The Indiana University School of Medicine is working with the Indiana Department of Health to help improve obstetric and pediatric healthcare in emergency rooms in rural communities.

It’s one of 12 initiatives to address health outcomes in the state’s rural communities, said Erin Cleary, IU School of Medicine’s assistant professor of obstetrics and gynecology.

Indiana was awarded over $200 million by the federal Rural Health Transformation Program for the first year of a five-year program.

The current initiative pledges $30 million over five years to help ensure that emergency departments in hospitals in rural communities have the education, equipment, training, policies and procedures to assess and stabilize pediatric and obstetric patients, and either discharge them or transfer them to a higher level of care, Cleary said. There are about 56 hospitals in the state that are eligible.

“This is important because there are increasing numbers of maternity care deserts and a little bit more limited access to obstetric care in rural places,” she said.

The concept of pediatric readiness is not new, Cleary said. The National Pediatric Readiness Project is an assessment tool done every five years and provided to every hospital in the country.

For the most recent assessment, in spring 2026, Cleary said the team tried to involve every hospital in the state.

Indiana Emergency Medical Services for Children provides pediatric emergency readiness certification. Cleary said about seven hospitals in the state are certified as ready for pediatric emergencies. One out of the 56 hospitals eligible for this initiative is pediatric emergency ready certified.

She said that’s “not for a lack of desire by many other hospitals,” but the difficulty of getting the resources to support the position of a pediatric emergency care coordinator.

Being certified involves identifying a pediatric emergency care coordinator within the hospital and potentially needing to purchase equipment.

Equipment can include a blood pressure cuff that is appropriately sized for an infant or child, or an endotracheal tube for intubating an infant or child, Cleary said.

There are other issues: “Are there easy tools for doing weight-based dosing for medications that would be appropriate in a pediatric population? Are there policies or protocols in place that support family-centered care?”

For obstetric care, there is no universal assessment tool or certification process. Cleary said when she thinks about obstetric readiness, she thinks of common obstetric emergencies like postpartum hemorrhages or a precipitous childbirth done in the emergency room.

There is also pregnancy and postpartum status that should impact the way care is delivered to a patient, she said. For example, the type of treatment given to a pregnant or postpartum patient who has a broken limb or an infection.

Data from the Indiana Maternal Mortality Review Committee about factors in preventable deaths help inform care, she said, with ectopic pregnancies, substance use disorders and mental health diseases.

“The simplest, easiest place to start would be identifying whether a hospital screens for pregnant or postpartum status when a patient presents and is registering for care within an emergency room,” Cleary said. “If we don't ask about whether somebody could be pregnant or had a baby in the last year, we'll miss 100% of the diagnoses and medical problems that only happen to pregnant and postpartum people. We have more anecdotal than hard evidence about how often this is potentially being missed.”

Though there is no standardized list of obstetric equipment, Cleary said she thinks of tools to perform fetal assessment such as fetal heart tone and ultrasound equipment. There are also medications that need to be readily available in cases of a patient who is experiencing a hemorrhage, and other tools like a uterine tamponade, a uterine balloon or a suction device, she said.

“So, especially on the OB side, we are really positioned to be at the forefront of piloting assessment tools, developing the checklist, and really being the first ones to potentially provide obstetric emergency readiness certification to hospitals here in Indiana,” Cleary said.