After a successful 14-year career as a pediatric emergency department (ED) nurse, Stephanie Haley-Andrews, RN, EMT-P, began searching for a new calling. As she thought about it, she knew she would stay in emergency medicine. She knew she had a profound respect for the EMS colleagues she encountered every day. And she knew she cared deeply about children’s medical and trauma care. The job she eventually fashioned for herself pulled all these elements together into something that has had a far-reaching effect on the state of Colorado and the neighboring region.
“I first had the opportunity to become the hospital’s part-time EMS coordinator,” says Haley-Andrews, founder and co-director of the EMS Outreach and Education program at Children’s Hospital Colorado.
“We are the only regional Level I pediatric trauma center, and we are one of the top five children’s hospitals in the nation. Kids come to us for specialty care from all over Colorado, and I had a vision for an EMS outreach and education program to better serve these children, and EMS. I created the mission and program in 2008 and haven’t ever stopped.”
That would be an understatement.
On a Mission
In addition to developing and implementing numerous groundbreaking EMS initiatives in 2011, Haley-Andrews gave 62 classes or lectures at more than 32 EMS agencies and spoke at 14 conferences. She also visited nine of the state’s 11 regional emergency medical and trauma advisory councils, which directly influence more than 800 EMS providers.
Why Is She So Driven?
Haley-Andrews is passionate about pediatric care, and in the state of Colorado, she has a lot of ground to cover and a lot of people to educate. Children’s Hospital Colorado serves a huge region, much of which is rural, and many of the EMS and fire agencies are volunteer-based.
Haley-Andrews says national statistics show that pediatric patients make up only about 10% of any EMS agency’s annual call volume, and only 2–3% of those are critical in nature. EMS providers simply don’t have a lot of exposure to sick infants and children, which has been Haley-Andrews’ driving force.
“If we want to best serve sick and injured kids, we must serve EMS,” says Haley-Andrews. “I understood a long time ago if we can help EMS providers take better care of kids in the field, it improves patient outcomes and ultimately helps the community.” Quality of care and evaluation of her education is an important focus of Haley-Andrews’ program, which was also recently recognized as a “best practice” hospital-based EMS program by Novia Strategies.
Relating to EMS
Knowing that EMS “is a far different animal” than emergency nursing, Haley-Andrews’ first order of business was to get her EMT certification and then start making visits to EMS agencies to give them the information and education they needed to treat children. “Children’s Hospital is not-for-profit, and a huge part of our mission is education,” she says. “Knowing how many of our EMS agencies are rural and/or volunteer, with very limited training budgets, I knew I had to take our education to them. So I hit the road to live out my program’s mission.”
Haley-Andrews initially reached out to a few EMS agencies with a presentation about child abuse, aimed specifically at EMS providers. Some were wary of cost and then enthusiastically accepted her invitation to give the presentation when they found out it was free. She now lectures at state conferences and is booked through word-of-mouth and exposure on Colorado’s EMS LISTSERV, which has thousands of subscribers.
“People often come up to me after I lecture and ask me to come to their agency,” she says. “That’s how it’s taken off. I have never said ‘no.’ Not once. I just can’t do that to them.”
Child Abuse Awareness
Haley-Andrews’ presentation on child abuse has been popular because she conveys the critical role EMS plays in spotting and stopping the abuse. “Everyone can see big signs of child abuse, but I go over very subtle signs with them,” she says. “I talk to them about how they richly serve this innocent, often voiceless victim of child abuse. EMS needs to know they have so much more power than they think they have, not only in terms of physical care of the patient, but also in the pursuit of justice.”
Children’s Hospital Colorado also is one of the top pediatric stroke centers in the country, and Haley-Andrews has been passionate about getting the message out about pediatric stroke. “When I started talking about pediatric stroke, people said, ‘Really? Kids have strokes?’ Yes, and we are finding out more about it every day,” she tells them.
Because the hospital is a specialty care center (e.g., cardiac and cancer), many families take up long-term residency in the Denver-Aurora area while their children undergo necessary treatment. She says research has shown 50% of pediatric stroke patients have an underlying condition that makes them susceptible to stroke. Haley-Andrews wonders if having an increased population of children with special healthcare needs in the metro area has attributed to higher stroke rates than published data. “We shall see,” she says. “The brilliant Dr. Timothy Bernard of our stroke program is watching the numbers.”
Sharing Her Message
Haley-Andrews and Bernard have partnered in getting the message to EMS about pediatric stroke, especially in light of an upcoming clinical trial involving clot busting agents in children. Children’s Hospital Colorado is one of only 15 hospitals in the world involved in this study. Because the overall incidence of pediatric stroke is relatively low, making sure pediatric stroke patients get to Children’s is paramount for the future of stroke care for children.
So Haley-Andrews developed and implemented quite possibly one of the nation’s first-ever EMS-activated pediatric stroke alert protocols that started with Aurora Fire Department.
“I went to Aurora Fire and asked if they would be open to developing a pediatric stroke alert for their system. Ideally, we need these kids within five hours of symptom onset, so I asked if they would bypass other hospitals and get those kids to us as fast as possible,” she says. “Aurora Fire is very quality focused and agreed. Because of their implementation, we’ve been able to talk about the protocol with other agencies.”
One of Haley-Andrews’ proudest accomplishments is the grant she wrote and was awarded to teach pediatric advance life support (PALS) to 40 rural EMS providers around Colorado. “We don’t have a lot of rural providers out there that have a lot of experience with critical kids,” she says. “What if the very first pediatric patient they treat is the one that needs their life to be saved?”
So Haley-Andrews wrote the grant and focused on the rural EMS agencies that would benefit the most from PALS education.
Haley-Andrews has also been instrumental in establishing the hospital’s Preferred EMS Provider program, in which EMS agencies must show a commitment to pediatric education by having paramedics PALS certified and agreeing to have specific equipment on hand, identified by the American College of Emergency Physicians. “They are the governing body in determining what should be on ambulances for pediatric patients,” says Haley-Andrews.
For this commitment, the agency becomes a preferred provider to the hospital, with the ability to call on medical directors and get advice on protocols, case reviews and all things pediatric. “This opens the doors between Children’s and EMS agencies,” says Haley-Andrews. “We are a resource for them. It’s not us telling them what to do. It’s a true partnership, and we learn a lot from them, also.”
In addition to being involved in all of these programs, Haley-Andrews sits on numerous advisory boards and teaches pediatric EMS content at two community colleges. “I’m so inspired by EMS and these amazing people that serve their communities,” she says. “I feel like I need to serve them, and part of that is being involved in certification education. The community colleges don’t have to pay me, and they’re getting expert education for their students.”
This workload would be daunting for most people, but Haley-Andrews finds her pediatric advocacy work rewarding and energizing. “Having worked in a pediatric ED my whole career, I have seen firsthand how EMS can save a child’s life,” she says. “EMS providers are the most down-to-earth, grounded, caring people, and I am so impressed by them that I will do anything to help them.”
Haley-Andrews stresses that a big part of the hospital’s role, and her role as well, is recognizing and acknowledging the remarkable contributions of EMS in saving lives, particularly children’s lives. “EMS is such an important part of helping kids and saving kids,” she says, “and I remind them of that.”
Ultimately, she says. “This is all about taking care of kids and taking care of EMS.”