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Emergency Medical Services for Children 04

Form Overview

NOTE: Grantees awarded under HRSA-23-063 (H33) are required to complete EMSC 04, EMSC 08, EMSC 09 and EMSC 10 forms.  EMSC 01, EMSC 05, EMSC 06, and EMSC 07 have been discontinued.  Data historically reported in EMSC 02 and EMSC 03 are now provided to HRSA via the EMSC Data Center (EDC).

On the following Emergency Medical Services for Children (EMSC) forms, the grantee provides details to assess the establishment of pediatric readiness recognition programs, as well as permanence and integration of EMSC priorities.

On the EMSC 04 form, the grantee provides details on hospitals with an Emergency Department (ED) that are recognized through a statewide, territorial or regional standardized program that are able to stabilize and/or manage pediatric medical emergencies.

The form will display under EMSC section on the left menu when the grantee start/edit a DGIS performance report.

Applicable Report Types

FormReport Type
NCPRNCCPRPPER
EMSC 04 - Emergency Department ReadinessXXX

The report types are as follows:

  • New Competing Performance Reports (NCPR)
  • Non-Competing Continuation Performance Reports (NCCPR)
  • Project Period End Reports (PPER)

Pre-population

The following data will pre-populate from one report to the next report:  

  • Data entered into the Annual Performance Targets section.

Note: Data will be entered into the NCPR and pre-populate to subsequent NCCPRs and PPERs. Data in this section will also pre-populate between the last approved report created prior to August 1, 2024, and those reports created after.

Form Sections

EMSC 04 - Emergency Department Readiness Detail Sheet  

In this section, the grantee may expand the accordion menu to view the following details:

  • Measure
  • Goal
  • Level
  • Domain
  • Definition
  • Grantee Data Sources
  • EMSC Strategic Objective
  • Significance

Screenshot of Detail sheet

Screenshot of Strategic objectives

Section I. Annual Performance Targets

  • In this section, the grantee provides targets for New Competing Performance Reports (NCPRs):
    • Targets (%): Enter an integer from 0 – 100. This is a required field.
  • For Non-Competing Continuation Performance Reports (NCCPRs) and Project Period End Reports (PPERs):
    • Pre-population: All budget period targets will be prepopulated from the previously approved report.
    • Annual Performance Targets: For current and previous years, annual target fields will not be editable.
  • For Non-Competing Continuation Performance Reports (NCCPRs) future years, the grantee will have the ability to edit/modify the annual target fields, if needed.
  • For Non-Competing Continuation Performance Reports (NCCPRs) and Project Period End Reports (PPERs) the grantee provides data in Section II.
  • The following note will display below the header:

For New Competing reports, you must provide targets in Section I.

For Non-Competing Continuation reports, you may update the targets for future years in Section I, if needed.

For Non-Competing Continuation and Project Period End reports, you must provide data in Section II.

Screenshot of section 1

NOTE: Click Save to ensure the information is not lost due to inactivity on the form.

Section II. Data Collection for Detail Sheet – Emergency Department Readiness

Indicate the degree to which a standardized program for pediatric emergencies exists  

This is a required section for NCCPRs and PPERs, and the following validation will display above the radio buttons: Provide a response for this field.

  • The grantee selects only one option from 0, 1, 2, 3, 4, and 5.
  • If the grantee selects options 0, 1, 2, 3, or 4, then all the numerator fields in later sections must remain disabled.
  • All numerator fields in later sections will be enabled only if the grantee selects option 5.
  • The denominator field in later sections will be enabled if the grantee selects any option between 0-5 in this question.

Screenshot of section 2

Total number of Hospitals with an Emergency Department (ED)

This is a required section for NCCPRs and PPERs, and the grantee answers the following question:

Denominator (Total number of hospitals with an ED in the state/territory. For the purposes of data collection, exclude Military and Indian Health Service hospitals.)

  • This is a required question if the grantee selects any of the options between 0 - 5 under Indicate the degree to which a standardized program for pediatric emergencies exists
  • The grantee can enter integer values 0 - 999,999 and the following validation will display on the data entry box: Enter an integer: 0 - 999,999.

Screenshot of Total number of EDs

Hospitals with an Emergency Department (ED) that manage pediatric emergencies

This is a required section for NCCPRs and PPERs, and the grantee answers the following question:

Numerator (Number of hospitals with an ED that are formally recognized through a statewide, territorial or regional standardized program that are able to stabilize and/or manage pediatric emergencies.)

  • This is a required question if the grantee selects option 5 under Indicate the degree to which a standardized program for pediatric emergencies exists
  • The grantee can enter integer values between 1 - 999,999 and the following validation will display on the data entry box: Enter an integer: 1 - 999,999.
  • If the numerator value entered by the grantee in this question is greater than the denominator value entered under Total number of Hospitals with an Emergency Department (ED) section, then the following validation will display on the data entry box: Numerator must be smaller than or equal to Denominator.
  • The numerator value entered for Rural area and Urban area sections combined must not be greater than the numerator value entered under Hospitals with an Emergency Department (ED) that manage pediatric emergencies section and the following validation will display on the data entry box:

The number of hospitals with an ED that manage pediatric emergencies should be equal or greater than the sum of number of hospitals with an ED that manage pediatric emergencies for rural and urban areas provided below.

Screenshot of Hospitals with ED

Hospitals with an Emergency Department (ED) in an urban area that manage pediatric emergencies

This is a required section for NCCPRs and PPERs, and the grantee answers the following question:

Numerator (Number of hospitals with an ED located in an urban area that are formally recognized through a statewide, territorial or regional standardized program that are able to stabilize and/or manage pediatric emergencies.)

  • This is a required question if the grantee selects option 5 under Indicate the degree to which a standardized program for pediatric emergencies exists
  • This field accepts integer values 0 - 999,999 and the following validation will display on the data entry box: Enter an integer: 0 - 999,999.

NOTE: The numerator value entered for Rural area and Urban area sections combined must not be greater than the numerator value entered under Hospitals with an Emergency Department (ED) that manage pediatric emergencies section.

Screenshot of ED in urban areas

Hospitals with an Emergency Department (ED) in a rural area that manage pediatric emergencies

This is a required section for NCCPRs and PPERs, and the grantee answers the following question:

Numerator (Number of hospitals with an ED located in a rural area that are formally recognized through a statewide, territorial or regional standardized program that are able to stabilize and/or manage pediatric emergencies.)

  • This is a required question if the grantee selects option 5 under Indicate the degree to which a standardized program for pediatric emergencies exists section.
  • This field accepts integer values 0 - 999,999 and the following validation will display on the data entry box: Enter an integer: 0 - 999,999.

NOTE: The numerator value entered for Rural area and Urban area sections combined must not be greater than the numerator value entered under Hospitals with an Emergency Department (ED) that manage pediatric emergencies section.

Screenshot of EDs in rural area

NOTE: Click Save to ensure the information is not lost due to inactivity on the form.

Section III. Annual Performance Score

  • In this section, the following note will display:

This indicator is calculated based on information provided in Section II.   Please note that the denominator for Hospitals with an ED recognized (%) is different than the denominator for Urban (%) and Rural (%). The denominator for Hospitals with an ED recognized (%) is all hospitals with an ED. The denominator for Urban (%) and Rural (%) is hospitals that are formally recognized.

  • A table will display with three columns of auto calculated percentage fields for current reporting period as follows:
    • Hospitals with an ED recognized (%)  

(Numerator/Denominator * 100) 

Calculation for % Hospitals with an ED recognized = [Number of hospitals with an ED that are formally recognized through a statewide, territorial or regional standardized program that are able to stabilize and/or manage pediatric emergencies.)]/ [Total number of hospitals with an ED in the state/territory. For the purposes of data collection, exclude Military and Indian Health Service hospitals.].

  • Urban (%) 

Calculation for % Urban= [Number of hospitals with an Emergency Department (ED) located in an urban area that manage pediatric emergencies/ [Number of hospitals with an ED that are formally recognized through a statewide, territorial or regional standardized program that are able to stabilize and/or manage pediatric emergencies.]

  • Rural (%) 

Calculation for % Rural= [Number of hospitals with an Emergency Department (ED) located in the rural area manage pediatric emergencies]/ [Number of hospitals with an ED that are formally recognized through a statewide, territorial or regional standardized program that are able to stabilize and/or manage pediatric emergencies.]

Screenshot of annual performance scores

NOTE: Click Save to ensure the information is not lost due to inactivity on the form.

Comments

In this section, the grantee can enter additional information (not to exceed 5,000 characters). The Comments field accepts text, numbers, and special characters.

Screenshot of comments

The grantee must click on Save or Save and Continue buttons before navigating away from this form to ensure all data entered is saved successfully.

  • The Save button will save the validated information captured in the form and the grantee will remain on the same form.
  • The Save and Continue button will save the validated information and the grantee will navigate to the next form.
  • The Go to Previous Page button will navigate to the previous form without saving any previously unsaved information.

Form-Level Rules and Validations

  • For New Competing Performance Reports (NCPRs), the grantee must provide targets in section I.
  • For Non-Competing Continuation Performance Reports (NCCPRs), the grantee may update the targets for future years in Section I, if needed.
  • For Project Period End Reports (PPERs), the grantee must provide data in Section II.
  • Data checks and validations for the Section I:
    • Accepts integer values between 0 - 100.
    • Does not accept decimal values.
    • Does not accept any text values.
  • Data checks and validations for all numerator and denominator fields:
    • Accepts integer values only.
    • Accepts a maximum of six digits.
    • Does not accept decimal values.
    • Does not accept any text values.
The Comments text box accepts text, numbers, and special characters (not to exceed 5,000 characters).
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