This is a joint policy statement from the American Academy of Pediatrics, American College of Emergency Physicians, Emergency Nurses Association, National Association of Emergency Medical Services Physicians, and National Association of Emergency Medical Technicians on pediatric readiness in emergency medical services systems.
Prehospital emergency care typically involves emergency medical technicians, paramedics, and other licensed medical providers who work in emergency medical services (EMS) systems in ground ambulances and fixed- or rotor-wing aircraft that are dispatched to an emergency when either a bystander calls 9-1-1 or when a patient requires interfacility transport for a medical illness or traumatic injury. Because prehospital emergency care of children plays a critical role in the continuum of health care, which also involves primary prevention, hospital-based acute care, rehabilitation, and return to the medical home, the unique needs of children must be addressed by EMS systems.1–5 Pediatric readiness encompasses the presence of equipment and medications, usage of guidelines and policies, availability of education and training, incorporation of performance-improvement practices, and integration of EMS physician medical oversight to equip EMS systems to deliver optimal care to children.6–8 It has been shown that emergency departments are more prepared to care for children when a pediatric emergency care coordinator is responsible for championing and making recommendations for policies, training, and resources pertinent to the emergency care of children.9,10 The specialty of EMS medicine has the potential to derive similar benefits when members of the EMS community are personally invested in pediatric patient care. Although a critical aspect of pediatric readiness in EMS involves strong EMS physician oversight of these investments, a discussion of physician oversight of pediatric care in EMS is outside the scope of this article. This topic is, however, well addressed in the National Association of Emergency Medical Services Physicians position statement “Physician Oversight of Pediatric Care in Emergency Medical Services.”1 This policy statement is accompanied by a technical report published simultaneously in this issue of Pediatrics.11
Recommendations
To provide infrastructure designed to support the prehospital emergency care of children, the American Academy of Pediatrics, American College of Emergency Physicians, Emergency Nurses Association, National Association of Emergency Medical Services Physicians, and National Association of Emergency Medical Technicians believe that EMS systems and agencies should do the following:
Include pediatric considerations in EMS planning and the development of pediatric EMS dispatch protocols, operations, and physician oversight (for example, as outlined in the National Association of Emergency Medical Services Physicians position statement “Physician Oversight of Pediatric Care in Emergency Medical Services”).1
Collaborate with medical professionals with significant experience or expertise in pediatric emergency care, public health experts, and family advocates for the development and improvement of EMS operations, treatment guidelines, and performance-improvement initiatives.2
Integrate evidence-based, pediatric-specific elements into the direct and indirect medical oversight that constitute the global EMS oversight structure.4
Have pediatric-specific equipment and supplies available, using national consensus recommendations as a guide, and verify that EMS providers are competent in using them.3,4,12–15
Develop processes for delivering comprehensive, ongoing, pediatric-specific education and evaluating pediatric-specific psychomotor and cognitive competencies of EMS providers.13,14,16–18
Promote education and awareness among EMS providers about the unique physical characteristics, physiologic responses, and psychosocial needs of children with an illness or injury.19–21
Implement practices to reduce pediatric medication errors.22,23
Include pediatric-specific measures in periodic performance-improvement practices that address morbidity and mortality.4
Submit data to a statewide database that is compliant with the most recent version of the National Emergency Medical Services Information System and work with hospitals to which it transports patients to track pediatric patient-centered outcomes across the continuum of care.4
Develop, maintain, and locally enforce policies for the safe transport of children in emergency vehicles.4
Develop protocols for the destination of pediatric patients, with consideration of regional resources and weighing of the risks and benefits of keeping children in their own communities.4
Collaborate, along with receiving emergency departments, to provide pediatric readiness across the care continuum.4–10
Include provisions for caring for children and families in emergency preparedness planning and exercises, including the care and tracking of unaccompanied children and timely family reunification in the event of disasters.3,4,24
Promote overall patient- and family-centered care, which includes using lay terms to communicate with patients and families, having methods for accessing language services to communicate with non–English-speaking patients and family members, narrating actions, and alerting patients and caregivers before interventions are performed. In addition, allow family members to remain close to their children during resuscitation activities and to practice cultural or religious customs as long as they are not interfering with patient care.19
Have policies and procedures in place to allow a family member or guardian to accompany a pediatric patient during transport when appropriate and feasible.19
Consider using resources compiled by the Emergency Medical Services for Children program when implementing the recommendations noted here.25
Conclusions
Ill and injured children and their families have unique needs that can be magnified when the child’s ailment is serious or life-threatening. Resource availability and pediatric readiness across EMS agencies are variable. Providing high-quality EMS care to children requires an infrastructure that is designed to support the care of pediatric patients and their families. Therefore, it is important that EMS physicians, administrators, and personnel collaborate with pediatric acute care experts to optimize EMS care through the development of care models to minimize morbidity and mortality in children as a result of illness and injuries.
Lead Authors
Brian Moore, MD, FAAP
Manish I. Shah, MD, MS, FAAP
Sylvia Owusu-Ansah, MD, MPH, FAAP
Toni Gross, MD, MPH, FAAP
Kathleen Brown, MD, FAAP
Marianne Gausche-Hill, MD, FACEP, FAAP, FAEMS
Katherine Remick, MD, FACEP, FAAP, FAEMS
Kathleen Adelgais, MD, MPH, FAAP
John Lyng, MD, FAEMS, FACEP, NRP (Paramedic)
Lara Rappaport, MD, MPH, FAAP
Sally Snow, RN, BSN, CPEN, FAEN
Cynthia Wright-Johnson, MSN, RNC
Julie C. Leonard, MD, MPH, FAAP
American Academy of Pediatrics Committee on Pediatric Emergency Medicine, 2017–2018
Joseph Wright, MD, MPH, FAAP, Chairperson
Terry Adirim, MD, MPH, FAAP
Michael S.D. Agus, MD, FAAP
James Callahan, MD, FAAP
Toni Gross, MD, MPH, FAAP
Natalie Lane, MD, FAAP
Lois Lee, MD, MPH, FAAP
Suzan Mazor, MD, FAAP
Prashant Mahajan, MD, MPH, MBA, FAAP
Nathan Timm, MD, FAAP
Liaisons
Andrew Eisenberg, MD – American Academy of Family Physicians
Cynthia Wright-Johnson, MSN, RNC – National Association of State EMS Officials
Cynthiana Lightfoot, BFA, NRP – American Academy of Pediatrics Family Partnerships Network
Charles Macias, MD, MPH, FAAP – Emergency Medical Services for Children Innovation and Improvement Center
Brian Moore, MD, FAAP – National Association of EMS Physicians
Diane Pilkey, RN, MPH – Maternal and Child Health Bureau
Katherine Remick, MD, FACEP, FAAP, FAEMS – National Association of Emergency Medical Technicians
Mohsen Saidinejad, MD, MBA, FAAP, FACEP – American College of Emergency Physicians
Sally Snow, RN, BSN, CPEN, FAEN – Emergency Nurses Association
Mary Fallat, MD, FAAP – American College of Surgeons
Former American Academy of Pediatrics Committee on Pediatric Emergency Medicine Members, 2012–2018
Alice Ackerman, MD, MBA, FAAP
Thomas Chun, MD, MPH, FAAP
Gregory Conners, MD, MPH, MBA, FAAP
Edward Conway Jr, MD, MS, FAAP
Nanette Dudley, MD, FAAP
Joel Fein, MD, FAAP
Susan Fuchs, MD, FAAP
Marc Gorelick, MD, MSCE, FAAP
Natalie Lane, MD, FAAP
Brian Moore, MD, FAAP
Steven Selbst, MD, FAAP
Kathy Shaw, MD, MSCE, FAAP, Chair (2008–2012)
Joan Shook, MD, MBA, FAAP, Chair (2012–2016)
Staff
Sue Tellez
American College of Emergency Physicians Emergency Medical Services Committee, 2017–2018
Jeffrey Goodloe, MD, FACEP, FAEMS, Chairperson
Kathleen Brown, MD, FACEP, FAAP, Workgroup Leader
Becky Abell, MD, FACEP
Roy Alson, MD, PhD, FACEP
Kerry Bachista, MD, FACEP
Lynthia Bowman, DO, FACEP
Heather Boynton, MD
Sara Ann Brown, MD, FACEP
Allen Chang, MD
Darby Copeland, EdD, RN, NRP
Robert De Lorenzo, MD, FACEP
Derek Douglas
Raymond Fowler, MD, FACEP
John Gallagher, MD, FACEP
Sheaffer Gilliam, MD
Frank Guyette, MD, FACEP
Dustin Holland, MD
Jeffrey Jarvis, MD, FACEP, EMT-P
Clinton Kalan, PA-C
Jacob Keeperman, MD, FACEP
Douglas Kupas, MD, FACEP
Julio Lairet, DO, FACEP
Michael Levy, MD, FACEP
Kristopher Lyon, MD, FACEP
Craig Manifold, DO, FACEP
Kristin McCabe-Kline, MD, FACEP
Howard Mell, MD, FACEP
Brian Miller, MD
Michael Millin, MD, MPH, FACEP
Brett Rosen, MD
Jared Ross, MD
Kevin Ryan, MD
Stephen Sanko, MD
Shira Schlesinger, MD, MPH
Charles Sheppard, MD, FACEP
Harry Sibold, MD, FACEP
Sullivan Smith, MD, FACEP
Michael Spigner, MD
Vincent Stracuzzi, MD
Christopher Tanski, MD, MS, EMT
Joseph Tennyson, MD, FACEP
Chelsea White IV, MD, NREMT-P
David Wilcocks, MD
Allen Yee, MD, FACEP
Staff
Rick Murray, EMT-P
Board Liaison
Debra Perina, MD, FACEP
Emergency Nurses Association Pediatric Committee, 2016–2017
Tiffany Young, BSN, RN, CPNP, Chair (2016)
Joyce Foresman-Capuzzi, MSN, RN, CNS, Chair (2017)
Rose Johnson, RN
Heather Martin, DNP, MS. RN, PNP-BC
Justin Milici, MSN, RN
Cam Brandt, MS, RN
Nicholas Nelson, MS, RN, EMT-P
Board Liaisons
Maureen Curtis-Cooper, BSN, RN, 2016 Board Liaison
Kathleen Carlson, MSN, RN, 2017 Board Liaison
Staff
Catherine Olson, MSN, RN
National Association of EMS Physicians Standards and Clinical Practice Committee, 2017–2018
John Lyng, MD, FAEMS, FACEP, NRP (Paramedic)
National Association of Emergency Medical Technicians Emergency Pediatric Care Committee, 2017–2018
Shannon Watson, CCEMT-P, Chairperson
Katherine Remick, MD, Medical Director
Ann Dietrich, MD, Medical Director
Kyle Bates, MS, NREMT-P, CCEMT-P
Frank Flake, EMT-P
Gustavo Flores, MD, EMT-P
Drs Moore and Shah were the 2 primary authors, but all of the listed authors contributed sections of the manuscript and reviewed and revised subsequent drafts; this was done in conjunction with the American Academy of Pediatrics staff and Board of Directors as well as the boards of directors of the American College of Emergency Physicians, the Emergency Nurses Association, the National Association of EMS Physicians, and the National Association of Emergency Medical Technicians; and all of these organizations have approved the final manuscript as submitted.
This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.
Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.
The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.
FUNDING: No external funding.
COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2019-3308.
Published simultaneously in December 2019 in Annals of Emergency Medicine and Prehospital Emergency Care.
References
Competing Interests
POTENTIAL CONFLICT OF INTEREST: Dr Shah has disclosed the following: Health Resources and Services Administration, EMSC Program. Relationship: Pediatric Prehospital Readiness Steering Committee member. Amount: $2000 per year maximum for travel reimbursement only. All other authors indicated they have no financial relationships relevant to this article to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
