Rhode Island team

returned home on the afternoon of

September 26.”

PED-SAFE-T, a targeted issue grant

awarded by EMSC for the purpose of

conducting ambulance crash safety

tests to observe the performance of these

vehicles and a variety of occupant and equipment restraint practices currently available or

in use for pediatric transport, has seen some

major milestones in this last year.

“Since relocating the project to Columbia

University in New York City, the project has

attracted the attention of many colleagues

both nationally and internationally,” said

Nadine Levick, MD, the grant’s principle

investigator. “In the last year, I have presented to several EMS, pediatric, injury, and

engineering audiences both in the U.S. and

abroad.” Most recently Dr. Levick served as

a keynote speaker at the Swedish National

EMS Congress and as a speaker at the

Australian Military Automotive Safety and

Emergency Services Conference.

Ambulance Crash Testing for the 

Safe Transport of Children Draws

International Interest

Her work has been featured in three

peer-reviewed engineering publications and

on the Discovery Channel. The most significant event, however, was her involvement 

in the coordination of an international symposium on EMS vehicle safety under the 

auspices of the Society of Automotive

Engineering (SAE). The symposium was

such a success that Dr. Levick was nominated for SAE’s Woman of the Year award.

EMSC would also like to congratulate

Dr. Levick for being named the director of

pediatric emergency services at Harlem

Hospital Center in New York City, the director

of the Harlem Hospital Injury Prevention

Program and the principle investigator of one

of five cooperative grants for the Network

Development Demonstration Project, an

EMSC Program award funded by MCHB.

For more information about the PEDSAFE-T targeted issue grant, please contact

Dr. Levick at nadine.levick@columbia.edu.

Guidelines for Providing FamilyCentered Prehospital Care by the

National Association of Emergency

Medical Technicians (2000)

This product, the result of a consensus

panel meeting, presents guidelines and recommendations for family-centered care practices in the prehospital setting, including family presence during out-of-hospital care and

transport and child and family member safety

during transport. The guidelines also address

effective methods for communicating with

family members and how to deal with prehospital healthcare provider stress. This

product is available on-line, free of charge, at

www.ems-c.org/downloads/doc/Guidelines.doc.

After the Emergency Is Over: 

Post- Traumatic Stress Disorder in

Children and Youth by the EMSC

National Resource Center (2001)

This two-page fact sheet defines posttraumatic stress disorder (PTSD), lists common symptoms of PTSD, and provides tips on

how to help children and youth who have suffered a traumatic event. The product is available on-line, free of charge, at www.ems-c.org/

downloads/pdf/ptstress.pdf. The cost per 100

hard copies is $5. Request product #901. 

To obtain hard copies of these products,

contact the EMSC Clearinghouse at (703) 902-

1203 or access the online order form through

the EMSC web site at www.ems-c.org. Once

there, click on “Products and Resources.”

What’s New? An EMSC Product Update
Six Targeted Issue Grants Awarded in FY 2002

I

n January 2002, the Maternal and Child

Health Bureau awarded six new EMSC

targeted issue grants, each of which

addresses a specific pediatric health care

need or concern and has regional and/or

national significance. These three-year grants

typically yield new products, data and

research findings, clinical practice guidelines,

and model programs. 

The objectives of each new grant are

listed below by grant title, organization, and

principal investigator. 

Pediatric Continuous Quality

Improvement (CQI) Model Project;

Michigan State University,

Kalamazoo Center for Medical

Studies; William Fales, MD

The objectives of this grant are to:

• Create a pediatric-focused CQI model 

and determine its impact on protocol 

compliance; 

• Develop and pilot-test the pediatric-focused

CQI Program (PCQI); 

• Implement the PCQI in randomized 

agencies throughout Michigan; and

• Measure protocol compliance before and

after the implementation of PCQI.

For more information about this grant,

contact Matthew Wilton, EMT-P, at

wilton@kcms.msu.edu.

Basic Emergency Lifesaving Skills in

Schools—A Model for Replication in

WI, MN, ND, and SD; Wisconsin

Department of Health and Family

Services; William Perloff, MD, PhD,

and Leslie Oganowski, PhD

The objectives of this grant are to:

• Increase the number of high school graduates in Wisconsin, Minnesota, North

Dakota, and South Dakota who are proficient in cardiopulmonary resuscitation, first

aid, automatic external defibrillators, safety

skills, and knowledge; 

• Ensure that the programs are offered using

current, interactive, age-appropriate curriculums that are culturally competent; 

• Establish a community safety network that

supports the delivery of these skills in

schools and continued awareness and use

of these skills in everyday life; and

• Support the implementation of an efficient

Emergency Preparedness Plan in school

districts.

For more information about this grant, 

contact Mary Jean Erschen at

erschmj@dhfs.state.wi.us.

Model Pediatric Component for

State Disaster Plans; Harlem

Hospital, Columbia University

–College of Physicians and

Surgeons; David Markenson, MD

The objectives of this grant are to:

• Build a coalition of experts from the fields

of pediatrics, disaster planning, emergency medicine, emergency response,

trauma, and mental health; 

• Utilize the expertise of the coalition to

build a consensus as to the appropriate

methodology for the development of a

model assessment method of both state

disaster plans and recent disaster incidents that are inclusive of the specific

needs of children; and

• Use the information gained from the

assessment models to develop a Model

Pediatric Component (MPC) for use in

state disaster planning.

For more information about this grant, 

contact David Markenson, MD, at

dsm2002@columbia.edu.

Screening and Secondary

Prevention for Psychological

Sequelae of Pediatric Injury;

University of Pennsylvania School of

Medicine; Flaura Winston, MD, PhD

The objectives of this grant are to:

• Refine, validate, and disseminate a

screening protocol; 

• Develop and pilot-test multiple secondary

prevention modules; and

• Create and disseminate practical evidencebased guidelines for EMS providers.

For more information about this grant, 

contact Susan Passante at

passante@mail.med.upenn.edu.

Model Training for Safe

Transportation of Children with

Special Health Care Needs;

Connecticut Children’s 

Medical Center; Eileen Henzy, MPH

The objectives of this grant are to:

• Describe the challenges faced by families

regarding safe transportation of their child

with special health care needs; 

• Develop a model training program for 

rehabilitation specialists that addresses 

selection and basic use of special needs

restraint systems; and 

• Implement and evaluate the efficacy of 

the model training program for product 

dissemination.

For more information about this grant, 

contact Eileen Henzy, MPH, at 

ehenzy@ccmckids.org.

Beyond the Barriers: Project 

EQUIP; University of Iowa; 

Dianne Atkins, MD

The objectives of this grant are to:

• Develop a pediatric cardiac arrest quality

improvement program for prehospital

providers; 

• Establish reporting methods to disseminate

information from the quality assurance 

program to the Iowa Bureau of EMS and

EMS providers; 

• Develop education methods to convey 

information from objectives one and two 

to EMS providers; and

• Analyze the impact of data analysis and

instructional programs on long-term 

outcomes.

For more information about this grant, 

contact Dianne Atkins, MD, at 

dianne-atkins@uiowa.edu.

8 EMSC NEWS SPRING 2002
Seven Regions Receive EMSC

Symposium Supplemental Grants

Seven EMSC coalitions will receive

awards of up to $50,000 each to

develop a regional meeting and to

help support activities that encourage collaboration and resource sharing. The funding

period for these one-year EMSC Regional

Symposium Supplemental Grants is February

1, 2002, through January 31, 2003. The 

tentative dates and topics for each meeting

are listed below by region/coalition name:

Heartland EMS for Children

Coalition (HECC)

Member states: Iowa, Kansas, Minnesota,

Nebraska, North Dakota, and South Dakota 

Meeting dates: September 12-14, 2002, in

Minneapolis, MN. Topics to be addressed:

Trauma/EMS, injury prevention, poison 

control centers, grant writing, rural health,

systems development, Basic Emergency

Lifesaving Skills, and family-centered care. 

For more information about the 

HECC Meeting, contact Claudia Hines at

claudia.hines@childrenshc.org.

Southeast EMSC Regional 

Council (SERC)

Member states: Alabama, Florida, Georgia,

Kentucky, Mississippi, North Carolina, South

Carolina, and Tennessee. Meeting date: Fall

2002 in Orlando, FL. Topics to be addressed:

Mass casualty planning, communication during a disaster, trauma system assessment,

and pediatric issues in state disaster plans.

For more information about the SERC

Meeting, contact Rhonda Phillippi at 

rhonda.phillippi@mcmail.vanderbilt.edu.

New England EMSC Region

Member states: Connecticut, Maine,

Massachusetts, New Hampshire, Rhode

Island, and Vermont. Meeting dates: January

4-5, 2003, at Ascutney Mountain Resort, in

Ascutney Mountain, VT. Topic to be

addressed: Regional informational sharing.

For more information about the New

England Meeting, contact William Clark at

wclark@vdh.state.vt.us.

Intermountain Regional EMSC

Coordinating Council (IRECC)

Member states: Arizona, Colorado, Idaho,

Montana, Nevada, New Mexico, Utah, and

Wyoming. Meeting dates: September 11-14,

2002, in Park City, UT. Topics to be

addressed: Information sharing on such 

topics as suicide and injury prevention, data

systems, technology-driven systems, and

training/education

For more information about the IRECC

Meeting, contact Breck Rushton at brushton@doh.state.ut.us.

Southcentral EMSC Region (SEC)

Member states: Arkansas, Louisiana,

Oklahoma, and Texas. Meeting date:

September 2002 in San Antonio, TX.

Topics to be addressed: EMS and emergency

department protocols and guidelines for

pediatric patients, EMSC data collection,

system design and analysis, family-centered

care, and integration of EMSC into EMS

For more information about the SEC

Meeting, contact Ron Hilliard at

ron.hilliard@tdh.state.tx.us.

Mid-Atlantic Regional EMSC

Member states: Delaware, District of

Columbia, Maryland, New Jersey, New York,

Pennsylvania, Virginia, and West Virginia 

Meeting dates: October 10-11, 2002, in

Baltimore, MD. Topics to be addressed:

Data collection and research, injury prevention and control, clinical models of excellence in the emergency care of children, and

systems and policy development

For more information about the MidAtlantic Meeting, contact Cynthia WrightJohnson at cwright@mdems.umaryland.edu.

Center of America Regional EMSC

(CARE)

Member states: Illinois, Indiana, Michigan,

Missouri, Ohio, and Wisconsin. Meeting

date: October 2002 in Indianapolis, IN.

Topics to be addressed: Information sharing

and exchange

For more information about the CARE

Meeting, contact Denise Giddens at 

dmgidden@iupui.edu.

In addition, the following territories will take

part in these regional symposia:

• Puerto Rico will attend the SERC Regional

Symposium.

• American Samoa will attend the HECC

Regional Symposium.

• Guam and the Northern Mariana Islands

will attend the IRECC Regional

Symposium.

EMSC NEWS SPRING 2002 9

New Web Page 

for Children and

Youth with TBI

Now Available

The Traumatic Brain Injury Technical

Assistance Center (TBI TAC), funded

by the Health Resources and

Services Administration’s Maternal and Child

Health Bureau, invites EMSC News readers

to visit its new Children and Youth with TBI

web page located within the TBI TAC web

site at www.tbitac.org. Once there, click on

the Tool Box section. 

This new page is part of the Center’s

children and youth with TBI initiative, which is

designed to help states improve the integration of children and youth into their existing

TBI projects and initiatives. It features information on emerging TBI and disability-related

education issues; successful strategies for

implementing TBI initiatives; and new products and resources for families, teachers, and

other school personnel.
h

Q

u

10 EMSC NEWS SPRING 2002

the out-of-hospital setting. An intended audience of out-of-hospital

providers, school nurses,

emergency room personnel, and critical care

unit providers will take

part in this lecture

and scenario-based 

training.

In other news,

a snowball effect

has been created

due to the successful

kickoff of last year’s

Pediatric Patient Care

— It’s In The Bag project.

Numerous EMS services

have partnered with local

Kiwanis organizations in an effort to

increase their knowledge and equipment

base for pediatric patient care. 

To date, 11 services in Iowa have received

the equipment and training. Successful

treatment of a pediatric patient has been

attributed to usage of the bag. 

For more information about either of

these activities, contact Katrina Altenhofen

at KAltenho@ health.state.ia.us.

New York

The New York State EMSC program

has released its EMSC Prehospital Pediatric

Care course, a continuing education course

for statewide use. Developed for EMSC by

the Fire Department of New York City, EMS

Training Division, the course contains eight

lessons, including one on children with special health care needs. The course is

designed to be used by EMS agency training officers in order to reach as many field

providers as possible. 

For more information, contact Gloria

Hale at ghc08@health.state.ny.us.

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

•

Continue on pages 11

w

Utah

The Utah EMSC program reports the

following:

• On November 29 and 30, 2001, the Great

Western Pediatric Symposium was held in

Salt Lake City. The conference focused on

trauma with tracks in EMS and intensive

care. 

• JumpSTART triage and children with special health care needs continue to be topics

of interest at statewide EMS seminars and

conferences, at the university, and at local

hospital and agency events.

• The Bureau of EMS is now accepting the

American Academy of Pediatrics’ Training

in Pediatric Education for Prehospital

Professionals (PEPP) — Advanced Life

Support (ALS) course as well as the

American Heart Association’s Pediatric

Advance Life Support course for paramedic

pediatric certification requirements.

• In the last year, the Utah EMSC Program

completed nine “before PEPP” PALS Plus

courses, 11 PEPP-ALS courses, and two

Coordinator Orientations courses.

• With the award of the three-year EMSC

Enhancing Pediatric Patients Safety Grant,

Dale Maughan, RN, EMT-P, will join the

program in 2002. 

For more information, contact Peter

Morris at pmorris@doh.state.ut.us or contact

Bryony Orwick at bnorwi0@uky.edu. As

always, we look forward to receiving any

additional comments or suggestions.

Washington

Cardiopulmonary resuscitation (CPR) is

a skill that can save lives. In 1999,

Washington State EMSC made it an objective to develop successful approaches to

increase the number of Washington State

high school students who receive CPR training prior to graduation. To that end, the

Washington State EMSC project has developed a resource manual for high school

administrators, parents, and teachers to use

in developing CPR student training programs.

K

Florida

Florida EMSC is delighted to announce

that it has published its statewide EMSC

needs assessment. It is available on the web

at www.doh.state.fl.us/emsc. Based on the

needs assessment findings, Florida is drafting a three-year EMSC plan with the help of

an ad hoc committee composed of representatives from EMSC-related disciplines, as

well as family advocates. On January 31,

Florida’s EMSC program co-sponsored a

Pediatric Disaster Module at the Florida

Emergency Management Foundation’s 23rd

Annual International Disaster Management

Conference. 

For more information, contact Melissa

Bassett at Melissa_Bassett@doh. state.fl.us.

Iowa

Blank Children’s Hospital in Des

Moines, IA, has been selected as a pilot site

to conduct one of the six Prehospital

Pediatric Care courses. The course was

developed by the National Association of

EMTs and is considered an in-depth study of

the care needed for the pediatric patient in
y

EMSC NEWS SPRING 2002 11

Association funded the original PHASE

study. Specially trained paramedic data collectors provide 24/7 coverage, interviewing

field personnel immediately following the call

to eliminate recall bias. CPEM is overseeing

the MCHB–funded pediatric component of

the project. The hypotheses being considered are as follows: (1) Ventricular fibrillation

in children experiencing cardiopulmonary

arrest is a more frequent occurrence than

was previously thought; (2) After adjustment

for initial rhythm, the outcome of cardiac

arrest in children is different than that of

adults; and (3) Patients in respiratory arrest

who are “adequately treated” demonstrate

no difference in outcome if they are treated

with bag-valve-mask vs. endotracheal 

intubation. 

In addition, the study will seek to

address the epidemiologic elements, causes,

locations, timing, interventions (by

bystanders, family, and EMS personnel), 

initial cardiac rhythm, and outcomes of all

children younger than 18 years of age who

suffer cardiac or respiratory arrest.

National Child Protection Education Project

In October 2001, a Blue Ribbon Panel

of national experts in EMS, EMSC, and child

protection was convened to review the

results of a nationwide survey of what EMTs

and paramedics know about child abuse and

neglect. The survey, which had a return rate

of 43%, was developed and distributed by

CPEM with the assistance of the National

EMSC Data Analysis Resource Center, the

National Registry of EMTs, and 15 state

EMS offices. The proceedings of this meeting will be published simultaneously in

Pediatric Emergency Care, Prehospital

Emergency Care, and Annals of Emergency

Medicine. A resource for prehospital

providers will also be developed based on

the gaps in education revealed by the

national survey.

For more information about these 

projects, contact Marsha Treiber at

Treiber@cpem.org.

State of the States...

(cont. from page 10)

The Center for Pediatric Emergency

Medicine (CPEM), a joint program of

the New York University School of

Medicine and Bellevue Hospital Center, was

established in 1985 to improve emergency

medical care for children in New York City

and across the United States. With its interdisciplinary staff and access to a national

network of experts in the field, CPEM is

involved in a variety of projects that will have

a positive national impact on the health care

of children in the prehospital setting. A few of

their most current projects are highlighted

below.

Paramedic TRIPP

After delaying release in order to

update the resource with the latest American

Heart Association (AHA) guidelines, the

advanced life support version of the

Teaching Resource for Instructors in

Prehospital Pediatrics (TRIPP) will be available on CD-ROM in April 2002. CPEM will

provide all attendees of the National

Congress on Childhood Emergencies with a

copy of the Paramedic TRIPP. Approximately

50 copies will also be distributed to each

state EMS director and/or training coordinator. Additional CD-ROM copies of this 1,400-

page resource will be available at $10 each.

The resource can also be downloaded, free

of charge, from the CPEM web site at

www.cpem.org. More than 20,000 copies of

the original national award–winning TRIPP

have been distributed in the U.S. and in 38

countries around the world.

Research

Pediatric PreHospital Arrest Survival

Evaluation (PHASE) 

In collaboration with the Fire Department of New York City (FDNY), Division of

EMS, and the New York Academy of

Medicine, CPEM is helping to conduct an

out-of-hospital cardiac and respiratory arrest

study in New York City. FDNY is replicating a

prospective data collection methodology created back in 1989, when the New York Heart

CPEM to Release Paramedic TRIPP,

Initiate Pediatric Research Projects A downloadable copy of the manual is available at www.washingtonemsc.org. Once

there, click on “CPR Student Training.” A

very limited number of hard copies is also

available by contacting Rachel Thompson at

rlt500@att.net. 

Comments and suggestions for

improving the manual are welcomed. For

more information, contact Sheri Reder at

sreder@chmc.org.

Wisconsin 

The Wisconsin EMSC Program combined education with family fun on October

14 and 15, 2001, with the success of the

Second Childhood Emergencies: Prevention

and Management Conference. It was held

at the Kalahari Resort and Conference

Center in Wisconsin Dells, WI.

Approximately 350 attendees — including

physicians; nurses; advanced practitioners;

social workers; pharmacists; first responders; EMTs; paramedics; firefighters; law

enforcement officers; child passenger safety

technicians; administrators, educators, and

staff of Wisconsin schools; child care

providers; parents; and grandparents —

enjoyed the indoor water park and many

excellent presentations on clinical pediatric

care, school health, child passenger safety,

injury prevention, and much more. 

Governor Scott McCallum proclaimed

the week of the conference “Childhood

Emergencies Week” to encourage all citizens to assume an active role in the promotion and improvement of injury prevention

and emergency services for children and to

applaud the work of our emergency care

providers and educators. 

Plans are underway for the 2002 conference, which will be held September 

16-17, at the Kalahari Resort. 

For more information, contact Mary

Jean Erschen at (608) 266-7457 or

erschmj@dhfs.state.wi.us.
2002

April 8-9

American College of Emergency Physicians

Emergency Medicine Connection

Las Vegas, NV

Contact: Stephanie Batson at 

(800) 798-1822, ext. 3274

April 10-13

American Association of Suicidology

Annual Conference

Bethesda, MD

Contact: (202) 237-2280

April 15-17

Emergency Medical Services for Children

3rd National Congress on 

Childhood Emergencies

Dallas, TX

Contact: Heather Crown at (202) 884-6881

April 20-23

American Trauma Society

Annual Meeting

Arlington, VA

Contact: (800) 556-7890

May 6-8

International Association of Fire Chiefs

Annual Meeting

Las Vegas, NV

Contact: (703) 273-0911

May 19-22

American Pediatric Surgical Association

Annual Meeting

Phoenix, AZ

Contact: Michele Stevens at (847) 480-9576

May 22

National EMSC Day

EMSC National Resource Center

Contact: Millree Williams at (202) 884-6843

May 19-25

National EMS Week

American College of Emergency Physicians

Contact: Denise Fechner at (800) 798-1822

June 15-18

General Federation of Women’s Clubs

Annual Meeting

Kansas City, MO

Contact: (202) 347-3168, ext. 144

June 21-25

Kiwanis International

Annual Convention

New Orleans, LA

Contact: Susie Goens at 

(317) 875-8755, ext. 134

June 30–July 1

National Association of School Nurses

Annual Conference

Lake Buena Vista, FL

Contact: Gloria Durgin at (877) 627-6476

July 22-28

National Conference of State Legislatures

Annual Conference

Denver, CO

Contact: Lean Hoff at (202) 624-5400

Important Dates to Remember

EMSC National Resource Center

Children’s National Medical Center

111 Michigan Avenue, N.W.

Washington, DC 20010

PRSRT STD

Postage and Fees

Paid HRSA

Permit No. G-286