Pediatric Emergency Care Capabilities: An Assessment of Indian Health Service Affiliated Tribal EMS Agencies in the United States

Purpose. Evaluate the capability of Indian Health Service (IHS) affiliated tribal EMS agencies to care for pediatric patients. Methods. Survey sent to 75 tribal agency directors. Results. Sixty-one agencies (81%) responded. Most agencies are stand-alone and operate Basic Life Support (BLS) ambulances. Pre-hospital runs for pediatric patients constituted 13% of total runs. Most directors (84%) indicated the need for pediatric continuing education. Almost half (49%) of the agencies have a Mass Casualties Plan, but 29% of directors reported responding to a mass casualty incident that involved a “large number of pediatric patients that overwhelmed their service”. Nine agencies (15%) do not have an EMS medical director. The top missing pieces of recommended pediatric equipment not carried on any of ambulances are Stethoscope, Suction catheters, Extremity splints, and Thermal blanket. Approximately half (53%) of agencies have EMS staff that participate in injury prevention activities. Most (95%) of the agencies collect EMS patient care data and half (48%) use the National EMS Information System (NEMSIS) 2.2.1 standard data elements. Over two thirds (76%) submit patient care data to the state EMS authority. Conclusions. Very little information exists on tribal EMS agencies ability to care for pediatric patients. Our survey indicates that in some areas, tribal EMS agencies are prepared to care for children including carrying most prehospital pediatric equipment, collecting and submitting patient care data and integration with the state EMS system. However, severe deficiencies remain including lack of medical direction and capacity to care for children during a mass causality.