Program Director/Principal Investigator (Last, First, Middle): Fishe, Jennifer, N K23 Abstract Project Summary Asthma is the most common chronic disease of childhood and a leading cause of emergency medical treatment. Yet there is a paucity of evidence and guidelines for emergency medical services (EMS) treatment of pediatric asthma prior to emergency department (ED) arrival. ED guidelines recommend early systemic corticosteroid (CS) administration within one hour of ED arrival, since studies have shown associated decreases in hospital admissions and ED length-of-stay (LOS). For patients treated by EMS, there exists an opportunity for even earlier administration of CS. The goal of this project is to determine whether EMS administration of CS improves patient outcomes. Our preliminary data demonstrate that currently less than 10% of EMS pediatric asthma patients receive CS prior to ED arrival. Given the time-sensitivity of CS' effects on patient outcomes in the ED, our hypothesis is that EMS administration of CS will decrease hospital admissions, ED LOS, and intensive care unit admissions. By performing a pilot cluster randomized controlled trial, this study will fill a significant prehospital knowledge gap in the continuum of emergent pediatric asthma care. This study analyzes cost and transport times, two factors relevant to EMS operations and future guideline implementation. Through our partnership with Nassau County, Alachua County and Lake County EMS agencies, we plan to enroll 330 patients over a three-year period to analyze clinical outcomes and costs of EMS CS administration, and how both vary with EMS transport time. During the five-year K23 career development award period, Dr. Jennifer Fishe will progress from a mentored investigator to an independent investigator positioned to achieve R01 funding. That transition will occur due to strong mentorship and a structured training plan which includes: 1) Development of knowledge and experience with clinical trials, including protection of human subjects, 2) Attaining a Master of Science in Biostatistics, and 3) Grantsmanship and Leadership training necessary to become an independent investigator. Dr. Fishe's mentor and scientific advisor team contains subject matter experts on clinical trials and pediatric asthma / emergency medical services, experience with R01 grants and clinical trials, as well as career development. PHS 398/2590 (Rev. 06/09) Page 1 Continuation Format Page

Program Director/Principal Investigator (Last, First, Middle): Fishe, Jennifer, N Project Narrative This pilot cluster randomized controlled trial of EMS-administered CS for pediatric asthma patients will help fill a knowledge gap in the EMS treatment of this common pediatric emergency condition. This study innovatively combines clinical, economic, and geospatial analysis to see how EMS-administered CS affects patient outcomes, healthcare costs, and EMS operations. That novel combination of analyses lays the foundation for developing adaptable pediatric asthma guidelines for implementation by diverse EMS agencies nationwide as part of a future multicenter trial. PHS 398/2590 (Rev. 06/09) Page 1 Continuation Format Page