We Answered Your Call!

When the PEPP program launched, the American Academy of Pediatrics (AAP) vowed that Pediatric Education for Prehospital Professionals (PEPP) would be subject to ongoing review and modification in concert with changes in the science of emergency pediatrics and advances in EMS educational design and methodology. As a result of our hard work and dedication, EMS providers now have access to an innovative online program, and two convenient renewal options to help providers keep their PEPP Course Completion Cards up-to-date.

Option 1: PEPP Online Renewal Course
In April 2002, the AAP announced the release of the online PEPP Renewal Course. This course allows current providers to use the online Pediatric Respiratory Emergencies module to renew their PEPP Course Completion card. There are three steps in the Online PEPP Renewal Course:

1. Complete the interactive online Pediatric Respiratory Emergencies module.
2. Refresh your pediatric skills with a local PEPP Course Coordinator.
3. After completing the online module and hands-on skills, retake the original PEPP Course final exam.

Option 2: On-site Classroom Renewal Course
While the online PEPP Renewal Course has been very well received, feedback from PEPP Course Coordinators indicated a need for a complete on-site renewal course. In direct response, the AAP created an on-site Classroom Renewal Course for PEPP providers. There are two steps in the on-site Classroom Renewal Course:

1. Complete a half-day on-site refresher covering the most important material presented in the original PEPP Course and the new skill stations from the Pediatric Respiratory Emergencies module.
2. After completing the on-site refresher, retake the original PEPP Course final exam.

Upon successful completion of either the online Renewal Course or the on-site Classroom Renewal Course, providers are eligible to receive an updated AAP PEPP Course Completion Card. For more information about the PEPP Course and the renewal options, please visit our web site at www.PEPPsite.com.

AHA Announces PALS Renewal through PEPP

The American Academy of Pediatrics (AAP) is pleased to announce that the ALS PEPP Course Coordinators may now offer a PALS Course Renewal to their students as part of the two-day ALS PEPP Course!

Over the past few months, many PEPP Course Coordinators have inquired about the possibility of offering PALS Course Renewal through PEPP. On August 20, 2002 the American Heart Association (AHA) released a memo to allow PALS Course Renewal through other pediatric courses. Although the initial version of this memo was drafted at the Third National Congress on Childhood Emergencies held in April of 2002, the AAP did not apply for this privilege until the official release of the memo this August. On September 30, 2002 the AHA informed the AAP that the proposal to include the PEPP Course had been approved.

PEPP Course Coordinators must ensure that the following guidelines are followed to allow for a PALS Course Renewal:

• A PALS Course Director must be responsible for supervising instruction and testing.
• The course must be registered with your Training Center.
• Participants should have a current PALS provider card. At the discretion of the PALS Course Director, a recently expired PALS card may be accepted; the participant with the expired card will not have the benefit of remediation if unsuccessful in completing the course.
• Participants must have access to the current PALS Provider Manual before, during, and after the course.
• The current PALS pretest should be distributed to all students at least one week prior to the course, and the completed pretest should be brought to the class.
• A score of at least 84% is required to pass the PALS post-test.
• PALS practical evaluation stations must be completed.
• Must use the approved renewal schedule, available on www.PEPPsite.com.

The AAP has designed the ALS PEPP Course and PALS Course Renewal to be completed in 2 days. However, because of the modular format of the PEPP Course you may choose to present the materials in smaller blocks of time to meet your needs, as long as course content and the length does not change.

If you have additional questions about the PALS Renewal through the PEPP Course, please contact the AAP at 800-433-9016 ext.4795 or via e-mail at PEPP@aap.org.

Cincinnati Children's Hospital Adds "High Tech" Simulator to PEPP Course
Submitted by Brian Pio, EMT-P

Beginning in November 2002, the PEPP Courses at Cincinnati Children's Hospital Medical Center will have a new look. No, there will not be a change to the textbook, slides, or content. There will, however, be a change in the way that the students learn and practice their skills.

The Division of Emergency Medicine, EMSC Education, at Cincinnati Children's Hospital Medical Center will attempt to "bridge the gap" of training models by incorporating the PediaSimª by Medical Education Technologies Inc. (METI), into all of the PEPP Courses. This simulator is a model of a 7-year old, 20-kilogram patient, which will respond in real time to procedures and actions taken for specific programmed scenarios. This computer controlled "manikin" is based on the same theories and technology that are used in flight simulators for pilots. Patient care is based on actual patient responses and student's correct or incorrect interventions are measured. The simulator is a dynamic addition to the PEPP Course, with features that include: the ability to alter respiratory rate and quality (based on adequate or inadequate ventilatory support provided by the student), the ability to palpate the presence and quality of pulses, and to auscultate and assess lung sounds. Feedback will no longer have to be "made-up" or "piece-mealed" because patient assessment and treatment can be done in real-time with no risk to a patient or the student.

Until now, we have had to practice and learn on "static" training aids. The standard pediatric manikin has been the main tool used to teach skills such as airway maintenance, vascular access, cervical spine immobilization, etc. Attaching a rhythm generator to the manikin would achieve the most dynamic interactivity possible. The student would base their treatment on the verbal responses made by the instructor as to the progression of the scenario. This "make believe" patient care made it due to the fact that most of our patient interaction is based on visual and physiologic changes, such as respiratory and pulse presence/absence, pupil size change, and lung sounds. The dosage of administered medications, energy settings, and the amount of a fluid bolus would be assumed to be correct if the student could repeat a formula back to the instructor, although calculations may or may not be performed.

As technology has improved, we have progressed from simple models to ones that give some indication that a performed skill was successful: chest rise-and-fall after intubation and flash back after vascular access. Instructors, as well as students, have become frustrated by the limited interaction of these patient models. Computer based patient assessment and care programs have made great strides with the introduction of interactive CD-ROMS, I-DVDs, and web-based case scenarios. The web-based PEPP Renewal Course is a great example of this technology, because the student can retrieve important patient information after hearing and seeing the specific items that the model has outlined.

Our plan is to incorporate the PediaSimª into the PEPP Course by programming some of the oral scenarios into the simulator and allowing the student to physically treat the patient. In addition, we also plan to research the efficacy of such a model in pediatric patient care. We hope to find that this simulator can make a dramatic impact in prehospital pediatric care.

For more information on EMSC Education at Cincinnati Children's Hospital, please visit www.cincinnatichildrens.org/emsc or email us at: ems@cchmc.org

For additional product information on the PediaSimª, please visit METI at www.meti.com

PEPP Rollout Courses

Throughout 2002 the PEPP Course has continued with unprecedented growth. In the two years that PEPP has been available, over 3,000 Course Coordinators and 32,000 providers have been trained! A great number of requests are received throughout the year for the American Academy of Pediatrics (AAP) to bring PEPP to a specific area. While we wish it were possible to provide this award winning education to all those who request it, the few locations we select are primarily based on a need for the education as identified by the EMS for Children (EMSC) authority in each state. In 2002, the AAP took part in a total of 6 rollouts, 3 domestic, and 3 international. Here is a summary of those rollouts:

Domestic rollouts: The (AAP) was fortunate enough to receive grant monies through the Federal EMSC authority, MCHB, that allowed us to offer 3 PEPP Course rollouts across the country. With these grant funds, we were able to successfully hold "train-the-trainer" rollouts in New York and Florida. A total of 111 Course Coordinators were trained from 5 different states. Because the PEPP Course requires a large amount of equipment, a local EMS agency was utilized to assist with equipment needs and logistics. All three courses were open to both Advanced Life Support (ALS) and Basic Life Support (BLS) providers and the course material was presented to the combined audience. The AAP extends a special thank you to the following people for their extraordinary efforts in making these courses possible: Phyllis Stenklyft, MD, FAAP, Sandra Hartley, EMT-P, Gloria Hale, MPH, Marjorie Geiger, Andy Stern, EMT-P, and Bridget OÔBrien, EMT-I.

Course evaluations were completed by each student and included questions regarding their level of comfort treating and assessing pediatric patients after participating in the PEPP Course. Combined results for all three courses revealed that over 96% of participants had a greater amount of confidence in treating and assessing the pediatric patient after taking the PEPP Course, and 98% would take the course again.

International rollouts: The AAP was honored to receive invitations by several countries to begin training with the PEPP Course. The motivation and initiative of individuals in each country has made PEPP a great success in many locations including Ireland, Scotland, and Great Britain. Although other countries are now using PEPP to train prehospital professionals, the AAP was only able to send faculty to 2 courses between September 2001 and August 2002. As you may remember from past issues of PEPPTalk, the instructors we sent to the United Kingdom provided initial training to participants from Ireland, Scotland, and Great Britain. In early 2002, PEPP Steering Committee chairman, Ron Dieckmann, MD, MPH, FAAP, returned to Belfast, Ireland to assist with another PEPP Course rollout. To read about these courses, please view past issues of PEPPTalk.

Because these courses targeted experienced EMS instructors we are confident that utilizing the PEPP Course has made a significant impact on maintaining high quality pediatric care in the respective rollout areas. Since the international rollouts in 2001 and 2002, other countries have expressed interest in using PEPP to train EMS providers. As PEPP gains worldwide recognition, we hope to continue to provide each PEPP Course Coordinator with the best possible administrative support. In addition to the UK, the PEPP Course is already available or will soon be available in Poland, Germany, Guam, Canada, Trinidad, and Siapan.

IRECCs Annual Meeting

On September 11-14, 2002 the Inter-Regional EMSC Coordinating Council (IRECC) held its annual meeting. This year, the AAP was honored to receive an invitation from IRECC President Teri Sandall to present an update on the PEPP Course. The setting for the meeting was the beautiful mountains of Salt Lake City, Utah at the Snowbird Resort.

Many milestones have been reached in the PEPP program over the past 2 years and IRECC has been a strong participant in the program since it was rolled out in March 2000. As a part of the discussion, Jeff Hummel presented IRECC with impressive PEPP statistics related to their region. To-date, the IRECC member states have trained close to 4,000 providers with PEPP and built a strong cadre of over 300 PEPP Course Coordinators who are actively teaching the course.

Other distinguished speakers included Alan L. (Lanny) Berman, Ph.D., ABPP and John Hrabovsky, Jr., RN, EMT-P. Dr. Berman is the author/editor of six books – including his latest Comprehensive Textbook of Suicidology –and more than 90 peer-reviewed articles and book chapters. He is also the consulting editor to three journals. John Hrabovsky, Jr., is the co-founder of Med-Media Inc., serves as vice president of sales and chief operating officer of the company.

PEPP Steering Committee Member Changes

Can you believe that the official AAP PEPP Steering Committee was formed four years ago? The AAP policy regarding new committees requires us to rotate members off in staggered years beginning in the fourth year. In June 2002 Deborah Mulligan-Smith, MD, FAAP, Art Cooper, MD, FAAP, Pam Baker, RN, BSN, CEN, CCRN, and Gary Rainey, EMT-P all rotated off the committee. With the assistance of these talented people, the PEPP course has achieved many milestones and won national recognition in a very short time. Each has been an asset to the PEPP Course and we are sad to see their term on the PEPP Steering Committee come to an end.

Because we wish to continue a productive relationship with the organizations each member represents, the AAP welcomed new faces to the PEPP Steering Committee on July 1, 2002. James M. Callahan, MD, FAAP, is now the National Association of EMS Physicians' (NAEMSP) representative to the committee. Dr. Callahan is the medical command physician from the SUNY Upstate Medical University in Syracuse, New York. Dan Cuoco, EMT-P joins the committee as the new representative from the International Association of Fire Fighters (IAFF). We extend a warm welcome to both new PEPP Steering Committee members.

It is a bittersweet time to see these changes to the PEPP Steering Committee, but with the continued support and collaboration of all our stakeholders, we anticipate many more years of continued success.