Special Needs Tracking and Awareness Response System (STARS): Improving Pre-Hospital Care for Complex Medical Needs Patients

Background: Pediatric patients with complex medical needs have suffered poor outcomes in prehospital settings due to under prepared emergency providers (EMS), a lack of accurate information, and delayed access to tertiary care. Patient guardians lack confidence in local EMS and community emergency departments (ED). EMS education fails to address the needs of this unique population. Methods: A hospital-based program, STARS, was developed to interface with community EMS and hospitals. Individualized emergency care plans (ECP) are developed for complex medical patients and each child is assigned a unique number linked to local 911 dispatch. ECPs include diagnoses, past procedures, medications, allergies, baseline physical exam, anticipated emergencies, procedures to be avoided, and the preferred tertiary hospital. The ECP is maintained in the child's home, with 911 dispatch, and with local EMS. Local air medical services are involved in rural settings. A STARS outreach team provides education seminars to local teams as complex medical patients are identified in their jurisdictions. Results: Over 3 years, 672 children have been enrolled in the STARS program and 158 educational programs have been provided to local EMS and community EDs. The system has been used multiple times with success, though detailed tracking of 911 calls continues to be established. Conclusion: STARS is improving pre-hospital care provided to medically complex children by creating individual care plans and providing education to local providers. This program may ultimately lead to improved guardian confidence, EMS training, and enhanced local care with prompt transfer to tertiary hospitals when needed.