UB professor leads team working to improve emergency care for children

BUFFALO, N.Y. — No one ever wants to hear about a sick or injured child. That’s especially true when the child’s condition requires emergency care.

Unfortunately, there is a large gap in knowledge about pediatric emergency medical services (EMS), which makes research into significantly improving emergency care in young patients especially crucial.

That’s where the Pediatric Emergency Care Applied Research Network (PECARN) comes in.

PECARN is part of the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services. It falls under the Emergency Medical Services for Children program, which is administered by HRSA’s Maternal and Child Health Bureau. PECARN’s goal is to conduct research on the prevention and management of acute illnesses and injuries in children and adolescents.

“Children, thankfully, are a small percentage of EMS calls. They make up between 7 and 10% of their call volume,” says E. Brooke Lerner, PhD, a Fellow of the Academy of Emergency Medical Services, and professor and vice chair for research in the Department of Emergency Medicine in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

“This is good, since no one wants kids to be sick, but it makes it really hard for prehospital care providers to stay skilled at treating kids. It means a single provider can go a long time without treating a kid, but at any moment could be called on to treat a child who needs emergent care,” she continued. 

“This means that we have to be diligent about skill maintenance and practice, which is hard, because it requires resources that a lot of agencies don’t have,” says Lerner, who leads a PECARN “node” and also serves as the chair of PECARN’s steering committee.

PECARN is made up of seven research nodes and a data coordinating center. Six nodes are made up of three hospital emergency department affiliates and one emergency medical service affiliate each. The seventh node, for which Lerner is principal investigator, is made up of emergency medical service affiliates.

The hospital emergency departments in PECARN’s other six nodes serve approximately 1.3 million acutely ill and injured children every year. The nine emergency medical service affiliates provide prehospital care for more than 113,000 children annually.

The goals of the Charlotte, Houston, and Milwaukee Prehospital EMS Research Node Center (CHaMP E-RNC) that Lerner oversees is to conduct research into significant innovations in pediatric treatments before the child arrives at the hospital.

Although Buffalo’s John R. Oishei Children’s Hospital is not an “official” hospital emergency department affiliate, it has a “tremendous” partnership with CHaMP, and is a site for ongoing prehospital research, Lerner said.  They, along with the EMS agencies in Western New York, allow researchers to study the care of children in the prehospital setting.

CHaMP is being funded by HRSA for four years starting in September 2019. It has $2.8 million in infrastructure funding.

CHaMP’s three EMS affiliates and American Medical Response of Western New York collectively respond to 25,000 pediatric calls each year.

“It is really hard to do research on what is the best care to provide to children, so we frequently rely on studies from adult populations or from the hospital, both of which may not accurately reflect what the pediatric population in the out-of-hospital setting needs,” Lerner said. “That’s why PECARN has instituted a strong effort to build an infrastructure that can conduct pediatric EMS research at multiple sites.”

Currently, CHaMP is working on a study to improve the care of children having seizures and one for those who have respiratory distress. In addition, it is working on an intervention that will improve prehospital pain management in children, as well as one that will help EMS providers identify those children with medical complaints that need the resources of a children’s hospital. 

PECARN also has a current study on identifying when children have a potential c-spine injury to guide the care given by EMS providers.

“We have built a cadre of investigators who have the experience and pilot data to answer the important questions,” Lerner said. “We have done a number of pilot studies that are just getting launched into large multi-center projects.

“We also have built a network of more than nine EMS agencies that are willing and able to work together on research” she said. “Basically we have been building momentum and with this new award the large projects are poised to start.”

Lerner has been working with PECARN since its inception in 2001 to try to bring EMS research to the network. “It took a while for them to develop their emergency department infrastructure and it is just in the last six years with the funding of CHaMP that we have really been able to bring a focus to EMS, while still doing some outstanding work in the emergency department care of children,” Lerner said.

Lerner’s interest in emergency medicine is long-standing. She worked as an emergency medicine technician when she was an undergraduate at UB in the 1990s. She later became a paramedic, working both for a paid service in the City of Buffalo and volunteering with an area agency and at the Veterans Affairs Hospital’s emergency department.

She became involved in research through a summer program at Erie County Medical Center, and was a research assistant in the center’s emergency department while working toward her master’s degree and her PhD in epidemiology at UB.

“I saw firsthand as an EMT and then as a paramedic how little we knew about the best care to provide to patients before they got to the ED, and fell in love with the idea of working to fill those knowledge gaps,” she said. “I have been working to fill those gaps since then.”