Most of us think of emergency medical services (EMS) as calling 911 after a health event that requires emergency care and/or transport to the nearest hospital. Calling 911 in such a scenario is only one part of EMS; it is also an entire health system and public health service itself, says Sylvia Owusu-Ansah, MD, MPH, assistant professor of pediatrics and of emergency medicine at the University of Pittsburgh School of Medicine.
As director of prehospital and EMS care for UPMC Children’s Hospital of Pittsburgh, Dr. Owusu-Ansah makes sure that EMS personnel know how to take care of children in emergency situations. EMS personnel are trained to treat any age level and are essential to public health and safety. However, Dr. Owusu-Ansah says only about 7-13% of out-of-hospital calls are for pediatric patients. Of those children, data show that very few are extremely sick or need immediate care.
“When EMS personnel do have to provide care for children, it can cause a lot of anxiety,” says Dr. Owusu-Ansah.
“Their pediatric care skills may be rusty because they’ve had few encounters with children beyond their initial simulation training. Also, it’s also a vulnerable population and may remind them of loved ones who are children.”
Caring for children is not the same as caring for adults. Children’s bodies are not yet the same as adults’. Children specifically need to be given medication based on weight, and, in the case of trauma, EMS personnel immediately focus on different areas of children’s bodies than adults’. Training EMS personnel with up-to-date skills and helping them feel comfortable to take care of children is vital.
Dr. Owusu-Ansah and colleagues also look at ways to prevent children from having to be admitted to the hospital.
One such research area is asthma. Researchers know that certain patients with asthma are more likely to be admitted to the hospital and in the intensive care unit (ICU). Social determinants of health—like systemic racism, educational opportunities, income level, food insecurity, access to housing, etc.—influence hospital admissions. Dr. Owusu-Ansah is conducting a study to see whether there is a racial disparity in out-of-hospital treatment of asthma. If there is, doctors can target those children ahead of time.
“We have data from in hospital and emergency room care that shows African Americans are more likely to be hospitalized and to die from asthma,” she says. “Those who have been admitted before, who have been in the ICU or have been intubated and put on a ventilator are at higher risk of being hospitalized or, worse, dying. So, if data show disparities in out-of-hospital asthma treatment, let’s be proactive. If there are patients who frequently call 911 for asthma, let’s be more aggressive in getting them the medication they need before they get to a hospital.”
Dr. Owusu-Ansah is part of a pioneering field of research—studying racial disparities in prehospital care, the results of which may help to curtail eventual hospitalizations or disease progression. For example, she says studies have shown that African Americans are less likely to receive pain medication in general. In the out-of-hospital environment, not treating pain appropriately can eventually affect a spectrum of health issues, including disease processes, stroke recognition and care and cardiac arrest.
As medical director for Pittsburgh EMS, Dr. Owusu-Ansah creates curriculum for and helps train EMS personnel in pediatric advanced life support. She has brought innovative change to the Pediatric Assessment Triangle, a quick way to assess in an out-of-hospital environment whether a child is needs immediate medical treatment. She has also integrated information about social determinants of health into curriculum and other information—like how to tell when a person of color looks blue from lack of oxygen or is pale (because those pictures aren’t usually included in training textbooks).
A growing part of prehospital care includes in-home care. Paramedics, instead of traditional caregivers like nurses, are going into the home to provide care, which is known as community paramedicine. In many areas, paramedics can give immunizations through mobile health care. During the COVID pandemic, Dr. Owusu-Ansah says EMS personnel have been going to homes to do follow-up checks on issues like people’s oxygen, getting vital signs and referring people to hospitals for more care. Community paramedicine can also be used to help in the opioid epidemic, for stroke care and cardiac care.
All in all, Dr. Owusu-Ansah says she and other researchers and physicians are trying to help people live healthier lives—not just when they get sick or have an emergency.
“We’re trying to provide the best evidence-based care to people outside of the hospital as much as we try to do inside of the hospital,” says Dr. Owusu-Ansah.
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