This announcement solicits applications for the Emergency Medical Services for Children State Partnership Regionalization of Care (EMSC SPROC) program. The goal of the EMSC Program is to reduce child and youth mortality and morbidity caused by severe illness or trauma. The EMSC Program does not intend
to promote the development of separate EMS systems for children, but rather to enhance the pediatric capabilities of EMS systems originally designed primarily for adults. “EMS for Children” broadly means a continuum of care that includes the following components: prevention, pre-hospital care, hospital-based emergency care, and rehabilitation and reentry of the child from the emergency care environment into the community.
The overall purpose of this grant program is to reduce pediatric morbidity and mortality by developing regionalized systems of care thus increasing access to pediatric specialists for children in rural, territorial, insular and/or tribal communities.
The 2006 Institute of Medicine (IOM) report on the future of emergency care described three key principles in its vision for the future of care:
regionalization, coordination, and accountability.[i] In January 2012, the National Quality Forum (NQF) published the Endorsement Summary: Regionalized Emergency Care Framework. The NQF organized a steering committee to develop a measurement framework that could serve as a roadmap for future measurement and development within regionalized systems. The steering committee established six key domains or areas considered critical to evaluating regionalized emergency medical care systems.
The domains include:
Domain 1: Capability, Capacity, and Access Domain 2: Recognition and Diagnosis Domain 3: Resource Matching and Use Domain 4: Medical Care Domain 5: Coordination of Care Domain 6: Outcomes In this next phase, the SPROC grant program will focus on the first of the NQF domains; Capability, Capacity, and Access. This domain focuses on five specific areas:
system public health initiatives; pre-hospital capabilities; real-time capacity information and the categorization of participating agencies, organizations, and facilities; preparedness, monitoring, and data sharing; and legal and regulatory frameworks.3 The EMSC SPROC program aims to develop systems of care to increase access to pediatric specialists for all children through the:
Development of facility recognition programs; Expansion of facility recognition programs to ensure the inclusion of children in tribal, territorial, rural and insular communities; and Development of similar coordinated systems of care that would reduce and prevent pediatric morbidity and mortality because of timely access to pediatric specialists through established networks.
Systems of care will:
increase pediatric readiness of facilities to stabilize and treat pediatric patients; improve the transfer process of pediatric patients to higher levels of care; and increase access to pediatric specialists through the use of established networks.
The goals for the EMSC SPROC program for the next four years and their corresponding targets are as follows:
By December 2016, identify healthcare facilities within and beyond state borders that will be included in the regionalized network.
By May 2017, establish baseline data of healthcare facilities that will be included in the regionalized network.
By May 2018, develop a pediatric facility recognition program/regionalized network. For applicants that have an established pediatric facility recognition program/regionalized network, increase the number of facilities to include tribal, rural, insular and/or territorial facilities.
By May 2020, improve the pediatric readiness score of all hospitals in the defined service area/network and the facility recognition program; and By May 2020, improve clinical quality performance metrics for pediatric emergency services in service area/network hospitals as determined by the applicant.
Applicants must develop specific, measurable, achievable, relevant, and time measurable (SMART) objectives that align with the five goals mentioned above. Applicants must provide further elaboration of the activities in detailed action steps, enumeration of the products and specific health outcomes, as described in the EMSC SPROC Program logic model. A Logic Model for this program is included in Appendix A.
 Regionalization refers to an established network of resources that delivers specific care – such as protocols, definitive procedures, higher-care levels, or care pathways – to a defined population of patients or within a defined geography. Source: National Quality Forum, Endorsement Summary: Regionalized Emergency Care Framework. January 201 2. 3 Endorsement Summary: Regionalized Emergency Care Framework. National Quality Forum. Washington, DC. January 201 2.  A subpanel of experts from the national steering committee was assembled to develop weighting criteria for the national pediatric readiness assessment.
Based on the results of the expert panel and the results of the California Pediatric Readiness Project, 24 of the questions were weighted in the national assessment to generate an overall weighted pediatric readiness score (WPRS) for each hospital.
The WPRS was normalized to a 100-point scale.
The final weighting for each section for the national assessment included 19 points for coordination of care, 10 points for physician/nurse staffing, 7 points for quality improvement, 14 points for patient safety, 17 points for policies/procedures, and 33 points for equipment and supplies.
[i] An excerpt from the Institute of Medicine (IOM) Reports.