California EMSC project establishes guidelines for rural pediatric emergency care.

Abstract

As part of a grant demonstration project of the California Emergency Medical Services for Children (EMSC), Northern California Emergency Medical Services, Inc.(NCEMS) became involved in the assessment ,of pediatric emergency care in the rural communities of northeastern California. NCEMS is a private, nonprofit public benefit corporation that regulates prehospital emergency medical care by contractual agreement with 10 counties. This area encompasses more than 32,ooO square miles and has a population of approximately 500,CGO people. farmlands and rugged mountain terrain; primary industries are logging, farming, and tourism. The medical community parallels the population density of the region. There are 21 hospitals, with at least one hospital in each county. The bed capacity of the individual hospitals ranges from 8 to 200. Ten of the hospitals have a bed capacity of 30 or less. There are 21 emergency departments, 7 licensed as basic emergency departments and 14 licensed as standby. A trauma center that serves the southern portion of the region was designated in September of 1988. m=‘F OF IYIEEDS The EMSC project was initiated in May 1986; under the direction of James Seid,el, MD, ‘PhD, of Harbor-UCLA Medical Center, and funded in part by a grant from the U.S. Department of Health and Human Services, Health Resources and.Services Administration. * The project had a goal that concentrated primarily on the collection of data on pediatric emergencies and the development of a model for pediatric emergency medical services in rural and urban areas. Our efforts were focused on the management of children by both prehospital care providers and emergency departments in rural areas. We wanted to know specifically how many children we were caring for, what they were treated for, and the outcome of the care given in the NCEMS area. When we began our assessment of “what is,” we found that there were 21 pediatricians in the region and no pediatric surgeons or pediatric critical care specialists. Two counties were without any pediatricians, and four counties had only one each. The other 17 pediatricians practiced in the remaining two counties, which have the higher population densities. There were no pediatric intensive care units. Only two facilities had any formalized pediatric critical care within their adult intensive care unit.