July 2016
Monthly Newsletter

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Do you know someone that goes above and beyond for children, or has done something extraordinary for a child?  If so, please nominate that pediatric hero!  iEMSC will be taking nominations all year long for the amazing work that happens on behalf of children all over the State of Indiana. Please make your nomination today!  All nominations will be considered for the 2017 Healthcare Heroes Awards breakfast. You can nominate your healthcare hero by completing this  nomination form and then emailing it to Margo Knefelkamp at  margo.knefelkamp@indianapolisems.org

Increase in Recalls, Market Withdrawals, & Safety Alerts from FDA

FDA emphasizes risks posed by eating raw dough
In the wake of a multistate Escherichia coli O121 outbreak, the Food and Drug Administration (FDA) issued a special consumer warning yesterday about the danger of eating raw dough, pointing out that flour can carry live bacteria.   "People often understand the dangers of eating raw dough due to the presence of raw eggs and the associated risk with Salmonella," the agency said. "However, consumers should be aware that there are additional risks associated with the consumption of raw dough, such as particularly harmful strains of E coli in a product like flour."

The grains used to make flour come directly from the field and typically are not treated to kill bacteria, said Leslie Smoot, PhD, a senior advisor in the FDA's Office of Food Safety and a specialist in the microbiological safety of processed foods. "So if an animal heeds the call of nature in the field, bacteria from the animal waste could contaminate the grain, which is then harvested and milled into flour." T he agency warned against eating raw cookie dough or giving children raw dough or baking mixes that contain flour to play with.

On May 31 General Mills recalled 10 million pounds of flour because of the recent E coli O121 outbreak, which involved 38 cases in 20 states. Ten people were hospitalized, but no one died or suffered hemolytic uremic syndrome. The flour was sold nationwide under the brand names Gold Medal, Signature Kitchens, and Gold Medal Wondra.

The FDA said some of the recalled flours had been sold to restaurants that allow children to play with dough made from the raw flour while waiting for their meals. The agency added that the Centers for Disease Control and Prevention is advising restaurants not to give customers raw dough.

Jun 29 FDA   statement.

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Pediatric Emergency Care Coordinator Newsletter

The first edition of the Pediatric Care Coordinator Newsletter has been launched. This quarterly newsletter will focus on the pediatric care coordinator role and will highlight different tools and resources to help support this important position.  Please take a moment to view this quarter's newsletter and to forward it along to your colleagues.  If you would like to start receiving this newsletter please email margo.knefelkamp@indianapolisems.org.


HRSA EMSC Program Announcement Regarding the EMSC Innovation & Improvement Center

The HRSA EMS for Children Program, within the Maternal and Child Health Bureau/Division of Child, Adolescent and Family Health, works to improve emergency systems of care to ensure that every child has access to optimal pediatric emergency care no matter where they live or travel. To accomplish this, investments are organized into six domains to build, sustain and improve pediatric emergency care, which include: Systems Integration, Innovation, Evidence Generation, Quality Improvement, Infrastructure Development, and Accountability. This year, HRSA established an EMSC Innovation and Improvement Center (EIIC) to support the Program's efforts to address each of these domains with an ultimate goal of improving outcomes of care. 

Beginning July 1, 2016, the BAYLOR COLLEGE OF MEDICINE and TEXAS CHILDREN'S HOSPITAL based in Houston, Texas will launch the EIIC. Charles Macias, MD, MPH, will direct the EIIC, with the executive leadership shared by Krisanne Graves, PhD, RN, Kate Remick, MD, and Manish Shah, MD, MS. The executive leadership will work in partnership with HRSA EMSC, the American Academy of Pediatrics, the Emergency Nurses Association, the National Association of State EMS Officials, and other national partners. Using a clinical systems integration framework (pictured) with input from subject matter experts and stakeholder organizations, the EIIC will collaboratively provide EMSC grantees and the emergency care community with the training, support and tools to use Quality Improvement methodologies to minimize morbidity and mortality in children who have sustained severe illness or injury. The EIIC will provide support to the State Partnership, State Partnership Regionalization of Care, Targeted Issues, and Pediatric Emergency Care Applied Research Network EMSC Program grant recipients. Specifically, the EIIC will help EMSC Program grant recipients to develop and implement Quality Improvement (QI) strategies to improve pediatric emergency medical services throughout the entire continuum of care in both prehospital and hospital care settings, and reduce childhood death and disability due to severe illness or injury. This will be accomplished by: 
  • Identifying evidence-based, evidence-informed, and innovative strategies and tools to improve pediatric emergency medical services and educating the EMSC community regarding those strategies and tools; 
  • Accelerating data analytics and transforming it to actionable strategies to drive quality improvement; and 
  • Advancing the National EMSC Performance Measures through the development and implementation of QI collaboratives. 

The HRSA EMSC Programs welcomes Baylor College of Medicine/Texas Children's Hospital. Should you have any questions or comments, you may contact Ms. Theresa Morrison-Quinata at TMorrison-Quinata@hrsa.gov or Dr. Elizabeth Edgerton at EEdgerton@hrsa.gov.


Liquid Nicotine is a Poison. Treat it like one.

I n the last few years, using eCigarettes, also known as "vaping," has become popular. The liquid nicotine (also called eJuice or eLiquid) used to refill eCig cartridges comes in more than 100 flavors, many of which taste and smell like things kids like to eat or drink - fruit punch, watermelon, gummy bears, and chocolate cake, for example. The scents, combined with the fact that some of the liquids are brightly colored and look a lot like juice, can make liquid nicotine attractive to kids. What many people don't realize is that this liquid nicotine is very concentrated and is a dangerous poison. 

Since these products hit the market, there has been a big jump in the number of calls to the poison help line about liquid nicotine. In 2014 alone, there were more 2300 calls to the poison help line for kids ages 5 years and younger, and at least one child died from swallowing some liquid nicotine in an eCig cartridge. 
So just how dangerous is liquid nicotine? Medical research has shown that if kids swallow just a half-teaspoon (2.5ml) of liquid nicotine, it can cause severe stomachache, vomiting, seizures, fast heart rate, breathing troubles, and even death. Liquid nicotine also soaks into the skin very easily, so just touching a small amount can be dangerous. Many of the "vaping" and liquid nicotine products that are available come in containers that are not child-resistant, so it is important to keep these products out of the reach of kids. 

The following tips can help you keep your children safe from liquid nicotine poisoning. 
  • Put it up and away and out of sight of children. Store bottles of liquid nicotine and other eCigarette supplies out of reach and out of sight of children - preferably in a locked cabinet. Check every place your child visits, such as the houses of grandparents, friends, and caregivers, to make sure they store liquid nicotine safely. 
  • Refill alone. Only refill eCig cartridges when children are not around, and put supplies away immediately after use. 
  • Protect skin. Wear rubber or latex gloves when handling liquid nicotine. If you spill some, clean it up with a paper towel right away, and then throw everything away in a trash can that kids cannot open. 
  • Safely dispose of liquid nicotine and supplies. Follow the instructions on the label for disposal. If there are no instructions, take the following steps:
    • Pour unused liquid into a bag of kitty litter or coffee grounds.
    • Put empty liquid nicotine containers, paper towels, and other used eCig supplies into the bag and close it. 
    • Throw the bag away in a trash can that kids cannot open. 
  • Know how to contact the poison help line. Have the number for the poison help line, 1-800-222-1222, posted in a visible place in your home, and saved in your phone. Call immediately if you think a child has come in contact with liquid nicotine. For more information on this and other topics, visit www.PreventChildInjury.org


Upcoming Courses:
    On Tuesday, July 19, 2016, Gary A. Roselle, M.D., F.A.C.P., Director, National Infectious Diseases Service, Department of Veterans Affairs (VA), Washington, D.C.will present "Zika Virus and Other Mosquito-Borne Diseases: What You Need to Know" at the Eugene and Marilyn Glick Indiana History Center, 450 West Ohio Street, Indianapolis, IN 46202.
    Dr. Roselle is a nationally acclaimed expert in infectious diseases and their significance to the healthcare arena and larger community. His expertise and experience are evidenced through his service on influential scientific and policy task forces, councils and committees such as: the Zika Task Force - HHS / ASPR; Chikungunya Committee - Executive Office of the President; Presidential Advisory Council for Combatting Antimicrobial Resistant Bacteria Working Group; and HHS Public Health Emergency Medical Countermeasures, Emerging Infectious Diseases Working Group.  Dr. Roselle's extensive scientific work and research on infectious diseases are reflected through his presentations, book chapters and publications. Dr. Roselle is also a Professor of Medicine, Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine.
    Grand Rounds admission is free and open to the public. A free continental breakfast will be served beginning at 7:30 AM, with a presentation following from 8:00-9:00 AM.
    For more information on this event, individuals are encouraged to view flyer, which can be found using the following l ink. (*MESH thanks Marion County Public Health Department for its support of this important event!) REGISTER NOW!
  • Indiana School Nurse Emergency Care Course.  Indiana EMSC and the Indiana Department of Education are pleased to announce the Indiana School Nurse Emergency Care course. This course is a hybrid course with an online portion to be completed prior to attending a one-day in-person training.    Online training modules include topics such as:
  • The School Nurse Role in Emergency Care
  • Legal Issues in Nursing
  • Assessment and Triage
  • Medical Emergencies
  • Abdominal and Genitourinary Emergencies
  • EENT and Dental Emergencies
  • Emergencies Involving Mental or Behavioral Health
  • School Emergency Response and Crisis Management
To register for this course, please click here
  • National Child Passenger Safety Certification. Child car seats reduce the risk of injury by 71% yet 73% of child restraints are used incorrectly and one-third of children are not using any type of restraint whatsoever. One way to help ensure that car restraints are being used correctly is to become a certified child passenger safety technician (CPST) through Safe Kids Worldwide ( http://cert.safekids.org/become-tech ). This is a four day course with three quizzes, three skills assessments and one car seat clinic. It is open to anyone who would like to become a technician. With the fee of $85 to sign up for the class, you are provided with a workbook that is essential to learning how to become a technician. Getting certified may be time-intensive but it is worth it when provided families the education they need to protect their child's future.    
  • Free Pediatric Online Training
  • FREE TRAINING - The Center for Global Health at the Colorado School of Public Health Online Pediatrics in Disasters Course
    Although a quarter of the world's population is under the age of five, 50 percent of the victims of man-made and natural disasters are children. Children are vulnerable in disasters for physiological, psychological and developmental reasons. Too often medical staff are ill-prepared for pediatric triage and emergency stabilization in terms of knowledge and experience, as well as equipment and supplies. The Pediatrics in Disaster training program trains health care providers to prioritize life-saving care for children in disasters. Because of the vulnerability of children and adolescents, pediatricians and other health professionals must ensure that local, regional and national disaster preparedness planning meets the specific needs of children and adolescents.  Click here to register
  • The 2016 PREP: EM - An Intensive Review and Update of Pediatric Emergency Medicine course , sponsored by the American Academy of Pediatrics and its Section on Emergency Medicine and the American College of Emergency Physicians, will take place August 6-10, 2016, in Chicago, IL. Registration is now open. Continuing medical education credits are available.  Click here for more information.
  • The Indiana Child Fatality Review Program is hosting a free training event for First Responders, Fire, Law Enforcement and EMS:  DOSE - DIRECT ON SCENE-EDUCATION is an innovative program to help eliminate sleep related infant death due to suffocation, strangulation or positional asphyxia by using First Responders to identify and remove hazards while delivering education on-scene during emergency and non-emergency runs.  Created by firefighter Captain James Carroll and NICU nurse Jennifer Combs in Broward County (FL), DOSE has been adopted as an initiative of emergency response agencies in Tennessee, New Jersey, Michigan and Louisiana, often in conjunction with the Cops & Cribs Program.  Over 1500 first responders have been trained and are beginning to see real impact in the lowering of the number of infant deaths in their jurisdictions.
  •   Why DOSETM?   In 2014, 14% of infant deaths in Indiana were due to Sudden Unexplained Infant Deaths or SUIDS.  This includes babies who die of SIDS or accidental suffocation in bed.  DOSE TM can put prevention in the hands of First Responders.  When Broward County Florida began the DOSE program, they had the highest SUID rate in the state.  Today, they are seeing less than one baby die per year! 
  • How Can My Department Get Involved?  The Indiana Child Fatality Review Program is pleased to be bringing Capt Carroll to the Indiana Emergency Response Conference (IERC) in August 2016.  He will be providing a keynote address at the conference, as well as conducting breakout sessions to guide learners in how to set up a DOSE program in their communities.  We will be providing the training materials to your department at NO COST to you or your department, as well as materials for you to provide to families receiving your Safe Sleep education and intervention.  This will include a book for the baby, a Sleep Sack, a pacifier and some educational materials.
        For more information please contact Gretchen Martin at  GMartin1@isdh.in.gov   or Kelly Cunningham at  kcunningham2@isdh.in.gov  
  • The Indiana Emergency Response Conference will be hosted at the Sheraton - Keystone at the Crossing in Indianapolis from August 24 - 27, 2016. The 2016 IERC theme is Preparedness: Past, Present, and Future. To register, visit: www.indianaerc.com
Contact Information:

Program Director:
Elizabeth Weinstein, M.D.

Program Manager:
Margo Knefelkamp

3930 Georgetown Rd., Indianapolis, IN 46254
(317) 630-7742