O2096: Special Needs Tracking and Awareness Response System (STARS): An Innovative Relationship Between Medically Complex Children and Prehospital Providers

Background: Over the last 50 years the prevalence of children living with complex medical conditions has increased, allowing children with complex conditions to live longer, often into adulthood, and to remain in their homes. Children with disabilities, although still a minority of the population, comprise a disproportionately high number of interactions with EMS and the healthcare system. As a result, these children’s reliance on EMS for critical care and transport continues to grow. Special Needs Tracking and Awareness Response System (STARS) is a multi-institutional approach designed to provide EMS with the knowledge and skills to care for medically complex children.

Methods: A team of coordinators, prehospital educators, and physicians work closely with subspecialists within the two major pediatric hospitals in Saint Louis, Missouri to create customized emergency care plans for medically complex children and provide education to first responders and community hospitals on how to best care for them during a medical emergency. Plans are built around individual needs, which include pertinent diagnoses, baseline physical exam, mental status, vitals, common complications, pitfalls to avoid, medications, and transportation recommendations. Plans are housed in a web-based registry for access by 911 dispatch centers, ambulance services, air medical services, and hospital emergency departments. Each child enrolled in the program is assigned a unique identifier that coincides with their emergency care plan. If a child experiences an out of hospital medical emergency, caregivers are instructed to identify the child as being enrolled in the STARS program when calling 911. Emergency dispatchers notify responding medical providers, prompting the review of the emergency care plan prior to arriving on scene.

Results: To date, the STARS program has enrolled 1062 total participants with ongoing enrollment and has expanded from a single site to include both pediatric hospitals in St. Louis with additional expansion planned. Care plans are reviewed every six months by a team of specialty care providers to meet the evolving needs of our patients. Expert outreach education is provided to the EMS agencies, first responders, and community hospitals who are tasked with caring for STARS patients. STARS currently spans 2 hospital systems, 3 states and 99 EMS agencies.

Conclusion: To our knowledge, the STARS program is the only multicenter initiative that provides tailored prehospital care to pediatric patients with complex medical conditions through collaboration with EMS, EMS medical directors, parents, patients, medical subspecialists, and 911 dispatch. STARS is helping EMS to adapt to meet the needs of this vulnerable population and provide the best possible care through focused education and specialized patient care plans.