PEPP TALK

Much like sleepy fire fighters suiting up for an alarm, pediatric care changes fast. In order to stay current on the latest medical information for the emergency care of infants and children, check out the new Pediatric Education for Prehospital Professionals (PEPP), 2nd Edition! This course is designed to give prehospital professionals the education, skills, and confidence they need to effectively treat pediatric patients. The PEPP program was developed by the American Academy of Pediatrics (AAP) and was designed to teach prehospital professionals how to better assess and manage ill or injured children.

"PEPP 2 embodies all of the science generated in prehospital pediatrics and emergency medical services over the last five years," said Ronald A. Dieckmann, MD, MPH, FAAP, who served with a team of editors in creating the new materials. "It also responds to the rising call for evidence-based treatment recommendations."

Geared to street-level prehospital professionals—fire fighters, paramedics, and emergency medical technicians (EMTs)—the PEPP 2 course offers advanced breathing techniques, a more descriptive medication formulary, and expanded resuscitation algorithms. Other updates cover medication therapies and procedural approaches. New topics include:

"PEPP 2 builds on the basic concepts and innovations of the highly successful original PEPP course but goes far beyond in its scope," explained Dr. Dieckmann. "PEPP is now the leading, standard-setting educational course for pediatric prehospital care nationally and internationally."

Course materials include a revised student textbook, DVD, ToolKit CD-ROM, Instructor Resource Manual, and Instructor Teaching Package with DVD. The first edition of the PEPP textbook, published five years ago, sold more than 100,000 copies worldwide, and the PEPP program extends into nine countries and includes more than 5,000 instructors worldwide.

To learn more about the PEPP program, contact the AAP at 800/433-9016, ext. 4795 or check out the PEPP Web site at www.peppsite.com.

To order PEPP materials, visit the PEPP Web site listed in this article or contact the AAP Customer Service Center at 888/227-1770. Or, visit the AAP Bookstore at www.aap.org/bookstore. On the bookstore homepage, enter "PEPP" in the "Browse the Bookstore" section of the site.

One of the biggest challenges facing the Pediatric Education for Prehospital Professionals (PEPP) program is getting more states to invest time and money in updating first responders' pediatric skills, according to Susan Fuchs, MD, FAAP, FACEP, new cochair of the PEPP Steering Committee. Dr. Fuchs is serving as committee cochair along side Dena Brownstein, MD, FAAP, of Seattle, WA, who has been on the committee as cochair since 2003.

"Many states do not require continuing education for EMTs or paramedics in any particular subject—especially pediatrics—so some people don't want to commit the time to continuing education," explained Dr. Fuchs. "Unless the course is offered for free or at a very low cost, they don't want to spend the money."

Looking towards the future, Dr. Fuchs wants to turn these challenges into accomplishments as she cochairs PEPP through 2009. Her goals are to:

Dr. Fuchs is an attending physician at Children's Memorial Hospital Emergency Department in Chicago and is professor of pediatrics at Northwestern University Feinberg School of Medicine, also in Chicago. In addition to her PEPP work, Dr. Fuchs serves on the Advanced Pediatric Life Support (APLS) Steering Committee and the American Academy of Pediatrics (AAP) National Conference and Exhibition Planning Committee. She is also a member of the AAP Section on Emergency Medicine.

Joining Dr. Fuchs as the newest members of the PEPP Steering Committee are James M. Callahan, MD, FAAP, FACEP; Dwayne Forsman, EMT-P; Daniel Cuoco, EMT-P; and Cynthia Wright-Johnson, MSN, RNC. Bruce L. Klein, MD, FAAP and Paul E. Sirbaugh, DO, FAAP, were reappointed to the PEPP Steering Committee in 2005.

Dr. Callahan represents the National Association of EMS Physicians (NAEMSP.) As medical command physician at the SUNY Upstate Medical University Department of Emergency Medicine in Syracuse, N.Y., he is involved in education and oversight of prehospital personnel. He says he hopes the insights he brings from the NAEMSP members to the program, "will help the PEPP program continue to be the premier educational course for prehospital professionals who hope to increase their knowledge and skills in pediatric care."

Forsman, a licensed paramedic in Winnipeg, MB, Canada and a paramedic educator, represents the Paramedic Association of Canada. "My goals are to try and include some Canadian content in the PEPP program," Forsman says. "Paramedic educational textbooks and resources in Canada are highly influenced by our American neighbors. This can be problematic with topics such as medical/legal issues, medications, weights, and measures."

Cuoco represents the International Association of Firefighters and is chief fire officer of the Miami-Dade County Fire Rescue Department in Florida. Cuoco intends to focus on PEPP curriculum development. With more than 30 years as a paramedic, including recent stints in Louisiana and Mississippi after Hurricanes Rita and Katrina, he sees a need to teach more clinical assessment and treatment skills to first responders so they can offer more medical and psychological support to disaster victims.

Dr. Klein represents the AAP Section on Transport Medicine and is Medical Director, Pediatric Transport Service, at Children's National Medical Center in Washington, DC. Dr. Klein, who was reappointed to the PEPP Steering Committee in 2005, said that during his tenure he would like to see the PEPP program be more evenly distributed in the US and Canada as well as involve PEPP in more international activities, such as having the PEPP materials translated into Spanish and other languages.

Dr. Sirbaugh represents the American College of Emergency Physicians and is Director, Pre-hospital Medicine at Texas Children's Hospital in Houston as well as Assistant Professor of Pediatrics at Baylor College of Medicine, also in Houston. Dr. Sirbaugh's primary focus is emergency medicine for pediatrics and serves as the Assistant Medical Director of prehospital pediatric emergency medicine for the city of Houston EMS.

Cynthia Wright-Johnson is the EMSC Program Director at the Maryland Institute for Emergency Medical Services Systems (MIEMSS) in Baltimore, MD and represents the National Association of State EMS Directors.

To review the complete list of PEPP Steering Committee members, visit the PEPP Web site at www.peppsite.com.

Jim Ogle, NREMT-B, decided to try something new with the Pediatric Education for Prehospital Professionals (PEPP) course: he incorporated the entire PEPP program into the core curriculum of the basic emergency medical technician (EMT) training offered at Capital Health System in Trenton, NJ.

Jim's 15 to 20 students ranged from uncertified trainees to veteran paramedics with 15 years' experience. They commented that the PEPP textbook, videos and slide shows were much more interactive than the standard EMT textbook alone and were full of valuable new insights.

"The sections on maltreatment and on pediatric immobilization were especially well received," Jim said.

Although the pediatric portion of the November 19, 2005, training session lasted two hours longer than usual, students didn't seem restless. "They got a little bit extra," Jim said. "They just loved it."

Jim was concerned that the students' wide range of experiences would be a problem. He feared boredom would set in among the veteran paramedics and the trainees might be intimidated. "I was really sweating it," he said, "but we mixed it up, and it worked really well." The veterans pitched in to help the trainees and, "they really fed off of each other."

In addition to Jim, course instructors included Ian Malik, NREMT-B; Bill Goerlich, NREMT-P; and Scott McConnell, CCEMT-P, NREMT-P.

PEPP materials were also used to highlight a November 28-2,9 2005, Capital Health System paramedic refresher course for advanced providers. Instructor Margaret Eslow, RN, MSN, PNP, BC, provided insight into pediatric care in the prehospital setting.

Jim says he expects to see PEPP training expand into field use throughout New Jersey over the next six to 12 months.
For more information about Jim's latest PEPP trainings or to share ideas, contact him at 732/865-2980.

This Web site is for PEPP instructors and students—in other words, YOU. You're invited to share your ideas, launch activities, inspirations and successes by submitting them via the PEPP Web site at www.peppsite.com/community_newsletter_submit.cfm. Or, send an e-mail to the American Academy of Pediatrics Division of Life Support Programs at lifesupport@aap.org. In the subject line of your e-mail, include "PEPP Feedback."

Robert Wiebe, MD, FAAP, FACEP, of Dallas, Texas, received the 2005 Lifetime Achievement Award at the Emergency Medical Services for Children (EMSC) National Heroes Awards program in April.

"I've known him personally for about 13 years, but I've heard of Dr. Wiebe as long as I've been in pediatric emergency medicine, and that's 22 years," said Thomas Abramo, MD, FAAP, professor of pediatrics and director and chief of pediatric emergency medicine at Vanderbilt Medical University in Nashville, Tenn.

"He's innovative," Dr. Abramo says. "He always asks the questions, 'Why are we doing this now? Is there a way we can do it better?'" Dr. Abramo adds, "He's just the greatest person to have as a boss and as a colleague."

Dr. Wiebe is the Sarah M. and Charles E. Seay Distinguished Chair in Pediatric Emergency Medicine, Professor of Pediatrics, at Children's Medical Center of Dallas. On Aug. 31, he stepped down as Director of Emergency Services at Children's and agreed to take over as Interim Medical Director of Transport. He will be involved in any rescue efforts the hospital undertakes after Hurricane Katrina, according to Lynn Heise, his administrative assistant for the past 7 years. He also is director of the pediatric emergency division of the University of Texas Southwestern Medical Center at Dallas.

Steven Krug, MD, FAAP, of Chicago, chairperson of the AAP Committee on Pediatric Emergency Medicine (COPEM), describes Dr. Wiebe's longstanding influence on the profession: "He has helped to guide the development of pediatric emergency medicine as a subspecialty and clinical standards for pediatric emergency care, and has been an important advocate for pediatric emergency readiness, both nationally and within his own community."

Carden Johnston, MD, FAAP, of Birmingham, Ala., past president of the Academy, recalls that Dr. Wiebe remained upbeat despite long days crammed with teaching, clinical care, and administration. "His workday all too often was 36 hours, and he did it calmly, without showing signs of stress, and without projecting hostility upon the people he worked with."

Heise concurs, observing, "What makes him so good at what he does is that he loves it. Medicine is his hobby, and he loves to teach."

Dr. Johnston agreed, noting, "He's an outstanding teacher. He would teach clinically, and would bring up one of the patients he'd seen in the emergency department. Instead of teaching didactically, where people would be just listening, he'd involve them in the education process."

Marianne Gausche-Hill, MD, FAAP, FACEP, the ACEP representative to the APLS Steering Committee, served as COPEM co-chairperson with Dr. Wiebe. They worked together for 18 months on pediatric guidelines for emergency department care of children, including children with special health care needs.

"He's a visionary," she observed. "His work ethic is unmatched by many. He doesn't always have to lead, which lets others have the opportunity—a real quality in a leader."

Besides his COPEM work, Dr. Wiebe is a member of the AAP Committee on Continuing Medical Education. He has served on the steering committees for PEPP, APLS, and the First Aid for Health Providers courses. He also has been a leader at the state level, developing the Texas Pediatric Society Committee on Pediatric Emergency Medicine and serving in the Texas Department of Health, Bureau of Emergency Management.

"Getting to know Bob Wiebe is one of the best things that has ever happened to me in my professional career," says Dr. Krug. "He has served, for me and likely for so many others, as a great role model for physician leadership. He is a remarkably effective leader and child advocate, one who leads by example—very inspiring, very engaging."

EMSC is a national initiative to reduce child and youth disability and death from severe illness and injury. It comprises medical personnel, parents and volunteers, community groups, businesses, and national organizations and foundations. EMSC is supported and jointly administered by the US Department of Health and Human Services' Health Resources and Services Administration and the US Department of Transportation's National Highway Traffic Safety Administration.