Annual EMSC Grantee Meeting

Welcome

June 20 – 22, 2006

DAN KAVANAUGH: First of all I’d like to welcome everybody to the Grantee Meeting. My name is Dan Kavanaugh. I’m the director of the EMSC program and my colleague, Tina Turgell is also here. However, she lost her voice last night. Now, how with seven children would you lose your voice? Tina was going to be talking this morning to do some introductions and some updates on EMSC but I will do that in her stead. She’s kindly given me her notes that she was working on. I will do that in her stead this morning, but Tina will be able to talk to you today but just probably whispering to you.

Couple of people though that I’d first like to acknowledge and recognize. Actually quite a few folks and also, I hope everybody had a safe trip. I know the weather was not that great last night and maybe people got stuck in some bad weather. Thanks for your perseverance in getting here. First of all, I’d like to acknowledge the staff of the EMSC National Resource Center, Jane Ball, Ken Allen, Eddie Liao, Susan Eads Role, Karen Belli , and others who are here and also the staff at the EMSC Data Analysis Resource Center in Salt Lake City. If you all could please stand up so people know who you are. Play Man is here. He should be standing up.

And also anybody who is involved in the planning committee, we’ve got a great program that was put together. It’s a very full two and a half days, if you could stand if you were involved in planning this conference. And thirdly, I would like to ask if there are any people who are new grantees, or if this is the first time that you’ve attended an EMSC Grantee meeting? We’d like to know who you are so that other seasoned folks can also connect with you. Please stand if this is your first meeting. Wow, okay. Super. Welcome. We hope it’s a great meeting for you all.

And also, I would like to ask our federal partners to stand. Some of them are here. I know Stephanie Bryn from HRSA, Susan McHenry from NHTSA, if there are others here from any of the other agencies that I can’t see. Mickey Reynolds, from Grants Management is here. I know some folks maybe from NIH who are going to be coming. I’m not sure if they’re here this morning but they are going to be coming I know specifically for some of the targeted issues breakout. So I would also like to thank our logistics folks with the Dixon group who do a great job with all of the EMSC meetings.

As I said, Tina was going to be talking to you this morning. If we could go ahead and put up the first slide. So, I’m going to be Tina this morning and go over -- what I’m going to do this morning is go over some current activities that the programs engaged in and then on Thursday morning, what I’m going to do is talk more about future plans next fiscal year information.

In terms of our state partnership grants in FY 06, we had 47 new grants, and we had nine that are in continuation and as you all know here, these grants are to solidify the integration of pediatric focus within the state’s EMS system and I think this was the second year where actually we had all 56 states and territories funded at $115,000 a year. We awarded -- actually is says eight targeted issue grants were awarded, we actually awarded nine, one was awarded a little bit later in the year and that’s Karen Guice’s grant on the National Trauma Registry for children.

But here’s our listing of our eight that we’ve awarded in FY 05. We currently actually have 16 that are continuations, seven that were awarded in FY 04. I’m going to talk on Thursday morning about next year’s plans for targeted issues. And all the information that I’m going over, obviously you can get more details when you go to the EMSC website. But this is just to give you a sense of the large portfolio of grants that is within the EMSC program. In terms of the Pediatric Emergency Care Applied Research Network, Doctor Nate Kuppermann is here. He’s going to be providing you an update on the network so I’m not going to go into too much information about that.

But one thing I do want to note is that a couple of weeks ago, Mike Dean, myself who is coordinating data, who leads the coordinating data center for PECARN and salary adjustment and Tasmine. We are at a meeting on the reporting on inventory and evaluation of clinical research networks and they really -- they were noting what are some benchmarks for successful networks. It was clear as we were looking at this inventory and what had been collected from other research networks across the country that PECARN in five short years, was already meeting and in some cases exceeding these benchmarks of what makes a good research network. And this is really—they were also comparing with data from research networks that had been around for 15, 20 years and I really think that speaks of the great job that Doctor Nate Kuppermann as Chair of the Steering Committee. The other PI’s and the network, Mike Dean have done to really get this network up and running and really be successful in five short years.

The EMSC National Resource Center, the EMSC Program supports two resource centers. Jane Ball is the director of resource center here in Silver Spring. If you have some time, we are right—the resource center is actually right next door to here, and I’m sure you’ll be able to go over there and have a visit if you would like. And obviously the staff is here within the meeting today. And also the National EMSC Data Analysis Resource Center, which I know all of you are familiar with in your work with their staff, Mike Dean’s the Principal Investigator of that also and Mike Ely is the director helping you with your data needs for your grants.

Last week was a busy week with the release of the IOMs report on the future of emergency care in the U.S. health system. Three reports were released; one on pediatrics, one on pre-hospital EMS and one on the hospital-based emergency department. This was the culmination of three years of work that was -- the study was co-sponsored by EMSC, NHTSA, CDC, AHRQ and the Josiah Macey Foundation. Now that these are released, they’re out there for discussion. There will be some follow-up workshops, implementation workshops that are being sponsored by these agencies also. I would say view these recommendations not as the end of the discussion but actually the beginning of the discussion that you will have an opportunity to participate in through the workshops that are going to be held across the country over the next six months.

I do want to say that none of the agencies, although we sponsored the study, we don’t take an official position on the recommendations. The recommendations are out there for either stakeholders or Congress to decide how they may or may not act on it. I think they’re definitely within and I’m going to talk about this more on Thursday. Definitely within the pediatric report, there are some specific things that the EMSC Program can be responsive to now. I’m going to talk more about that on Thursday morning.

In terms of our arranged agreements, we currently have two that are active and one, actually three that are active. The Indian Health Services one led by Lieutenant Commander Betty Hastings who’s going to be—I’m not sure if she’s here this morning but we’ll be talking during the grantee meeting, and the purpose of this is integrating EMSC resources into the Indian Health Services and to Native American and tribal EMS, a lot of the funding provides for pediatric specific training for pre-hospital providers who are serving Native American communities and also helps to fund the rights, the Rights Safe Child Passenger Safety Program. Betty, as of June 1, her job within IHS is being moved into their new off—well it’s new, it’s been about a year old now. IHS now has an office of EMS and so that’s where Betty will be in order to better integrate her into that office from where she has been within IHS.

In terms of NHTSA, this has been a 20-year partnership with NHTSA. We work very collaboratively together with NHTSA. This is a very strong partnership and really again I find this really getting stronger every year with myself and Drew and Susan and their staff. We’ve really showed that we had a successful history of cooperation and collaboration around EMS and injury prevention issues, not only for children and adolescents but also for the overall EMS system. So we work very closely together and will continue to strengthen our collaboration together. And some of the things that EMSC contributes to support the work of the office of EMS within NHTSA is the National EMS Information System, infrastructure support for the National Association of State EMS Officials, and the National EMS Education Standards Project are three of those that we worked collaboratively with them on.

In terms of the CDC, that recently was published -- our agreement with the CDC resulted in the publication of availability of pediatric services and equipment and emergency department on United States 2002 to 2003. And as we know the majority of children who need emergency medical care are brought to hospitals that have appropriate emergency care specialists and equipment, but a significant number are treated at facilities that lack the recommended pediatric equipment and fully trained staff according to the report that was done. They’re going to be doing another survey. This year actually they’re collecting data, which is going to include a larger sample of children’s hospitals so they’ll be able to compare the data they collected from 2000 to 2003 with the data that they’re collecting this year and that will be published either in late 2007 or early 2008. So that activity with the CDC is ongoing.

And some other projects that are--or our other news that is continuing--the American Academy of Pediatrics are continuing to work on their work evaluating the impact of their jointly published guidelines with the American College of Emergency Physicians. The American Pediatric Surgical Association; developing clinical guidelines for the management of specific subsets of pediatric trauma patients, isolate the liver or spleen injuries, pelvic fractures and burns.

And also the March and June issues of Clinical Pediatric Emergency Medicine were dedicated to articles on the EMSC and these actually are available online for free and we’ll get you the link to those. Doctor Steve Krug is the editor. Doctor Joe Wright and Nate Kuppermann are part of the editorial board and they really did an excellent publication. These are really great resources that cover everything from injury prevention, pre-hospital to hospital care. And the June issue just came out, and I want to thank them for their work on highlighting EMSC--using that issue to highlight EMSC. In terms of performance measures I know you’re probably all too familiar with getting a lot of calls about registering your grant, putting in your targets. The one’s that are listed here are specific for the state partnership grants and they’ll be some breakout sessions today that address these issues further.

For those of you who may not have yet -- may not have as yet registered your grant in the electronic handbook, the resource center staff is available here to help you do that providing that we’d asked you to bring your notice of grant award if you haven’t done that yet so that they can work with you on that. The deadline for getting the grant registered and putting in your targets of how you’re going to meet—what you think you’re going to meet in terms of your performance measures for this year is July 3, so we ask that you don’t meet this—we ask you to please meet this deadline, we want to help you meet this deadline.

I know this is new for everybody and again I’m going to talk on Thursday more about the implications for next year because starting with this year HRSA is only allowing, whether it’s a non-competing continuation grant, or a competing grant to be submitted electronically. But you can’t submit electronically unless you get registered with HRSA’s electronic handbook. But I’ll go into a little more about that on Thursday and actually Mickey Reynolds is here and in a minute I’m going to bring Mickey up to talk to you a little bit about some grant management and budget issues.

Some of the highlights for the meeting just want to remind you. We want you to attend everything. We hope you have a lot of time at night to have some fun. The Silver Spring Metro is right—a couple blocks south of here and it’s just a fifteen minute train ride into DC, but also around Silver Spring there’s a lot of truly revit--this neighborhood’s really been revitalized. A lot of great restaurants, the Kennedy Center’s American Film Institute is just two blocks south of here so if you have a lot of time at night to enjoy the area. This afternoon we’re actually going to be having a webcast at 3:30. Some of the folks who were leaders in the study will be presenting on three reports and you’ll have time to ask questions. It will be live webcast so people who are watching remotely will also be able to send in their questions. That’s going to be from 3:30 to 5:00 and it will include the Chair of the overall committee, Dr. Gail Warden from Detroit.

There’s going to be an EMSC Jeopardy just for fun this evening. Ken, where’s that going to be? Is it the ballroom? It’s going to be here in the ballroom. Our Heroes Awards presentation will be tomorrow at 3:30. There will be somebody here from the call center, Mary Hole on Thursday morning at 9:00 a.m. who’s going to go into more detail about registering your grant, how to put in your performance measures, and your targets. So she will be here at 9:00 on Thursday to go over that and then on Thursday at 10:30 a.m. I’m going to talk some about some future initiatives for the program. And there’s the contact information for myself, Tina, Jane Ball, and Mike Eely and before I introduce our next speaker to come up I’d like Mickey Reynolds from the Grants Management office to come up and she’s going to share some budget wisdom with us.

MICKEY REYNOLDS: Good morning. I was going to talk about budget submission but you know that, I’m preaching to the choir, so I changed my topic. I’m going to talk about issues as they relate to electronic submission of your application. The bad news is you’ve had to deal with this new system. It’s not easy. The good news is once you’re registered, you’re registered. So, thank you all for doing what you’ve done. I’ve received quite a few phone calls and emails lately about people trying to register their grants electronically and there have been some problems. If you have problems continue to call the Call Center. There is a Call Center. If they do not respond please contact me, Dan, or the NRC and we will help you. We will do whatever we can. My name is Mickey Reynolds I’m the Grants Management Specialist for the EMSC program and I’m not the only one, I have another lady in my office named Marilyn Stewart and she is also a Grants Management Specialist for this program.

What I wanted to talk to – talk about were a couple personnel issues. One with electronic submission if you are changing project directors, if a new person’s coming on board and they are not listed on the application or the notice of grant award that you received, contact me immediately. I need to have a written document saying there’s a new project director and I need to have a CV for that person. Once I receive that information I can change the notice of grant award and the information will be corrected in the electronic handbook so you can register in the electronic handbook. A change in project director is an official change so it does require a change notice of grant award and in order to do that, like I said, I need CV from you.

When you list your project director in your application you must have two individuals listed on the application. There must be a business official and a project director. There can’t be one person doing both roles because that’s illegal. So, keep that in mind if you are the business official and the project director that might be a problem. With personnel on the application we need you to list all the individuals as you know and not the contractors. In the budget justification describe their title and role, indicate their percentage of yearly salaries, and include the CV’s for the major personnel or the key personnel involved.

Travel is another issue. I know some states have had problems getting their travel approved which is unfortunate but if you do have a problem getting your travel for the grantee meeting approved, please contact Dan or myself and we will do what we can to help you. And in your application budget justification please include the travel for the grantee meeting, that’s critical and some applications have been conditioned because they do not have the correct information.

For the partnership program you have to have three individuals attending the grantee meeting and for the targeted issues two have to attend. And we need the expenses in the budget, in the travel section for that.

Equipment: I have received many final reports from you and thank you all I know that’s a lot of work and I really appreciate your sending them to me and in those final reports I need a list of equipment. Lou? I need a listing of equipment that you have on hand and most of – I’ve received that from most people and I appreciate that. With equipment issue – I recently received some requests about equipment issues. When you purchase equipment, when the state purchases equipment you are the owner of the equipment. You retain the title to the equipment when the grant ends, and if you want to use that equipment for a similar project or another project, that’s perfectly understandable.

Contractual category in the budgets is kind of tricky. A contract, as you know, is a mutually binding legal relationship that obligates the seller to furnish supplies or services for the buyer and the buyer to pay them. It must be in writing and it does not include grants and cooperative agreements. With the budget justification and the contracts, we need a separate budget justification for each contract, which includes all the budget categories. And we do not want a copy of the contracts, just a summary of what is involved in the contract itself.

Other expenses as you know are other expenses that are not included in the other budget categories and they could be communication costs, printing costs, there’s all kinds of different things that could be considered other expenses. If you request $25,000 or more for printing expenses in other expenses category it must be approved by the Department of Health and Human Services, so please don’t request $25,000. It’s not fun.

Indirect charges. Each state has a rate agreement as you know and in order to access that document the web address is http://rates.psc.gov and you can access your state rate agreement by using that address. When you total your budget you determine that by adding all the budget categories as you know and it should be listed on the 424A budget form and the total for the year, that year should be listed on the face page of the application.

Terms and conditions of award. I want thank you all for submitting your conditions, your response to the conditions of award. That’s very important. As you know they appear on the subsequent pages of the notice of grant where they used to appear on the face page. Now they’re on page two. We need your response if you haven’t sent them in. Most people have. If you don’t comply with those there could be a draw down restriction on your grant, so please do that.

For grantees who are in their second or third year of funding which is nine partnership grants and all of the targeted issue grantees I need a carry-over request from you so please do that. The majority of the new grantee, are new grantees this year so you will not submit a carry-over request. Any correspondence that is submitted to HRSA should go to me with a copy to Dan. We’re the official recipient of all grant related correspondence. Once we receive it – Dan and Tina and I work together, I will submit it to them if you don’t or vice versa. They will approve or disapprove or we will ask for additional information and notice of grant award will be issued to respond to your request.

I’ve had quite a few requests for re-budgeting of grant funds lately and the rule on that is if the amount of funds exceeds 25% of the total then I need to issue a notice of grant award. If the request is for less than 25% of the total of award for re-budgeting then you do not receive a revised notice of grant award and we can approve that by email. But please, when you re-budget funds include the budget category that you’re taking the money from, the exact amount of money and what budget category it’s going to and the reason it’s being done. If we don’t have all the information we can’t approve it. I talked about carry-overs and I’ve enjoyed working with you and I look forward to working with you in 2006 and 2007 and if you need to contact me I think you all know it’s mreynolds at hrsa dot gov. And if you need to contact Marilyn Stewart it’s mstewart at hrsa dot gov. Thank you.

DAN KAVANAUGH: I want to thank Mickey very much. Her and Marilyn, I mean the EMSC program alone is you know 78 grants and the EMSC program is not the only program that Mickey and Marilyn also work with so I think they really do a phenomenal job to service all – to try to service all, not only you but Tina and myself. And I also want to take this time just to thank you for your work. I mean your – the quality of the work that you do as grantees is really what has made the program so successful. Thank you for all your work. I know often times many of you are wearing a lot of different hats in your stage or at your university. I know that from sometimes I’m seeing emails at 11:30 at night at 2 in the morning and I know everybody’s working really hard so I thank you for all the work that you have done and however Tina and I can be most responsive to you, please let us know.

Seventy-eight grants is a large number and we try to keep track as best as we can but when you feel like we’re not keeping track of you, let us know how we can be more responsive. If we’re not being responsive enough please let us know that also, please feel free to give us that feedback.

So now I would like to introduce our first speaker and I had – Mickey you might have taken my introduction there. Thank you. I mean I know Nate well, but I want to read his official – I want to be official for him. Dr. Nathan Kuppermann is the Professor in the Department of Emergency Medicine in Pediatrics and Chair and Director of Research at the Department of Emergency Medicine at the University Of California Davis School Of Medicine. He is both a Pediatric Emergency Physician and clinical epidemiologist. Dr. Kuppermann has been funded as a Principal Investigator since 2001 and is a co-investigator on NIH and EMSC grants – Principal Investigator for PECARN. He served as the Chair of the steering committee of PECARN since it’s inception in 2001.

The network as you know is funded by EMSC and it consists of 21 hospital pediatric emergency departments, which see over 800,000 children annually. PECARN – he’s going to be talking to you about the research that PECARN performs, give you kind of a status of where we’re at with the network and the great work that he’s done.

Welcome