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.15  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.68  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 

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.3,4,1215 

  • Develop processes for delivering comprehensive, ongoing, pediatric-specific education and evaluating pediatric-specific psychomotor and cognitive competencies of EMS providers.13,14,1618 

  • Promote education and awareness among EMS providers about the unique physical characteristics, physiologic responses, and psychosocial needs of children with an illness or injury.1921 

  • 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.410 

  • 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 

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.

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

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

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

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)

Sue Tellez

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

Rick Murray, EMT-P

Debra Perina, MD, FACEP

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

Maureen Curtis-Cooper, BSN, RN, 2016 Board Liaison

Kathleen Carlson, MSN, RN, 2017 Board Liaison

Catherine Olson, MSN, RN

John Lyng, MD, FAEMS, FACEP, NRP (Paramedic)

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.

     
  • EMS

    emergency medical services

1
National Association of EMS Physicians
.
Physician oversight of pediatric care in emergency medical services
.
Prehosp Emerg Care
.
2017
;
21
(
1
):
88
2
Remick
K
,
Gross
T
,
Adelgais
K
,
Shah
MI
,
Leonard
JC
,
Gausche-Hill
M
.
Resource document: coordination of pediatric emergency care in EMS systems
.
Prehosp Emerg Care
.
2017
;
21
(
3
):
399
407
3
Institute of Medicine, Committee of the Future of Emergency Care in the U.S. Health System
.
Emergency Medical Services at the Crossroads
.
Washington, DC
:
National Academies Press
;
2006
4
Institute of Medicine, Committee of the Future of Emergency Care in the U.S. Health System
.
Emergency Care for Children: Growing Pains
.
Washington, DC
:
National Academies Press
;
2006
5
Gausche-Hill
M
,
Johnson
RW
,
Warden
CR
,
Brennan
JA
;
American College of Emergency Physicians’ Pediatric Emergency Committee
.
The role of the emergency physician in emergency medical services for children
.
Ann Emerg Med
.
2003
;
42
(
2
):
206
215
6
Gausche-Hill
M
,
Wiebe
RA
.
Guidelines for preparedness of emergency departments that care for children: a call to action
.
Ann Emerg Med
.
2001
;
37
(
4
):
389
391
7
American Academy of Pediatrics
;
Committee on Pediatric Emergency Medicine
;
American College of Emergency Physicians
;
Pediatric Committee
;
Emergency Nurses Association Pediatric Committee
.
Joint policy statement–guidelines for care of children in the emergency department
.
Pediatrics
.
2009
;
124
(
4
):
1233
1243
8
Gausche-Hill
M
.
Integrating children into our emergency care system: achieving the vision
.
Ann Emerg Med
.
2006
;
48
(
2
):
131
134
9
Gausche-Hill
M
,
Ely
M
,
Schmuhl
P
, et al
.
A national assessment of pediatric readiness of emergency departments
.
JAMA Pediatr
.
2015
;
169
(
6
):
527
534
10
Remick
K
,
Kaji
AH
,
Olson
L
, et al
.
Pediatric readiness and facility verification
.
Ann Emerg Med
.
2016
;
67
(
3
):
320
328.e1
11
Owusu-Ansah
S
,
Moore
B
,
Shah
MI
, et al;
American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, Section on Emergency Medicine, Subcommittee on EMS, Section on Surgery
.
Technical report: pediatric readiness in emergency medical services systems
.
Pediatrics
.
2020
;
145
(
1
):
e20193308
12
Glaeser
PW
,
Linzer
J
,
Tunik
MG
,
Henderson
DP
,
Ball
J
.
Survey of nationally registered emergency medical services providers: pediatric education
.
Ann Emerg Med
.
2000
;
36
(
1
):
33
38
13
Hansen
M
,
Meckler
G
,
Dickinson
C
, et al
.
Children’s safety initiative: a national assessment of pediatric educational needs among emergency medical services providers
.
Prehosp Emerg Care
.
2015
;
19
(
2
):
287
291
14
Gausche-Hill
M
.
Pediatric continuing education for out-of-hospital providers: is it time to mandate review of pediatric knowledge and skills?
Ann Emerg Med
.
2000
;
36
(
1
):
72
74
15
American Academy of Pediatrics
;
American College of Emergency Physicians
;
American College of Surgeons Committee on Trauma
;
Emergency Medical Services for Children
;
Emergency Nurses Association
;
National Association of EMS Physicians
;
National Association of State EMS Officials
.
Equipment for ground ambulances
.
Prehosp Emerg Care
.
2014
;
18
(
1
):
92
97
16
Su
E
,
Schmidt
TA
,
Mann
NC
,
Zechnich
AD
.
A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course
.
Acad Emerg Med
.
2000
;
7
(
7
):
779
786
17
Henderson
DP
,
Gausche
M
,
Goodrich
SM
,
Poore
PD
,
Michael
WB
,
Lewis
RJ
.
Education of paramedics in pediatric airway management: effects of different retraining methods on self-efficacy and skill retention
.
Acad Emerg Med
.
1998
;
5
(
5
):
429
18
Gausche
M
,
Henderson
DP
,
Brownstein
D
, et al;
Pediatric Education Task Force Members
.
Education of out-of-hospital emergency medical personnel in pediatrics: report of a national task force
.
Ann Emerg Med
.
1998
;
31
(
1
):
58
64
19
Ayub
EM
,
Sampayo
EM
,
Shah
MI
,
Doughty
CB
.
Prehospital providers’ perceptions on providing patient and family centered care
.
Prehosp Emerg Care
.
2017
;
21
(
2
):
233
241
20
Schonfeld
DJ
,
Demaria
T
;
Disaster Preparedness Advisory Council and Committee on Psychosocial Aspects of Child and Family Health
.
Providing psychosocial support to children and families in the aftermath of disasters and crises
.
Pediatrics
.
2015
;
136
(
4
). Available at: www.pediatrics.org/cgi/content/full/136/4/e1120
21
Schonfeld
DJ
,
Demaria
T
;
Committee on Psychosocial Aspects of Child and Family Health, Disaster Preparedness Advisory Council
.
Supporting the grieving child and family
.
Pediatrics
.
2016
;
138
(
3
):
e20162147
22
Kaji
A
,
Gausche-Hill
M
,
Conrad
H
, et al
.
Emergency medical services system changes reduce pediatric epinephrine dosing errors in the prehospital setting
.
Pediatrics
.
2006
;
118
(
4
):
1493
1500
23
Lammers
R
,
Byrwa
M
,
Fales
W
.
Root causes of errors in a simulated prehospital pediatric emergency
.
Acad Emerg Med
.
2012
;
19
(
1
):
37
47
24
Disaster Preparedness Advisory Council
.
Medical countermeasures for children in public health emergencies, disasters, or terrorism
.
Pediatrics
.
2016
;
137
(
2
):
e20154273
25
Emergency Medical Services for Children Innovation and Improvement Center. Prehospital based care. Available at: https://emscimprovement.center/domains/prehospital-care/. Accessed November 19, 2019

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.