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Children account for approximately 10% of the total patients treated by prehospital providers, thus, limiting reinforcement of pediatric assessment and life-saving skills.
There are two levels of response in the prehospital setting: Basic life support is provided by emergency medical responders (EMRs) and emergency medical technicians (EMTs); advanced emergency medical technicians (AEMTs) and paramedics provide advanced life support care.
Rural EMS providers face many challenges when caring for children as they have longer transport times and care for fewer children in general (limiting pediatric-specific skills retention).
Prehospital protocols are approved by agency medical directors and are limited in development by a paucity of pertinent prehospital literature. With implementation, they should be linked to provider education, performance metrics, and quality improvement strategies.
Standardized ambulance equipment checklists addressing the specific needs of children have been derived under a collaborative effort of multiple stakeholder organizations.
Offline, or indirect, medical oversight involves the development, implementation, monitoring, and iterative improvement of medical policies and protocols used by field personnel. Online, or direct, medical oversight is the concurrent clinical direction provided to field personnel by a medical director or his/her delegate.
Regionalization is the geographical organization of services to ensure access to care (including transport) at a level appropriate to patient needs while maintaining efficient use of available resources and the avoidance of duplicative ED visits. For certain conditions (e.g., trauma, burns, stroke, pediatric critical care), it has been shown to improve outcomes.
Emergency care without parental consent can be provided regardless of age. Although minors cannot refuse treatment and transport in an emergency situation, if a legal guardian is present, he/she can make an informed decision to refuse transport; refusal of EMS care for children occurs in about 5% of all EMS runs.
For EMS providers interacting with children with end-of-life issues, Do Not Resuscitate (DNR) orders must be present in written form, acknowledged verbally by the family as still in effect, link to correct identification of the child as the recipient of the DNR order, and occur in a state that includes children in DNR laws.
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History and Pediatric Considerations in EMS
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Emergency Medical Services for Children
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Medical experiences in both the Korean and Vietnam Wars demonstrated that survival rates improved when patients were stabilized in the field and transported immediately to a well-equipped emergency facility.1 In 1966, the National Highway Traffic Safety Act mandated that states develop Emergency Medical Services (EMS) systems, and Congress passed the Emergency Medical Services Act in 1973 to provide direct funding for regional EMS systems.2 With its origins in the military and its civilian focus on cardiac and trauma care, the nation's EMS systems were slow to consider the needs of the pediatric population. In 1984, the federal government approved the EMS for Children (EMSC) program through the Health Resources and Services Administration's Maternal Child Health Bureau of the Department of Health and Human Services.2...