Resource Document: Coordination of Pediatric Emergency Care in EMS Systems

Figures & data

Figure 1. Flowchart of the review process.

Table 1. Summary of the 9 included citations

Citation	Method	N	Population	Setting	Type of Coordination	Recommendations and/or Outcomes
Sadovich et al.^15 (2015)	Survey (100% response rate)	45	EDs	Tribal/Indian Health Services	Physician PECC, Nurse PECC	Overall WPRS 60.9, 22% had physician PECC, 42% had nurse PECC. Presence of PECC associated with higher readiness scores across all domains: administration and coordination (13.1 vs. 0), Staff competencies and training (5.5 vs. 4.2), Pediatric quality improvement processes (2.1 vs. 1.8), Pediatric patient safety (10.2 vs. 9.2), policies and procedures (9.8 vs. 8.5), Equipment, Supplies and Medications (30.4 vs. 28.3) but this was only statistically significant for Equipment/Supplies/Medications score
Remick et al.^16 (2016)	Survey (90% response rate)	335	EDs	California	Physician PECC, Nurse PECC	43% at least one type of coordinator, 33% both types of coordinator; wide range of responsibilities; associated with higher WPRS (85 vs. 58)
Gausche-Hill et al.^17 (2015)	Survey (83% response rate)	5017	EDs	United States	Physician PECC, Nurse PECC	48% physician PECC, 59% nurse PECC, 42% both PECCs; PECC associated with increased WPRS (82.2 vs. 66.5) across all patient volumes, scores for both PECCs higher than for physician or nurse PECC alone (82.2 vs. 75.3 vs. 69.7); associated with increased likelihood of pediatric quality improvement process (ARR 4.11), pediatric policies and procedures (ARR 2.33), pediatric equipment supplies, and medications (ARR 1.44), and pediatric patient safety measures (ARR 1.30)
Clancy and Kacica^18 (2012)	Survey (80% response rate)	145	Hospitals	New York	Pediatric Coordinator (physician and/or nurse)	60% physician coordinator, 49% nurse coordinator; presence of physician vs nurse coordinator respectively associated with increased likelihood of having emergency management plan that includes pediatrics (OR 4.02 vs. 3.06), tracking plan for unaccompanied children (OR 6.50 vs. 5.36), plan to house pediatric patients in-place (OR 15.13 vs. 11.50), pediatric equipment (OR 7.22 vs. 6.14), and staff to meet pediatric patient medical needs (OR 28.56 vs. 33.30)
Barfield et al.^20 (2011)	Literature review, Expert opinion	53 experts	Experts in public health, disaster, and medical response	Oak Ridge Institute for Science and Education	Pediatric experts as advisory council	Need for pediatric experts to ensure children are included in mass critical care preparations
AAP, ACEP, ENA^22 (2009)	Consensus statement	Expert panel	AAP, ACEP, ENA	—	Physician PECC; Nurse PECC	Recommend PECC
Gausche-Hill et al.^19 (2007)	Survey (29% response rate)	5144	EDs	United States	Physician PECC, Nurse PECC	18% doc PECC, 12% nurse PECC, 10% both PECC; 52% had pediatric QI/PI plan (not compared by coordinator role); median 11 of 13 pediatric care policies (not compared by coordinator role); presence of physician and nurse PECC associated with higher WPRS across all types of facilities: Standby (81 vs. 57), Basic (80 vs. 68), General (84 vs. 72), Comprehensive (87 vs. 79).
(Continued on the next page)

Table 1. (Continued).

Citation	Method	N	Population	Setting	Type of Coordination	Recommendations and/or Outcomes
Oakley et al.^21 (2004)	Interventional study with survey and retrospective review	117 charts	ED, Families, Staff	Melbourne, Australia	Joint Liaison Committee: Emergency Directors, Hospital Executives, Director of Pediatric Services, Director of Medicine Services, physician and nurse PECCs	Development of a designated pediatric area within the ED, identification of physician and nurse PECCs to provide education and training, development of pediatric specific protocols for top 15 most common diagnoses and 10 high-risk diagnoses, Outcomes included decreased pediatric inter-facility transfers (4.9 vs. 4.1 per month) and inpatient pediatric bed usage (6% reduction), improved triage documentation (50% vs. 85%), decrease in inappropriate asthma management (12 vs. 5), increased pain management (50% vs. 100%), and increased staff awareness of high priority issues in pediatrics (12% vs. 29%)
AAP and ACEP (2001)^23	Consensus statement	Expert panel	AAP, ACEP	—	Physician PECC, Nurse PECC	Recommend PECC

ED: Emergency Department; PECC: Pediatric emergency care coordinator; WPRS: Weighted pediatric readiness score; AAP: American Academy of Pediatrics; ACEP: American College of Emergency Physicians; ENA: Emergency Nurses Association; QI/PI: Quality Improvement/Process Improvement.

Table 2. Pediatric resources

Online and Offline Pediatric Medical Direction Resources:

Children with Special Healthcare Needs: A Template for Prehospital Protocol Development^25

Model EMS Clinical Guidelines^26

EMS for Children Medical Direction Toolbox^27,28

Consent of EMS for children and adolescents^29

Educational Resources:

Teaching Resource for Instructors in Prehospital Pediatrics – BLS^30 and ALS^31

Pediatric Education of Prehospital Professionals^32

Emergency Pediatric Care^33

EMS for Children Prehospital Education Toolbox^34

Special Children's Outreach and Prehospital Education (SCOPE)^35

EMS for Children Patient- and Family-Centered Care Toolbox^36

EMS for the Pediatric Emergency Physician^37

Disaster Resources:

EMS for Children Pediatric Disaster Preparedness Toolbox^38

Pediatric Disaster Preparedness Resource^39

Pediatric Disaster Triage: JumpSTART^40

California EMS for Children Pediatric Disaster Preparedness Guidelines for Local EMS Agencies^41

Pediatric Preparedness Resource Kit^42

System-Based Policies and Procedures:

Joint position statement on Equipment for Ambulances^43

Models for Facility Categorization^44,45

EMS for Children Facility Categorization Toolbox^46

EMS for Children Inter-facility Transfer Toolbox^47

Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients^48

Sadovich J, Adirim T, Telford R, Olson LM, Gausche-Hill M, Edgerton EA. Pediatric readiness in Indian Health Service and tribal emergency departments: results from the National Pediatric Readiness Project. J Emerg Nurs. 2015; Oct 31:S0099–1767(15)00449-3. doi:10.1016/j.jen.2015.09.004. [Epub ahead of print].

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Remick K, Kaji AH, Lenora LM, et al. Pediatric readiness and facility verification. Ann Emerg Med. 2016;67(3):320–8.

 PubMed Web of Science ®Google Scholar

Gausche-Hill M, Ely M, Schmuhl P, et al. National assessment of pediatric readiness of US emergency departments. JAMA-Pediatr. 2015;169:527–34.

 PubMed Web of Science ®Google Scholar

Clancy KA, Kacica MA. Ready for our children? Results from a survey of upstate New York hospitals' utilization of Pediatric Emergency Preparedness Toolkit guidance. Disaster Med Public Health Prep. 2012;6:138–45.

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Barfield WD, Krug SE, Kanter RK, et al. Task Force for Pediatric Emergency Mass Critical Care. Neonatal and pediatric regionalized systems in pediatric emergency mass critical care. Pediatr Crit Care Med. 2011;12:S128–34.

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American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians, Emergency Nurses Association Pediatrics Committee (AAP, ACEP, and ENA). Joint policy statement - guidelines for care of children in the emergency department. Pediatrics. 2009;124(4):1233–43.

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Oakley E, Crellin D, Barty N, Braitberg G, Young S. Improving emergency care for children: a model of collaboration between emergency departments. Emerg Med Australasia. 2004;16:417–24.

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American Academy of Pediatrics, Committee on Pediatric Emergency Medicine and American College of Emergency Physicians Pediatric Committee (AAP and ACEP). Care of children in the emergency department: guidelines for preparedness. Pediatrics. 2001;107:777–81.

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Singh T, Wright JL, Adirim TA. Children with special health care needs: a template for prehospital protocol development. Prehosp Emerg Care. 2003;7:336–51.

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American Academy of Pediatrics. (2013) The PEPP Course. Available at: http://www.peppsite.com. Accessed July 22, 2016.

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EMS for Children Innovation and Improvement Center. Prehospital Education Toolbox. December 2013. Available at: https://emscimprovement.center/resources/toolboxes/pediatric-prehospital-education-toolbox/. Accessed October 20, 2016.

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Adirim T, Smith E. Special Children's Outreach and Prehospital Education. 1st ed. Sudbury, MA: Jones and Bartlett, 2006.

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