Pediatric Readiness in Emergency Medical Services Systems

Abstract

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.

Key words:

• pediatrics
• EMS
• readiness

Introduction

Prehospital emergency care typically involves emergency medical technicians, paramedics, and other licensed medical providers who work in emergency medical services (EMS) systems on 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 that also involves primary prevention, hospital-based acute care, rehabilitation, and return to the medical home, the unique needs of children must be addressed by emergency medical services (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 (EDs) 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 paper. 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.” This policy statement is accompanied by a technical report published simultaneously (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:

• Include pediatric considerations in EMS planning and 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, physiological 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 EMS 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 destination of pediatric patients, with consideration of regional resources and weighing the risks and benefits of keeping children in their own communities (4).

• Collaborate, along with receiving EDs, 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 child 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 (EMSC) program when implementing the recommendations noted herein (25).

Conclusion

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 is variable. Providing high-quality EMS care to children requires an infrastructure designed to support the care of pediatric patients and their families. Therefore, it is important that EMS physicians, administrators, and EMS 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.

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 prior to that time.

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 Leonard, MD, MPH, FAAP

American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, 2018–2019

Joseph Wright, MD, MPH, FAAP, Chairperson

James Callahan, MD, FAAP

Javier Gonzalez del Rey, MD, MEd, FAAP

Toni Gross, MD, MPH, FAAP

Madeline Joseph, MD, FAAP

Lois Lee, MD, MPH, FAAP

Elizabeth Mack, MD, MS, FAAP

Jennifer Marin, MD, MSc, FAAP

Suzan Mazor, MD, FAAP

Nathan Timm, MD, FAAP

Liaisons

Andrew Eisenberg, MD, MHA – American Academy of Family Physicians

Cynthia Wright Johnson, MSN, RN – NationalAssociation of State EMS Officials

Cynthiana Lightfoot, BFA, NRP – AAP FamilyPartnerships Network

Charles Macias, MD, MPH, FAAP – EMSCInnovation and Improvement Center

Brian Moore, MD, FAAP – NationalAssociation of EMS Physicians

Diane Pilkey, RN, MPH – Maternal and ChildHealth Bureau

Katherine Remick, MD, FAAP – NationalAssociation of Emergency Medical Technicians

Mohsen Saidinejad, MD, MBA, FAAP, FACEP –American College of Emergency Physicians

Sally Snow, RN, BSN, CPEN, FAEN – EmergencyNurses Association

Mary Fallat, MD, FAAP – American Collegeof Surgeons

Former AAP Committee on Pediatric Emergency Medicine Members, 2012-2018

Alice Ackerman, MD, MBA, FAAP

Terry Adirim, MD, MPH, FAAP

Michael S.D. Agus, MD, 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

Prashant Mahajan, MD, MPH, MBA, 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

ACEP 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

Ena Pediatric Committee, 2016–2017

Tiffany Young, BSN, RN, CPNP, 2016 Chair

Joyce Foresman-Capuzzi, MSN, RN, CNS,2017 Chair

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, 2016Board Liaison

Kathleen Carlson, MSN, RN, 2017 Board Liaison

Staff

Catherine Olson MSN, RN

NAEMSP Standards and Clinical Practice Committee, 2017–2018

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

NAEMT 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

Abbreviations
ED	=	emergency department
EMS	=	emergency medical services.