Emergency Preparedness
for Children with Special Health Care Needs

COMMONLY ASKED QUESTIONS AND ANSWERS REGARDING THE

AMERICAN ACADEMY OF PEDIATRICS/AMERICAN COLLEGE OF EMERGENCY PHYSICIANS

EMERGENCY INFORMATION FORM (EIF)

 

Why was the Emergency Information Form created?

Many physicians have been in the situation in which they are treating an acutely ill or injured child with a significant past medical history but accurate and relevant information cannot be obtained from the accompanying parent or caregiver. The adults accompanying the child may recall some important data, but they are usually unable to provide the critical information sought by the emergency physician, intensivist, paramedic, nurses, etc. In addition, children frequently become ill or injured when they are not with their parents. In both of these situations, a succinct and accurate health summary is needed to give the health care professionals relevant and critical information.

Contacting the child�s physician or specialist would be ideal, but this is often difficult and time-consuming to accomplish. Sometimes the parents or caregivers do not have the names or contact numbers with them. At other times, paging systems do not work efficiently. Finally, it is common for the primary care physician or specialist to be off call to a colleague who knows little or nothing about the patient being seen.

 

Is not this form the same as the American College of Emergency Physicians (ACEP) Data Set published in the Annals of Emergency Medicine in 1997?

The "Data Set" was the original document created by the ACEP Pediatric Emergency Medicine Committee that prompted the American Academy of Pediatrics (AAP) and ACEP to work together in creating the EIF. The EIF represents several levels of review and refinement after being subject to review by numerous committees and sections within AAP and ACEP as well as several other national organizations, such as the Emergency Nurse�s Association, the Maternal and Child Health Bureau�s Emergency Medical Services for Children program, the National Association of EMS Physicians, and the National Association of Children�s Hospitals and Related Institutions.

 

Who will fill out this form?

Information from both the physicians and parents is needed to complete the EIF, so there needs to be a collaborative effort by both parties. In some cases, most of the EIF could be completed by the parents with verification of information only by the treating physician(s). However, in a majority of cases, the form will need to be filled out by their primary care physician, the subspecialist, or their designee.

 

How often does a patient�s EIF need to be updated to maintain its validity?

Most effort should be expended in completing the EIF as accurately and completely as possible the first time so it can serve as a template for future updates. The EIF should be revised or updated with:

  • significant and longstanding changes in a patient�s condition;
  • the performance of a major procedure;
  • significant change in the treatment plan; or
  • change in physician(s).

The EIF should be reviewed and updated every two to three years.

 

How could it be expected that physicians would have the time to fill out the EIF?

Out of concern and sensitivity for practitioners� time, the form was limited to two pages. The EIF can be filled out in part or in its entirety. If the form is only going to partially be completed, attention should be given to providing accurate contact numbers so that a patient�s physician could be reached within minutes. Subsequent sections, in order of importance, would be:

  • parent or guardian contact numbers;
  • allergies;
  • critical actions to avoid;
  • life-saving maneuvers or interventions; and
  • relevant past medical history.

The EIF was created with the intent of it being a snapshot or overview of a child�s health status until the parents and physician could be contacted so any information would be better than none. It is in the patient�s best interest to have an EIF completed, and the pediatrician or specialist should find a way to fill it out or delegate the responsibility to someone in the office or clinic.

 

Shouldn�t the EIF be longer to include more information?

Longer forms that allow more information to be included have been created. The EIF was limited to two pages to maximize participation and support by those who will be filling out the forms. Many health care professionals have had input in the content of the EIF, and there is space to include the data considered to be most relevant and helpful in an acute emergency. In addition, a two-page form is much easier for health care professionals to reproduce and distribute to their patients.

 

What happens if a child has an EIF completed and on file somewhere but presents without it?

Retrieval of the EIF will be a function of when and where a child presents with an emergency. During office hours, a primary care provider or school nurse could fax it to the ED. Outside of office hours, a parent should have access to the form or have it on their person.

A fail-safe system of information access could exist by having EIFs in a central repository, such as the MedicAlert® 24 Hour Emergency Call Center, that could be accessible for queries by health care professionals 24 hours a day. Children with EIFs in a central repository could be identified with MedicAlert® medical identification jewelry.

In fact, MedicAlert® Foundation has partnered with ACEP and the AAP in an agreement to use its call center as a central repository for the EIFs for children registered with MedicAlert®.

 

How would a system using a central repository such as MedicAlert® work?

Parents would register their child with MedicAlert® Foundation like all other patients prior to the advent of the EIF. However, parents now have the option to submit an EIF with their MedicAlert® registration. This EIF will be kept on file at the Call Center.

In the case of an acute illness or injury, a health care professional can call MedicAlert® Foundation toll-free from anywhere in the world and request the EIF for that child. The EIF would then be faxed within minutes to the health care professional.

 

Where do the parents and child keep the EIF?

In addition to using a central repository, such as MedicAlert® Foundation, a copy of the EIF should be kept in the home in a place that can be easily reached and where it can easily be found. Copies of the EIF should be kept on file in the primary care provider�s office, the subspecialist�s office, in the emergency department to which the child is most likely to present in an emergency, in the parents� cars and workplace, in the child�s school nurse�s office, and with the child�s belongings when he or she is traveling.

 

Where can I get blank EIFs?

The EIF can be obtained several ways:

  • it can be downloaded from the AAP (www.aap.org/advocacy/blankform.pdf) [Adobe Acrobat PDF file - 84K] and ACEP (www.acep.org) Web sites;
  • blanks will be available for purchase at a nominal cost in packets of 100 from the AAP;
  • copy-ready forms have been published in the October 1999 issues of ACEP�s Annals of Emergency Medicine and the AAP�s Pediatrics.

 

Is it OK to make copies of the EIF? Isn�t it copyrighted?

The EIF was created with the intent of it being reproduced without copyright restrictions as long as it is used for patient care and is not sold. However, the content and design of the form are copyright protected by the AAP and ACEP. This means that the AAP/ACEP EIF cannot be altered and subsequently reproduced with AAP and/or ACEP logos.

 

How does a parent assure confidentiality?

The EIF was created for exclusive use by pre-hospital, medical, and nursing professionals to guarantee that an acutely injured or ill child with special health care needs would receive prompt and appropriate care. The AAP and ACEP have created this in a spirit of cooperation with the sole motivation being improved care for children and do not envision any secondary gain by individuals trying to access this information. However, if confidentiality is a major concern to a degree that it would deter the completion of the form by parents or physicians, parents have the option to keep the EIF solely with themselves. Recognizing that there are consent issues, the AAP and ACEP have included a signature block for consent to release the form to health care professionals. It should be noted that national organizations that have kept similar data on file have not had problems with breaches of confidentiality to date.

 

What happens if a health care professional using the EIF misinterprets the information and there is a medical misadventure or complication? Who is responsible?

Because the EIF has just been released, there are no legal cases involving the document, and it is hoped that there will be none. However, in cases in which the EIF were used and there was an untoward event, attorneys (personal communications) have opined that liability would be limited to those professionals providing direct patient care. This is assuming, of course, that the information provided on the EIF is accurate.

If physicians are concerned about their legal risks when filling out the EIF, they have several options that they can employ to minimize their malpractice exposure. They could elect to:

  • not sign the form; or
  • let the parents complete the form by themselves and not participate in the process; or
  • create a "hold harmless" agreement with the parents / guardians. A "hold harmless" agreement would be signed by the parents / guardians and be kept on file with the EIF, and a notation acknowledging the existence of such a form should be made on the EIF.


For more information, please contact:
American Academy of Pediatrics
Susan Tellez
847/434-7395
American College of Emergency Physicians
Elaine Jastram
972/550-0911, ext. 3140