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

Enhancing Prehospital Care for Medical Complex Children

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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 have chronic conditions, functional limitations, and reliance on medical technology. Because more CMC now live at home, EMS encounters are increasing, yet EMS clinicians have limited pediatric training and infrequent exposure to these high-risk, high-acuity situations. The authors also emphasize that social determinants of health affect emergency care use, with children in disadvantaged neighborhoods experiencing higher EMS and emergency department utilization and worse outcomes.<br /><br />STARS began in 2014 as a local EMS agency initiative using standardized, numbered paper care plans to help dispatch and EMS crews rapidly identify and manage complex patients. Expansion revealed major limitations with binders (updating difficulties, inconsistent access, multi-jurisdiction issues, and data security risks). In 2017, STARS moved to a hospital-hosted electronic platform, improving access but exposing new problems: inconsistent paramedic-authored plan content, uncertainty about plan ownership/updates, and concern about instructions that differed from standard EMS protocols.<br /><br />In 2019–2020, STARS transitioned to a hospital-based, physician-led model supported by tertiary children’s hospitals, featuring standardized care plans with dual physician review (including local EMS medical director approval when plans vary from protocol), dedicated hospital liaisons, automated EMS notifications, and analytic tracking. The program also introduced disaster-focused risk stratification (low to critical) based on technology and medication dependence.<br /><br />By 2025, STARS enrolled 2,424 patients and partnered with 160 EMS agencies across 122 counties in three states, later expanding to Florida and supporting disaster response during Hurricane Ian. Use of STARS care plans helped reduce unnecessary transports (12% in 2021; 15% in 2023) by enabling safe at-home interventions. COI analysis showed disproportionately higher EMS use among children in lower-opportunity neighborhoods, highlighting STARS’ potential to address health inequities through better coordination and real-time guidance.

Keywords

STARS program

Special Needs Tracking and Awareness Response System

prehospital emergency care

children with medical complexity (CMC)

EMS care plans

electronic care plan platform

physician-led standardized protocols

dual physician review

disaster risk stratification

health inequities and social determinants of health