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The Federal EMSC Program Initiative

Early EMS systems were designed to provide rapid intervention for sudden cardiac arrest in adults and rapid transport for motor vehicle crash victims. The specialized care that children require was often overlooked. Pediatricians and pediatric surgeons, identifying poor outcomes among children receiving emergency medical care, became advocates on behalf of their patients. They sought to obtain for children the same positive results that EMS had achieved for adults.

In the late 1970s, Calvin Sia, MD, president of the Hawaii Medical Association, urged members of the American Academy of Pediatrics to develop multifaceted EMS programs that would decrease illness and death in children. Dr. Sia worked with U.S. Senator Daniel Inouye (D-HI) and his staff assistant, Patrick DeLeon, PhD, to generate legislation for an initiative on pediatric emergency medical services for children.

In 1984, Senators Orrin Hatch (R-UT) and Lowell Weicker (R-CT) joined Senator Inouye in sponsoring the first EMSC legislation. C. Everett Koop, MD, then Surgeon General of the United States, strongly supported this measure, as did the American Academy of Pediatrics.

The 1984 legislation led to the establishment of the Emergency Medical Services for Children (EMSC) Program. Two years later, Alabama, California, New York, and Oregon became the first recipients of federal grant money specifically earmarked to improve pediatric emergency medical services.

Since then, EMSC grants have helped all 50 states, the District of Columbia, and five U.S. territories (the Commonwealth of the Northern Mariana Islands, American Samoa, the U.S. Virgin Islands, Guam, and Puerto Rico).

Grant funds have improved the availability of child-appropriate equipment in ambulances and emergency departments; supported hundreds of programs to prevent injuries; and provided thousands of hours of training to EMTs, paramedics, and other emergency medical care providers.

EMSC Program support also has led to legislation mandating EMSC initiatives in several states, and to educational materials covering every aspect of pediatric emergency care. Most important, EMSC efforts are saving kids' lives.

In Fiscal Year 2007, the EMSC Program administered two types of grants: State Partnership and Targeted Issue. In addition, the program funded the Network Development Demonstration Project Cooperative Agreement and the Central Data Management Coordinating Center. A description of each follows.

  • State Partnership grants fund activities that improve, refine, and integrate pediatric care within the state EMS system. In addition, beginning in FY 2006, all new State Partnership grantees had to address three new core program requirements: (1) designate an EMSC program manager to build coalitions, manage projects, and provide leadership for EMSC activities; (2) report annually on performance measures (specific to EMSC), an accountability effort instituted by HRSA to measure the effectiveness of its federal grant programs; and (3) enhance data collection, analysis, and information dissemination efforts

  • Targeted Issue grants are intended to address specific needs or concerns that transcend state boundaries. Typically the projects result in a new product or resource or the demonstration of the effectiveness of a model system component or service of value to the nation. Since FY 2005, many Targeted Issue grants have focused on building an evidence base for pediatric medical practice.

  • The Network Development Demonstration Project Cooperative Agreement demonstrates the value of an infrastructure or network designed to be the platform from which to conduct investigations on the efficacy of treatments, transport, and care responses, including those preceding the arrival of children to hospital emergency departments.  This infrastructure helps overcome historical barriers with establishing an evidence base for pediatric emergency care, such as low numbers of pediatric patients, the lack of rigorous scientific evidence for pediatric practice, and ethical challenges in conducting EMSC studies. In FY 2006, four NDDP cooperative agreements received continuation funds: Children's National Medical Center in Washington, DC; Columbia University in New York City, NY; University of California-Davis in Sacramento, CA; and the University of Michigan in Ann Arbor, MI. These four cooperative agreements collectively form the Pediatric Emergency Care Applied Research Network or PECARN.

  • The Central Data Management Coordinating Center (CDMCC) is operated through a cooperative agreement to provide PECARN with critical data management services, including: electronic data collection; cleaning, storage, and analysis; site monitoring and training in standardized informed consent procedures; research methodology and protocol development; and assistance with Institutional Review Board (IRB) issues.

The federal EMSC Program also supports two resource centers: the EMS for Children Innovation and Improvement Center (EIIC) in Houston, Texas, and the National EMSC Data Analysis Resource Center, located in Salt Lake City, UT. A description of each follows.

  • The EMS for Children Innovation and Improvement Center (EIIC) was established in 2016, building on the work started by the former EMSC National Resource Center in Washington, DC. The EIIC utilizes a clinical systems integrated framework to provide the emergency care continuum with training, support, and tools to use quality improvement methodology. The center focuses on accelerating to improvements in the care received by children in urgent and emergency settings through an infrastructure that ensures routine, integrated coordination of quality improvement activities between key stakeholder organizations and their champions to reduce morbidity and mortality in children. 

  • National EMSC Data Analysis Resource Center (NEDARC) - NEDARC assists EMSC grantees and state EMS offices in developing their own capabilities to collect, analyze, and utilize EMS and other healthcare data to improve the quality of care in state EMS and trauma systems. NEDARC is part of the University of Utah in Salt Lake City, UT.
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