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North Carolina Division of Public Health
Children and Youth Branch
Emergency Care Plans for Emergency Care Plans for Children with Special Children with Special Health Care NeedsHealth Care Needs
North Carolina Division of Public Health
Children and Youth Branch
ObjectivesObjectives
Describe 3 examples of emergency needs that Describe 3 examples of emergency needs that providers will encounterproviders will encounter
Describe the benefits for use of an emergency Describe the benefits for use of an emergency care plan care plan
Describe KIDBase and one way to implement Describe KIDBase and one way to implement a KIDBase program in your communitya KIDBase program in your community
North Carolina Division of Public Health
Children and Youth Branch
Children (and Youth) With Special Children (and Youth) With Special Health Care Needs (CYSHCN)Health Care Needs (CYSHCN)
““Children with special health care needs are Children with special health care needs are those who have or are at increased risk for a those who have or are at increased risk for a chronic physical, developmental, behavioral, chronic physical, developmental, behavioral, or emotional condition and who also require or emotional condition and who also require health and related services of a type or health and related services of a type or amount beyond that required by children amount beyond that required by children generally.” generally.”
North Carolina Division of Public Health
Children and Youth Branch
Some Numbers from the National Some Numbers from the National Survey of CSHCN (2005-06)Survey of CSHCN (2005-06)
In NC 15.4% of children have special health In NC 15.4% of children have special health care needs care needs
This is approximately 333,895 children in NCThis is approximately 333,895 children in NC
Only about 7.8% of CSHCN report receiving Only about 7.8% of CSHCN report receiving SSI benefits in NC for a disabilitySSI benefits in NC for a disability
About 2.4% of CSHCN were uninsured at the About 2.4% of CSHCN were uninsured at the time of the surveytime of the survey
North Carolina Division of Public Health
Children and Youth Branch
More Numbers from NC Schools….More Numbers from NC Schools….
Among children enrolled in public schools Among children enrolled in public schools in NC, more than 237,000 (17%) have in NC, more than 237,000 (17%) have chronic health conditionschronic health conditionsMore than 30,400 medication orders are on file in More than 30,400 medication orders are on file in schoolsschoolsMore than 24,000 school children need specialized More than 24,000 school children need specialized interventions at school every day (bladder interventions at school every day (bladder catheterization, tracheal suctioning, tube feedings)catheterization, tracheal suctioning, tube feedings)
(Source: NC DHHS, NC DPH, Annual Report of School Health Services, (Source: NC DHHS, NC DPH, Annual Report of School Health Services, School Year 2007-08)School Year 2007-08)
North Carolina Division of Public Health
Children and Youth Branch
And more numbers from NC child And more numbers from NC child care…care…
Almost 43,000 of the more than NC 250,000 Almost 43,000 of the more than NC 250,000 children enrolled in regulated, center-based children enrolled in regulated, center-based child care have special health care needschild care have special health care needsSource: NC Division of Child Development – December 2007Source: NC Division of Child Development – December 2007
North Carolina Division of Public Health
Children and Youth Branch
Children are more vulnerable…Children are more vulnerable…
Skin is thinner and larger surface to mass ratioSkin is thinner and larger surface to mass ratioInhale larger doses in same period of timeInhale larger doses in same period of timeCloser to the groundCloser to the groundLess fluid reserve--get dehydrated fasterLess fluid reserve--get dehydrated fasterLimited motor and cognitive skillsLimited motor and cognitive skillsCan shift quickly from stable to life-threateningCan shift quickly from stable to life-threateningMore sensitive to changes in temperature and More sensitive to changes in temperature and faster metabolismfaster metabolism
North Carolina Division of Public Health
Children and Youth Branch
CYSHCN: Many Conditions CYSHCN: Many Conditions
Respiratory conditions Respiratory conditions
Cardiac conditions Cardiac conditions
Endocrine disordersEndocrine disorders
Genetic disordersGenetic disorders
Hematology and cancer disordersHematology and cancer disorders
Immune disordersImmune disorders
Kidney disordersKidney disorders
North Carolina Division of Public Health
Children and Youth Branch
More ConditionsMore Conditions
Metabolic disorders Metabolic disorders
Severe food allergiesSevere food allergies
Neurological disordersNeurological disorders
Developmental disordersDevelopmental disorders
Mental health disordersMental health disorders
And the list goes on……And the list goes on……
North Carolina Division of Public Health
Children and Youth Branch
Common Themes Across ConditionsCommon Themes Across Conditions
Baseline is difficult to assess without caregiver’s Baseline is difficult to assess without caregiver’s inputinput
Require medical devices, medical supplies or life-Require medical devices, medical supplies or life-sustaining treatment (nebulizers, chest sustaining treatment (nebulizers, chest physiotherapy vests, oxygen, ventilators, dialysis)physiotherapy vests, oxygen, ventilators, dialysis)
Require medication (insulin, anti-epileptics, inhalers, Require medication (insulin, anti-epileptics, inhalers, Hemophilia factor) on a regular Hemophilia factor) on a regular basisbasis
North Carolina Division of Public Health
Children and Youth Branch
Common Themes (cont.)Common Themes (cont.)
Often cannot move independently or require Often cannot move independently or require assistance to ambulateassistance to ambulate
Exercise tolerance limits the endurance required for Exercise tolerance limits the endurance required for walking/running during transport/evacuationwalking/running during transport/evacuation
Require tube or parenteral feedings by trained Require tube or parenteral feedings by trained personnelpersonnel
North Carolina Division of Public Health
Children and Youth Branch
Common Themes (cont.)Common Themes (cont.)
Condition may be exacerbated by separation, Condition may be exacerbated by separation, transition or anxietytransition or anxiety
Communication issuesCommunication issues
An immunocompromised state due to their An immunocompromised state due to their medical condition or its treatment, when medical condition or its treatment, when exposed to infectious agentsexposed to infectious agents
North Carolina Division of Public Health
Children and Youth Branch
Some Helpful ResponsesSome Helpful Responses
Identifying children with special needsIdentifying children with special needs
Generating a portable medical summaryGenerating a portable medical summary
Including these children in registries for care Including these children in registries for care coordination coordination
North Carolina Division of Public Health
Children and Youth Branch
Portable Medical SummaryPortable Medical Summary
Emergency folders with updated health information, Emergency folders with updated health information, medications, complete list of diagnoses, allergies, medications, complete list of diagnoses, allergies, etc.etc.Implementation of AAP/ACEP Emergency Implementation of AAP/ACEP Emergency Information Form on all special needs children Information Form on all special needs children Consent for emergency medical care from parent or Consent for emergency medical care from parent or guardianguardianAdhering to HIPAA standards and protecting Adhering to HIPAA standards and protecting confidentiality of children in our careconfidentiality of children in our care
North Carolina Division of Public Health
Children and Youth Branch
Emergency Information Form for Emergency Information Form for CSHCN (AAP/ACEP)CSHCN (AAP/ACEP)
Name, DOB, date of last update, weight, guardian’s Name, DOB, date of last update, weight, guardian’s name, emergency contact, pediatricians and other name, emergency contact, pediatricians and other health care professionals, primary EDhealth care professionals, primary EDMajor chronic illnesses and disabilities, baseline Major chronic illnesses and disabilities, baseline physical and mental status, baseline vital signs, physical and mental status, baseline vital signs, physical findings and neurological status physical findings and neurological status Immunization history, medications, med allergies, Immunization history, medications, med allergies, food allergies, and advancedfood allergies, and advanceddirectives*directives*
(*Most states have advanced directives forms that need to be filled(*Most states have advanced directives forms that need to be filled out for EMS to honor.)out for EMS to honor.)
North Carolina Division of Public Health
Children and Youth Branch
AAP/ACEP (cont.)AAP/ACEP (cont.)
Primary language and language constraintsPrimary language and language constraintsSignature and consentSignature and consentProstheses, appliances, and advanced Prostheses, appliances, and advanced technology devicestechnology devicesBaseline labs and other studiesBaseline labs and other studiesFoods to be avoided and procedures to be Foods to be avoided and procedures to be avoided and whyavoided and whyCommon presenting problems and findings Common presenting problems and findings with specific suggested managementswith specific suggested managements
North Carolina Division of Public Health
Children and Youth Branch
Hitchcock Care PlanHitchcock Care Plan
NicknameNickname
Assets and strengthsAssets and strengths
Challenges (list behavioral, communication, Challenges (list behavioral, communication, sensory, stamina/fatigue, learning, etc.)sensory, stamina/fatigue, learning, etc.)
List of specific equipment and assistive techList of specific equipment and assistive tech
School system and child care School system and child care
Special circumstances/what would like to Special circumstances/what would like to knowknow
North Carolina Division of Public Health
Children and Youth Branch
Palmetto Primary Care PlanPalmetto Primary Care Plan
Different approach to how to identify language Different approach to how to identify language spoken and communication concernsspoken and communication concerns
Requires pre-cert/authRequires pre-cert/auth
Family membersFamily members
Pharmacy and DME supplierPharmacy and DME supplier
Dose, time and route for meds and special Dose, time and route for meds and special formulaformula
Key community contactsKey community contacts
North Carolina Division of Public Health
Children and Youth Branch
Registry: Care CoordinationRegistry: Care Coordination
Practices create a “list” with some info on CYSHCN Practices create a “list” with some info on CYSHCN to do care coordination by condition or issue to do care coordination by condition or issue
Practices and communities can use info to create a Practices and communities can use info to create a database system for emergency situations to access database system for emergency situations to access basic health information basic health information
Selected information on CSHCN from this “list” can Selected information on CSHCN from this “list” can be made accessible to EMS, health departments, be made accessible to EMS, health departments, hospital staff, SMAT, etc. hospital staff, SMAT, etc. with parental consentwith parental consent
North Carolina Division of Public Health
Children and Youth Branch
KIDBaseKIDBase
KKids ids IInformation nformation DDatabase atabase AAccess ccess SSystem for ystem for EEmergenciesmergencies
What is it?What is it?
Who does it benefit?Who does it benefit?
How does it work?How does it work?
How can EMS use it in the community?How can EMS use it in the community?
North Carolina Division of Public Health
Children and Youth Branch
What is KIDBase?What is KIDBase?
NC EMSC Program helps ensure that children NC EMSC Program helps ensure that children with special health care needs receive the with special health care needs receive the care they need in medical emergencies.care they need in medical emergencies.
A way to keep emergency medical care A way to keep emergency medical care personnel informed of the special needs of a personnel informed of the special needs of a special health care needs child so that special health care needs child so that appropriate and timely care can be providedappropriate and timely care can be provided
North Carolina Division of Public Health
Children and Youth Branch
What is KIDBase?What is KIDBase?
North Carolina Division of Public Health
Children and Youth Branch
How Does It Work?How Does It Work?
KIDBase brochure for familiesKIDBase brochure for families
KIDBase medical information formKIDBase medical information form
KIDBase enrollment postcard KIDBase enrollment postcard
KIDBase window cling for IDKIDBase window cling for ID
North Carolina Division of Public Health
Children and Youth Branch
KIDBase Medical Information FormKIDBase Medical Information Form
North Carolina Division of Public Health
Children and Youth Branch
KIDBase Medical Information FormKIDBase Medical Information Form
North Carolina Division of Public Health
Children and Youth Branch
How Does It Work?How Does It Work?
ScenarioScenario– 911 call involving child with a tracheostomy tube 911 call involving child with a tracheostomy tube
who is in respiratory distresswho is in respiratory distress– Dispatcher notifies local EMS, “This is a KIDBase Dispatcher notifies local EMS, “This is a KIDBase
child and he/she has an emergency care plan.”child and he/she has an emergency care plan.”– EMS arrives and asks for KIDBase form or other EMS arrives and asks for KIDBase form or other
portable medical summaryportable medical summary– Assists EMS with assessment and treatmentAssists EMS with assessment and treatment– Copy of KIDBase form or summary taken with Copy of KIDBase form or summary taken with
EMS for EDEMS for ED
North Carolina Division of Public Health
Children and Youth Branch
How Does It Work?How Does It Work?
ScenarioScenario– Who needs to be involved in the program to make Who needs to be involved in the program to make
this scenario work?this scenario work?
FamilyFamily Child’s primary care providerChild’s primary care provider Public Service Answering Point/DispatcherPublic Service Answering Point/Dispatcher EMS personnel - EMS Training OfficersEMS personnel - EMS Training Officers
North Carolina Division of Public Health
Children and Youth Branch
How Does It Work?How Does It Work?Important component: Reach out to families Important component: Reach out to families of CSHCNsof CSHCNs– Exceptional Children’s Program, Family Voices, Exceptional Children’s Program, Family Voices,
non-profit children’s disease specific groupsnon-profit children’s disease specific groups– Pediatricians offices, family practice officesPediatricians offices, family practice offices– Neonatal intensive care unitsNeonatal intensive care units– Hospital social services departments, child life Hospital social services departments, child life
specialistsspecialists– Schools, child care, local health departments, Schools, child care, local health departments,
faith-based organizationsfaith-based organizations
North Carolina Division of Public Health
Children and Youth Branch
How Does It Work?How Does It Work?
Outreach resources available, NC EMSCOutreach resources available, NC EMSC– Parent/caregiver letterParent/caregiver letter– Primary Care Provider letterPrimary Care Provider letter– Dispatcher letterDispatcher letter– Community Based Services Agency letterCommunity Based Services Agency letter– FAQsFAQs– Promotion TipsPromotion Tips
North Carolina Division of Public Health
Children and Youth Branch
How Can EMS Use This in The How Can EMS Use This in The Community?Community?
Convene meeting of stakeholders, i.e. folks in Convene meeting of stakeholders, i.e. folks in scenario, representatives of organizations who scenario, representatives of organizations who may be willing to do outreachmay be willing to do outreach
Provide materialsProvide materials
Do outreach to identify families to participateDo outreach to identify families to participate
North Carolina Division of Public Health
Children and Youth Branch
How Can EMS Use This in The How Can EMS Use This in The Community?Community?
How to get KIDBase materials?How to get KIDBase materials?
Gloria Hale, MPHGloria Hale, MPH
(919) 855-3953(919) 855-3953
[email protected]@ncmail.net
Downloadable on web: Downloadable on web: www.ncems.org/emsc/kidbase.htmlwww.ncems.org/emsc/kidbase.html
North Carolina Division of Public Health
Children and Youth Branch
How Can EMS Use This in The How Can EMS Use This in The Community?Community?
Web-based KIDBase medical information Web-based KIDBase medical information form is in interactive pdf formform is in interactive pdf form
KIDBase materials will also be in SpanishKIDBase materials will also be in Spanish
Remember that parents/caregivers are the Remember that parents/caregivers are the experts on their childexperts on their child
North Carolina Division of Public Health
Children and Youth Branch
Questions?Questions?
North Carolina Division of Public Health
Children and Youth Branch
ReferencesReferences
http://www.amchp.org/topics/a-g/emergency.php#defhttp://www.amchp.org/topics/a-g/emergency.php#def http://www.amchp.org/topics/a-g/emergency_trans.phphttp://www.amchp.org/topics/a-g/emergency_trans.phpCommittee on Pediatric Emergency Medicine. Emergency Preparedness for Children with Special Health Care Needs. Pediatrics 1999;104;e53PEDIATRICS Vol. 117 No. 2 February 2006, pp. e340-e362 PEDIATRICS Vol. 117 No. 2 February 2006, pp. e340-e362 PEDIATRICS Vol. 116 No. 3 September 2005, pp. 787-795 PEDIATRICS Vol. 116 No. 3 September 2005, pp. 787-795 http://ncchildcare.dhhs.state.nc.us/general/mb_contact.asp http://ncchildcare.dhhs.state.nc.us/general/mb_contact.asp
North Carolina Division of Public Health
Children and Youth Branch
ResourcesResources
www.redcross.orgwww.redcross.orgwww.mass.gov/eohhs/MassSupportwww.mass.gov/eohhs/MassSupportThe State of Florida Family Preparedness Guide: The State of Florida Family Preparedness Guide: www.doh.state.fl.us/rw_webmaster/prepareenglish04www.doh.state.fl.us/rw_webmaster/prepareenglish042.pdf2.pdfwww.childhealthdata.org www.childhealthdata.org
http://www.aap.org/advocacy/emergprep.htmhttp://www.aap.org/advocacy/emergprep.htm
http://client.blueskybroadcast.com/AAP/AAP_Peds_2http://client.blueskybroadcast.com/AAP/AAP_Peds_21/index.html1/index.html
North Carolina Division of Public Health
Children and Youth Branch
Thank You!Thank You!
Gloria Hale, North Carolina Office of Gloria Hale, North Carolina Office of EMS, EMS-C Coordinator EMS, EMS-C Coordinator
[email protected]@ncmail.net
Gerri Mattson, MD, MSPHGerri Mattson, MD, MSPHPediatric Medical Consultant,Pediatric Medical Consultant,
Children and Youth Branch, North Children and Youth Branch, North Carolina Division of Public HealthCarolina Division of Public Health
[email protected]@ncmail.net