The North Coast EMS (NCEMS) region includes Humboldt, Lake, Del Norte, and southern Trinity counties in California. These primarily rural counties have a population of 215,000 living in an area of 6,000 square miles. Eight hospitals serve the area with six being previously recognized as Emergency Department approved for Pediatrics (EDAP) facilities. No PICU or PCCU capability exists in the region.. The purpose of this project was to develop and implement a comprehensive Emergency Medical Services System for Children in the region through the accomplishment of eight specific multifaceted objectives. The Northern California Safety Consortium (NCSC) was contracted as the consultant to NCEMS for this project.

A centralized EMSC program was established as part of the EMS system to ensure quality emergency medical care for all children. This project was conducted between October 1, 1996 and June 25, 1997, and second year funding has been secured to fully implement the program.

Existing social and medical services for children were assessed and incorporated in referral pathways that will be made available to prehospital personnel. Prevention strategies using EMS personnel were evaluated and presented. Existing policies and procedures and equipment lists were modified to reflect recommendations of the California EMS Authority’s EMSC Final Report and current American Heart Association guidelines. Pediatric training equipment was purchased. An Annual Skills Refresher Day program was developed to ensure EMS personnel are proficient in seldom used skills. EDAP standards were modified and two new applications for EDAP were received and site visits were scheduled. A Pediatric Liaison Nurse handbook was developed as an orientation tool for EDAP personnel. Pediatric transfer guidelines were reviewed. Post incident recovery and CISD programs were evaluated and additional personnel were trained. Pediatric components to the computerized prehospital data base program were reviewed for inclusion of pediatric CQI parameters and the pediatric components of the EMS plan were addressed.

Objectives of the project were accomplished by the NCSC team through extensive use of surveys and questionnaires distributed to EMSC taskforce members. Medical Advisory committees in Humboldt and Lake County were utilized to evaluate policy and procedure changes. Drafts of all products were broadly circulated for comments.

New policies, procedures and equipment lists have been distributed for public comment. New EDAP Standards and a Pediatric Liaison Nurse handbook are available in both print and Word 6 electronic media formats. CISM classes have been scheduled for September. The Annual Skills Refresher materials are available in draft. It is anticipated that all draft documents will be finalized by October, 1997.

The NCEMS region will soon have a comprehensive EMSC program in place. Prehospital personnel will have readily available resources for children’s service referrals, current protocols, an understanding of their role in injury prevention, and a comprehensive continuing education program in place to ensure competency in seldom used skills. By the conclusion of the second year funding a community based post recovery team will be in place, pediatric transfer agreements will be established, and all eight hospitals in the region will be EDAP facilities.