Data Collection Tool Examples

Child Abuse & Neglect (Suspected)

• Child Abuse and/or Neglect Resource Booklet - Example 
• Illinois EMSC Child Abuse and Neglect Policy & Procedure Guidelines/Toolkit, 2nd Edition (see pages 37-40 for monitor tool)

Critically Ill/Injured Child

• QI Monitoring Tool: Critically Ill/Injured Child in Need of Stabilization OR Pediatric Death  
• QI Monitoring Tool: Critically Ill/Injured Child in Need of Stabilization OR Pediatric Death  (fillable format)  

Death

• Pediatric Death Review Tool 
• QI Monitoring Tool: Critically Ill/Injured Child in Need of Stabilization OR Pediatric Death 
• QI Monitoring Tool: Critically Ill/Injured Child in Need of Stabilization OR Pediatric Death  (fillable format)   

Interfacility Transfer

• Pediatric Interfacility Transfer Review Tool 
• Pediatric Transfer Quality Feedback Tool (sending facility)
• Pediatric Transfer Quality Feedback Tool (receiving facility)

Pediatric Diabetic Ketoacidosis (DKA)

• Pediatric DKA - Full set of quality improvement resources‌
• Pediatric DKA Record Review Monitor (abbreviated format) 
 
• Pediatric DKA Data Dictionary (for abbreviated format)  

Pediatric Mild Traumatic Head Injury

• PMTHI - Full set of quality improvement resources   

Pediatric Pain Management

• Pediatric Pain Assessment Tool 
• Pediatric Pain Management Tool 

Pediatric Respiratory Distress

• Pediatric Asthma Management Tool 
• Pediatric Prehospital Respiratory Distress Tool 

Pediatric Seizure Management

• Pediatric Seizures - Full set of quality improvement resources
• Pediatric Prehospital Seizure Assessment and Management Tool  
• Pediatric Seizure Management Tool