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http://www.ihi.org/resources/Pages/Tools/Ask-Me-3-Good-Questionsfor-your-Good-Dealth.aspx Accessed March 18, 2020 Ismail S, McIntosh M, Kalynych C, et al Impact of video discharge instructions for pediatric fever and closed head injury from the emergency department J Emerg Med 2016;50(3):e177–e183 Jang M, Plocienniczak MJ, Mehrazarin K, et al Evaluating the impact of translated written discharge instructions for patients with limited English language proficiency Int J Pediatr Otorhinolaryngol 2018;111:75–79 Joint Commission Advancing effective communication, cultural competence, and patient-and family-centered care: a roadmap for hospitals Available online at http://Jointcommission.org Accessed April 9, 2019 Kutner M, Greenberg E, Jin Y, et al The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy (NCES 2006–483) Washington, DC: National Center for Education Statistics, U.S Department of Education; 2006 Available online at http://eric.ed.gov/?id=ED493284 Accessed March 18, 2020 McDonnell WM Pediatric emergency medicine In: Donn SM, McAbee GN, eds Medicolegal Issues in Pediatrics 7th ed Elk Grove Village, IL: American Academy of Pediatrics; 2011:141–152 Meaningful Use Available online at https://www.healthit.gov/sites/default/files/resources/022514_nlc_mureq uirementschecklist.pdf Accessed April 8, 2019 Navanandan N, Schmidt SK, Cabrera N, et al The caregiver perspective on unscheduled 72-hour return visits to pediatric acute care sites: a focus on discharge processes Acad Pediatr 2017;17(7):755–761 North Carolina Program on Health Literacy List of tools Available online at http://nchealthliteracy.org/toolkit/toollist.pdf Accessed April 9, 2019 Ray M, Dayan PS, Pahalyants V, et al Mobile health technology to communicate discharge and follow-up information to adolescents from the emergency department Pediatr Emerg Care 2016;32(12):900–905 Saidinejad M, Zorc J Mobile and web-based education: delivering emergency department discharge and aftercare instructions Pediatr Emerg Care 2014;30(3):211–216 Samuels-Kalow ME, Stack AM, Porter SC, et al Effective discharge communication in the emergency department Ann Emerg Med 2012;60(2):152–159 Shoeb M, Merel SE, Jackson MB, et al “Can we just stop and talk?” Patients value verbal communication about discharge care plans J Hosp Med 2012;7(6):504–507 Thomas DG, Bradley L, Servi A, et al Parental knowledge and recall of concussion discharge instructions J Emerg Nurs 2018;44(1):52–56 US Department of Health and Human Services, Indian Health Service Health literacy Available online at http://www.ihs.gov/healthcommunications/health-literacy Accessed March 18, 2020 Wallin D, Vezzetti R, Young A, et al Do parents of discharged pediatric emergency department patients read discharge instructions? Pediatr Emerg Care 2018;29(6):699–704 Wolff M, Balamuth F, Sampayo E, et al Improving adolescent pelvic inflammatory disease follow-up from the emergency department: randomized controlled trial with text messages Ann Emerg Med 2016;67(5):602–609 Wood EB, Harrison G, Trickey A, et al Evidence-based practice: videodischarge instructions in the pediatric emergency department J Emerg Nurs 2017;43(4):316–321 Yamamoto LG, Manzi S; Committee on Pediatric Emergency Medicine, et al Dispensing medications at the hospital upon discharge from an emergency department Pediatrics 2012;129(2):e562 CHAPTER 134 ■ PREHOSPITAL CARE TONI K GROSS, THERESA A WALLS, GEORGE A (TONY) WOODWARD EMS SYSTEMS The term Emergency Medical Services (EMS) is used to refer to emergency or lifesaving care that takes place out of the hospital This could represent the entry point into the continuum of emergency care, interfacility transports, and medical care delivered in austere environments This chapter will cover prehospital EMS care, encompassing the initial response to emergency calls, the dispatch of personnel, as well as the triage, treatment, and transport of patients EMS operates at the intersection between health care, public health, and public safety ( Fig 134.1 ), but its primary mission is emergency medical care EMS systems in the United States were initially developed primarily to treat medical problems that are prevalent in adults, with limited attention to the special needs of children Despite this, many sick or injured children will enter the EMS system for initial evaluation, treatment, and transport to the hospital Acutely ill pediatric patients may represent a challenge to many EMS systems and providers They represent a lowfrequency, high-intensity patient population They may be too small for conventionally available EMS equipment They may be one part of a large family unit needing care, and may present an emotional challenge to the provider Despite these difficulties, the goal is to seamlessly integrate the care of children in the prehospital environment into EMS systems that were originally designed to care for adults EMS for children (EMSC) is a concept for an all-encompassing, multidisciplinary care system that includes parents, primary care providers, prehospital care providers and transport systems, community hospital and tertiary care referral center emergency departments (EDs), and pediatric inpatient units, including critical care facilities The elements of this system should be linked by effective communication and transportation systems and governed by well-established policies and procedures The provision of pediatric EMS, although a single link in this chain, is a critical component EMS providers are continually balancing the need for rapid transport to the hospital with the ability to recognize and stabilize the sick or injured child in the field This must all be done with the patient’s best interest in mind, being mindful that prehospital care is only one portion of the patient’s medical management FIGURE 134.1 EMS is at the intersection of health care, public health, and public safety History of EMS Systems The first organized prehospital transport systems were developed and organized by the military During the late 18th century, a system of field triage and transport provided that the most seriously wounded soldiers were transported from the front lines to field hospitals in the rear After the Civil War, civilian systems of emergency care and transport were developed in the United States What is now University Hospital in Cincinnati, Ohio, developed the first civilian-run, hospital-based ambulance service in 1865 In 1928, volunteers organized to be trained to deliver assistance at the scene of injury or illness, establishing the first “EMS agency.” EMS in the United States underwent rapid growth and development in the 1960s and 1970s Two historic advances in medicine: the introduction of mouth-to-mouth ventilation in 1958, and closed cardiac massage in 1960, led to the realization that rapid response of trained personnel could help improve cardiac outcomes This provided a firm foundation on which the concepts of advanced life support (ALS) and emergency care systems could be further developed The current EMS system was established in part through the passage of the National Highway Safety Act of 1966 In response to traffic accidents being recognized as a major health problem of the time, The Highway Safety Act established the U.S Department of Transportation (DOT) and charged it with improving EMS in the United States States were required to develop regional EMS systems The DOT developed a 70-hour basic Emergency Medical Technician (EMT) curriculum In 1970, the Wedsworth-Townsend Act was signed, permitting paramedics to act as physician surrogates Prior to this, paramedics were required to have a physician or nurse present to administer medications During this period, federal grant funding for EMS demonstration programs led to the development of regional EMS systems As states became responsible for appropriating their own EMS funds, many of the regional EMS management entities established by federal funding dissolved Although the goal was a well-coordinated system of prehospital training and care, EMS development progressed in a disorganized manner, with organizational structure and scope of practice based on local needs and concerns The result of regional development is wide practice variation among EMS systems across the United States The EMS Systems Act of 1973 authorized responsibility of EMS programs to what is now the Department of Health and Human Services and identified the scope of practice of EMS personnel It led to the establishment of several hundred new EMS regional systems across the United States, albeit without a clear mandate for physician oversight initially Congress established a Federal Interagency Committee on Emergency Medical Services (FICEMS) in 2005, to ensure coordination among Federal agencies involved with State, local, tribal, and regional EMS and 9-1-1 systems and streamline the process through which federal agencies provide support to these systems Some foresee the possibility that one day the U.S EMS system could have a single lead federal agency for EMS, which would improve the quality of EMS care by standardizing training and treatment and by reducing the redundancies within state and regional systems Affected by the evolution of health care, EMS has been identified as being in a position to integrate into the community healthcare system A recently developed area of EMS called mobile-integrated health care, that has also been referred to as community paramedicine, offers the ability for patients to receive mobile healthcare services outside of medical facilities This care provided by EMS providers in a paradigm that differs from the typical transport to hospital can expand the reach of public health services to bridge healthcare gaps Epidemiology Over the past four decades, EMS capabilities have grown to provide emergency prehospital access to nearly every American There are more than 21,000 EMS systems in the United States utilizing approximately 800,000 EMS personnel Approximately 5% to 15% of calls for an ambulance in the United States will be for a patient younger than 18 years of age This subgroup of the population usually enjoys relatively good health; however, accidental trauma is the leading cause of death Similar to older patients, pediatric patients are also susceptible to acute medical illness and exacerbations of chronic conditions such as asthma, diabetes, or oncologic disease Infants may present with complications of congenital cardiac, respiratory, or metabolic disease or with perinatal complications during and after delivery out of the hospital Roughly half of EMS pediatric transports are for injury, and the other half are for medical complaints The vast majority of trauma is blunt injury, and common medical complaints include respiratory distress, seizures, and ingestions Data from multiple studies show a bimodal age distribution for pediatric EMS patients with infants and adolescents making up the majority of the patient population—teenagers with trauma and infants and preschoolers with illness Children with special healthcare needs (CWSHCN) are also more likely to use an ... practice: videodischarge instructions in the pediatric emergency department J Emerg Nurs 2017;43(4):316–321 Yamamoto LG, Manzi S; Committee on Pediatric Emergency Medicine, et al Dispensing medications... discharge from an emergency department Pediatrics 2012;129(2):e562 CHAPTER 134 ■ PREHOSPITAL CARE TONI K GROSS, THERESA A WALLS, GEORGE A (TONY) WOODWARD EMS SYSTEMS The term Emergency Medical... http://www.ihs.gov/healthcommunications/health-literacy Accessed March 18, 2020 Wallin D, Vezzetti R, Young A, et al Do parents of discharged pediatric emergency department patients read discharge instructions? Pediatr Emerg Care 2018;29(6):699–704