422 - A Statewide Survey of Strengths, Challenges, and Resources for Emergency Medical Services Responses for Children and Youth with Special Health Care Needs and Caregivers

Publication Number: 4413.422

Samantha J. Papp, St. Christopher's Hospital for Children, Millersville, MD, United States; Zekarias Berhane, Drexel University, Drexel Hill, PA, United States; Duane Spencer, St. Christopher's Hospital for Children, Mechanicsburg, PA, United States; Jennifer Griffin, Drexel Dornsife School of Public Health, Philadelphia, PA, United States; Manya Mittal, Drexel University College of Medicine, Kendall Park, NJ, United States; Renee Turchi, St. Christopher's Hospital for Children, Abington, PA, United States

Background: Children and youth with special health care needs (CYSHCN) are more likely than other children/youth to experience medical events requiring emergency medical services (EMS), yet few studies have addressed EMS providers' experiences when responding to calls for this fragile population.

Objective: To better understand EMS professionals' expectations about responding to EMS activations involving CYSHCN, what they have felt were the strengths and barriers to prehospital care of these patients, and their knowledge and use of local supports for CYSHCN-families.

Design/Methods: From February to April 2020, we circulated a 9-question online survey to a convenience sample of EMS professionals via Pennsylvania EMS for Children and Pennsylvania Department of Health EMS. Closed questions in the survey were analyzed via descriptive statistics; open-ended items were qualitatively explored for shared themes and illustrative statements. This study was reviewed and approved by the Institutional Review Board of the Drexel University College of Medicine.

Results: Responses were received from 401 EMS professionals spanning 66/67 counties (99%) in Pennsylvania (Figure); 301 (75%) affirmed having ever responded to an emergency at a CYSHCN-household. Respondents described EMS calls to homes of CYSHCN as involving longer service times, requiring patience and compassion, and being aided by the expertise of family-caregivers (Tables 1 and 2). Challenges included communication barriers, absence of pre-arrival health-needs information, and insufficient training on diverse CYSHCN conditions. There was widespread uncertainty regarding whether the provider's county of service had a special needs registry/identification system, accepted Emergency Information Forms, had a designated person with whom CYSHCN-families could share those forms, or offered fire safety support, with 68%-86% of respondents answering "I don't know" to those questions. Most of the respondents (76%-99%) affirmed that these systems/resources are or would be helpful.

Conclusion(s): EMS providers in Pennsylvania identified family-caregivers as assets in EMS calls involving CYSHCN and value anticipatory information about the health and needs of these children and youth. Dedicated training/education on EMS calls involving CYSHCN and their caregivers and better sharing of information on the registries/identification systems available to a given EMS organization may help providers prepare for emergencies at CYSHCN-households in their response areas. These efforts can foster cross-system collaboration and have the potential to improve outcomes for CYSHCN and their families.

EMS respondent coverage by county in Pennsylvania
EMS Figure.pdfNumbers indicate survey respondents providing EMS in each county; more representation is depicted by darker shades (range, 0-37 per county, with respondents each working in 1-11 counties).

Inductive categorization of responses to qualitative questions in Emergency Responder Survey
Values indicate the numbers and percentages of total allocated responses. The categories were not mutually exclusive. Therefore, the categorized text responses exceed the total number of individual responses, and the summed percentages within each item exceed 100%.

Illustrative quotations from EMS professionals regarding their attitudes about and experiences with responding to emergencies at the homes of CYSHCN
EMS Table 2.pdf