PROBLEM
Successful resuscitation of pediatric cardiac arrest remains at distressingly low levels despite intensive efforts to improve resuscitation protocols. Young and Seidel recently called for a complete re-assessment of our approach to pediatric CPR and resuscitation and placed a high priority on the prospective collection of population-based data (especially rural areas) so that outcomes can be accurately measured and treatment protocols could be developed. They also placed high priority on evaluation of AEDs in very young children.
Iowa has initiated a required statewide data registry of all EMS calls. The database includes standardized definitions and provides the ability to perform probabilistic linkage to Iowa hospital discharge. We will use the database to provide a quality improve program to EMS providers. We plan to analyze the data on pediatric and relay this information to the EMS providers. We will evaluate measures of outcomes of victims of pediatric cardiac arrest. We can assess the effectiveness of this program with subsequent analysis of the database. Evaluation of AED technology will serve as a nidus for change.
GOALS & OBJECTIVES
The overall goal of this proposal is to develop a quality improvement system of data collection, analysis and feedback to promote effective resuscitation of pediatric cardiac arrest victims. The specific objectives are:
1. Develop a quality improvement program for pediatric cardiac arrest for pre-hospital providers
2. Develop reporting methods to disseminate information from the Quality assurance program to the Iowa Bureau of EMS and EMS providers.
3. Develop education methods to convey information from Objectives 1 and 2 to EMS providers
3. 4. Analyze impact of data analysis and instructional programs on long-term outcomes.
METHODOLOGY
Objective 1
Action 1. Collect and collate data on cardiac arrest in children using Iowa’s population-based out-of-hospital database.
Action 2. Analyze data from EMS Service Program to evaluate and report outcomes along the “chain of Survival” for children
Action 3. Compare data to that of other established databases
Action 4 Analyze current algorithms and technology being used for cardiac arrest
Objective 2
Action 1. Generate data reports for the data gathered in Objective 1
Action 2. Disseminate data from the quality assurance program to Iowa Bureau of EMS, EMS Medical directors and EMS providers.
Action 3 Encourage interaction between Project Director, and EMS Medical Directors and providers
Objective 3
Action 1. Develop and implement a Web-based interactive site for EMS Providers
Action 2. Develop and distribute a videotape for AED use in pediatric resuscitation.
Action 3. Increase opportunities for refresher courses in pediatric resuscitation in already established continuing education venues
Action 4. Seek continuing education credits from the University of Iowa for the Web site and the refresher courses.
Objective 4
Action 1 Evaluate effectiveness of training program on performance of EMS providers
Action 2. Measure impact of training programs and potential new algorithms on outcomes of pediatric resuscitation.
COORDINATION
The primary agency will be the University of Iowa, Department of Pediatrics. The University will contract with the Iowa Bureau of EMS and the Critical Illness and Trauma Foundation.
EVALUATION
Objective 1 will result in a population-based database for analyzing the achievement of goals fore pediatric resuscitation. We will use this as the foundation for a quality improvement program and to determine protocols and technology for pediatric resuscitation in a predominantly rural population
Objective 2 will result in a mechanism to provide information to The Bureau of EMS and EMS services to improve their performance.
Objective 3 will result in a Web site to provide information to improve knowledge and performance for pediatric resuscitation. A videocassette tape will be produced. We will evaluate the Web site and videotape through student evaluation forms, pre-and post-tests of the students and a follow-up test 6 months after registration.
Objective 4 will evaluate the effectiveness the Web-based instruction and videocassette tape on the crew performance. Linkage of the EMS Program Registry to the Iowa hospital discharge database will result in an analysis of long-term outcomes of pediatric resuscitation.
ANNOTATION
KEYWORDS
Quality Assurance and Improvement, Prehospital Education, Data Collection
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