STARS Train the Trainer Class (TtT) - Beta-Enhancing Prehospital Care for Medical Complex Children

Pdf Summary

The article describes the development and impact of the Special Needs Tracking and Awareness Response System (STARS), a program designed to improve prehospital emergency care for children with medical complexity (CMC)—a growing subset of children and youth with special health care needs who often rely on medical technology and have high-risk, low-frequency emergencies. Because EMS clinicians have limited pediatric training and infrequent exposure to CMC, care quality and clinician confidence can vary. The authors also highlight how social determinants of health affect emergency care use, with children in lower-opportunity neighborhoods experiencing higher EMS and emergency department utilization and worse outcomes.<br /><br />STARS began in 2014 as an EMS agency initiative in Missouri using numbered, paper-based care plans created with families. Early expansion revealed major limitations: difficulty keeping binder plans updated and secure, challenges sharing plans across jurisdictions, and risks of data loss. In 2017, STARS moved to a hospital-hosted electronic platform accessible to EMS and emergency physicians, improving access but raising concerns about inconsistent paramedic-authored plans and unclear ownership for updates.<br /><br />In 2019–2020, STARS transitioned to a hospital-based, physician-led model supported by pediatric tertiary centers, with standardized care plans, dual physician review, and local EMS medical director approval—allowing individualized recommendations that may differ from standard protocols (e.g., ketogenic diet hypoglycemia management, stress-dose steroids, complex seizure plans). The system also introduced disaster-oriented risk stratification (low to critical) based on technology and medication dependence, enabling rapid identification of patients vulnerable to power loss or supply disruptions.<br /><br />By 2025, STARS enrolled 2,424 patients across three states and partnered with 160 EMS agencies. Use of care plans helped some patients avoid unnecessary ED transport (12% in 2021; 15% in 2023) through safe home interventions. Analyses using the Child Opportunity Index showed disproportionate EMS utilization among children in more disadvantaged neighborhoods, positioning STARS as a tool to improve equity, readiness, and disaster response through real-time, patient-specific guidance and targeted EMS education.

Asset Subtitle

STARS Paper

Keywords

STARS program

prehospital emergency care

children with medical complexity (CMC)

EMS care plans

electronic care plan platform

physician-led standardized protocols

pediatric emergency medical services training

social determinants of health

Child Opportunity Index

disaster risk stratification