Notice of Special Interest: Research on Emergency Medical Services for Children (EMSC)

Notice Number: NOT-HD-19-022

Key Dates
Release Date: October 9, 2019
First Available Due Date: February 5, 2020
Expiration Date: September 8, 2022

Related Announcements

PA-19-056 - Research Project Grant (Parent R01 Clinical Trial Not Allowed)

PA-18-480 – NICHD Research Project Grant (R01 Clinical Trial Required)

PA-18-481 - NICHD Small Grant Program (R03 - Clinical Trial Optional)

PA-18-482 - NICHD Exploratory/Developmental Research Grant (R21 - Clinical Trial Optional)

Issued by
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Purpose

Unintentional injury is the leading cause of death for individuals from ages 1 to 44 years. There are almost 137 million emergency department visits yearly of which 39 million are injury related. In 2015, children and young adults from birth to 24 years of age were involved in more than 1/3 of the total number of emergency department visits. Death rates are climbing in U.S. adolescents due to unintentional injuries, murder, and suicide. Natural disasters, school shootings, drug overdoses, and suicide attempts add to the number of injured children and adolescents needing emergency care and make this a timely initiative. Advances in communication such as telehealth and in genetic research offer new avenues for the advancement of EMSC research.

Emergency care for Infants and children differs from care for adults in terms of medication doses, resuscitation equipment, procedural techniques, and psychological support. Research is needed to improve the quality and quantity of research related to emergency medical services for children (EMSC) with the goal of reducing morbidity and mortality in children through improved care delivery. Improvements in pre-hospital care, emergency department care, and in-hospital critical care are needed to reduce pediatric deaths and disability, and to improve long-term recovery.

The 2006 IOM report, Emergency Care for Children: Growing Pains identified gaps in basic, translational, and health services research in the area of emergency care. The report described a fragmented system of emergency care with emphasis on the uneven and disparate nature of emergency care for children in the United States. Among the key recommendations of the report were the following: improve coordination of care; regionalize specialty pediatric medical care; increase accountability; arm the emergency care workforce with pediatric knowledge and skills; enhance patient safety advancements in technology and information systems; improve emergency preparedness for children involved in disasters; and build an evidence base for pediatric emergency care. In 2009, the NIH sponsored a series of roundtables on the needs and challenges in the field of emergency medicine research. The roundtables identified research gaps including the need for rigorous out-of-hospital research, the translation of existing research findings in adults to children, the need to link multiple databases to incorporate pre-hospital, emergency department, and in-hospital data to conduct certain types of pediatric research studies. Noting the numerous differences between pediatric and adult patients, the report highlighted the need for pediatric focused studies on cardiac arrest and the use of resuscitation fluids, drugs, and therapeutic hypothermia. The 2010 report to the President and Congress issued by the National Commission on Children and Disasters listed recommendations to address gaps in laws, regulations, policies, and programs to meet the needs of children during disasters. This funding opportunity will catalyze the field of inquiry by calling attention to unanswered questions and remaining research gaps identified through these reports.

According to the National Academies 2007 report, children represent a special challenge for emergency care providers, because they have unique medical needs in comparison to adults. While providers have recognized the special needs of children, the system has been slow to develop an adequate response to their needs. This is in part due to inadequacies within the broader emergency care system. Most children receive emergency care in general hospitals, which are less likely to have pediatric expertise, equipment, and policies in place for the care of children. Children make up 27 percent of all ED visits, but only 6 percent of EDs in the U.S. have all the necessary supplies for pediatric emergencies. Many drugs and medical devices have not been adequately tested on, or dosed properly for children. While children have increased vulnerability to disasters—for example, children have less fluid reserve, which leads to rapid dehydration—disaster planning has largely overlooked their needs.

Research in EMSC is essential to identify new and improved ways of diagnosing and treating injured and acutely ill children, to evaluate current and evolving emergency medical practices, to devise better ways to deliver emergency medical care, and to learn where best to direct prevention activities. With the increase in deaths due to distracted driving, recent traumatic events in school communities, hurricanes and natural disasters, more public attention is now focused on the physical, psychosocial and behavioral health of children and youth. It is anticipated that research stemming from this initiative will help to induce a paradigm shift and change clinical practice.

Research Objectives

This Notice of Special Interest (NOSI) invites research applications that focuses on three specific areas of research on emergency medical services for children which were understudied in earlier versions of this program. These are:

1) Clinical and translational research which includes building the evidence base for clinical aspects of emergencies and emergency care and assuring pediatric safety and quality in emergency care.

2) Methodology which includes improving data collection, patient outcomes and outcome measures in pediatric emergency care, and system organization, configuration, and operation to provide optimal care.

3) Evaluation which includes costs and cost-effectiveness, diagnostic tests, procedures, and services provided by medical, nursing, social work, first responders, ancillary personnel and others involved in EMSC care, and the evaluation of systems of EMSC care.

Topics of Interest

The NICHD is issuing this Notice to highlight interest in receiving grant applications focused in the following high priority areas which include, but are not limited to studies that propose to:

Clinical and Translational Research

  • Demonstrate safe practice interventions that reduce or eliminate medical errors, risks, hazards, and harms associated with emergency care in children;
  • Identify and/or develop effective disaster preparedness and response approaches for all children including those with disabilities, special health care needs, emotional or psychological risk profiles, or living in rural or disadvantaged situations;
  • Investigate medical and behavioral aspects of emergency medical treatment of children with illness or injury documenting management of pain, stress, and/or adherence to treatment or completion of indicated follow-up care;
  • Assess innovative approaches based on the translation of recent basic science studies into clinical practice, such as new methods of circulatory and ventilatory support, and newer strategic applications of more conventional methodologies.

Methodology

  • Develop an evidence base for clinical aspects of emergencies and emergency care;
  • Demonstrate the efficacy and effectiveness of interventions provided to children in emergency settings, including pre-hospital interventions;
  • Identify, develop, and refine effective and efficient methods, structures, and strategies to implement and evaluate evidence-based interventions in EMSC;
  • Develop and test novel interventions, informatics support, and decision-making strategies for pediatric trauma patients.
  • Link multiple databases to incorporate pre-hospital, emergency department, and in-hospital data to facilitate optimal care for pediatric patients.

Evaluation

  • Improve data collection and evaluation systems in EMSC and the use of telemedicine in underserved areas both domestic and international;
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  • Evaluate emergency medical services and systems of care for pediatric patients in terms of availability, effectiveness, and outcomes, using prospective cohort models to discover and describe potential systematic deficits that impede optimal delivery and outcome of emergency medical care;
  • Assess mechanisms by which emergency medical service delivery for children might be altered or enhanced to ensure safety, efficacy and availability of services appropriate for children's age and physiologic condition;
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  • Evaluate studies designed to improve diagnosis (including the use of decision trees and diagnostic tests including genetics), treatment, and health outcomes of children in need of emergency assessment and treatment;
  • Evaluate disparities in access to and quality of emergency medical services for children based on socioeconomic status, geographic location, race, ethnicity, gender, gender identity, language, or health literacy;
  • Develop and evaluate the scientific basis of pediatric resuscitation practice with the goal of improving neurodevelopmental outcomes in injured or acutely ill children;
  • Evaluate basic and clinical pharmacology studies related to efficacy, safety, dosing and pharmacogenomics of medications used in the prevention and treatment of emergency-related conditions in children;
  • Evaluate the need for pediatric formulations and devices for use in emergency situations;
  • Study long-term developmental outcomes of children treated with pharmacologic agents, including anesthetics and analgesics, for emergency indications;

Low priority areas include studies that:

  • Describe and/or evaluate existing coordination of care procedures involved in EMSC services;
  • Evaluate the emergency department as a site for counseling on health-risk behaviors, health promotion, and intentional and unintentional injury prevention;
  • Describe and/or evaluate the link between acute interventions and chronic illness and disability in children across the developmental trajectory;
  • Describe the epidemiology of critical illness and injury in childhood.

Application and Submission Information

This Notice applies to due dates on or after February 5, 2020 and subsequent receipt dates through September 8, 2022.

Submit applications for this initiative using one of the following FOAs or any reissues of these announcements through the expiration date of this Notice.

PA-19-056 - Research Project Grant (Parent R01 Clinical Trial Not Allowed)

PA-18-480 – NICHD Research Project Grant (R01 Clinical Trial Required)

PA-18-481 - NICHD Small Grant Program (R03 - Clinical Trial Optional)

PA-18-482 - NICHD Exploratory/Developmental Research Grant (R21 - Clinical Trial Optional)

All instructions in the SF424 (R&R) Application Guide and referenced FOAs must be followed, with the following additions:

  • For funding consideration, applicants must include "NOT-HD-19-022" (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B, or non-responsive to the terms of this NOSI will not be considered for this NOSI initiative.
  • Applicants planning to submit an application in response to this NOSI are strongly encouraged to contact the NICHD scientific/programmatic contact(s) listed on this NOSI in advance of the application due date.

Applications non-responsive to terms of this NOSI will be not be considered for the NOSI initiative.

Inquiries

Please direct all inquiries to the contacts in Section VII of the listed funding opportunity announcements with the following additions/substitutions:

Scientific/Research Contact(s)

Valerie Maholmes, PhD, CAS
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Telephone: 301-496-1514
Email: maholmev@mail.nih.gov