Emergency Medical Services for Children Program

As a Level One Pediatric Trauma Center designated by the D.C. government and the American College of Surgeons, Children’s National is uniquely positioned to handle injured patients who are survivors of trauma. This designation, along with D.C. Fire and Emergency Medical Services’ protocols, define which patients should be transported to Children’s National, creating a standardized system for care for such patients in D.C.

Children’s National Emergency Medicine Specialist Pavan Zaveri, M.D., is developing a new simulation course for three District of Columbia hospitals with emergency departments to improve care for children. The course, known as Improving Pediatric Acute Care through Simulation (ImPACTS), will train healthcare providers on how to administer medication and use pediatric medical equipment to improve outcomes and survival for acutely ill and injured infants and children. The work will connect adult community emergency departments with care at Children’s National, aiming to reduce infant morbidity and mortality through higher standards of pediatric emergency care.

The EMSC Program has advocated ensuring that our D.C. Fire and Emergency Medical Services (FEMS) ambulances are all prepared to handle pediatric trauma. Children’s National emergency department physicians visit firehouses to check and see if they have pediatric versions of their equipment. While there, we describe how children aren’t just simply tiny adults and require equipment that is specialized to their size. We encourage firehouses and D.C. FEMS to make sure equipment such as correct needle gauges, pediatric c-collars for immobilization, pediatric papoose boards, pediatric defibrillator pads and other emergency equipment suitable for children is available on ambulances.

Pediatric emergency medicine physicians at Children’s National, who are either board certified or board eligible pediatric emergency medicine specialists or fellows in training, are available to train peers on the use of pediatric medical equipment. These specialists stay up-to-date on D.C. Fire and Emergency Medical Services (FEMS) protocols and work to improve the quality of education to D.C. FEMS healthcare providers. Our D.C. FEMS peers also participate in pediatric rotations at the Children’s National Emergency Department, with our Emergency Department staff accompanying them on grand rounds as they visit patients in their care.

Children’s National staff continue to advocate at the local government level for a voluntary process of recognition for hospitals that stabilize or manage pediatric patients in Washington, D.C. As part of this effort, our team and partners at the D.C. Department of Health and its Health Emergency Preparedness and Response Administration have proposed legislation that would incorporate pediatric expertise in a cabinet-level position in D.C. government, as well as coordinate agencies to recognize pediatric healthcare facilities.

Whether an emergency department has interfacility transfer agreements and guidelines with other area emergency departments or hospitals is one key factor in making sure patients are getting the best care possible, wherever they seek it. The latest survey of local emergency departments by the EMSC-DC program found that 63 percent of area hospitals have transfer agreements (compared with 69 percent nationally) and that 88 percent of area hospitals have transfer guidelines (compared with 76 percent nationally). Having these benchmarks helps us track progress and make improvements to the local emergency healthcare system.

The EMSC-DC Program has guided D.C. Fire and Emergency Medical Services to submit 911 call data to the National EMS Information System to improve data reporting. For example, by analyzing 911 call data, EMSC leadership can identify areas that have a high number of calls and can station more ambulances in those areas – and potentially add training for pediatric emergencies in those areas if trends indicate such a need. In doing so, the region is able to efficiently collect data on health emergencies and analyze the performance of the local healthcare system, leading to better care across all D.C. hospitals and less strain on emergency departments in cases where emergency care may not be needed.