Providing Care to Pediatric Patients in EMS: Are We Improving as a Nation?

Background: As children have unique medical needs, access to online medical direction, patient care protocols, and equipment for EMS personnel is essential in providing appropriate pediatric emergency care.

Methods: In 2010-2011 and 2013-14, an online assessment was sent to EMS agency directors in 54 states and territories focusing on the availability of online medical direction, pediatric protocols, and equipment on ambulances for treating children. Responses were compared to identify progress made and remaining gaps.

Results: Assessments were completed for 6176/7632 (81%) agencies in 2010-11 and 7902/9507 (83%) agencies in 2013-14. Availability of online medical direction was high in both years (90%).  Availability of pediatric protocols increased from 78% to 85%, most notably among Basic Life Support agencies. While ambulances carried a majority of the nationally recommended pediatric equipment items (< 90% in both time periods), a lower percentage of ambulances in both time periods (30% and 34%) carried all pediatric equipment. Items such as pulse oximetry, drug/equipment sizing aids, and pediatric sizes of rescue airway devices were frequently reported as missing. Agencies in urban compared to rural locations more frequently had medical direction and pediatric protocols available, and carried more pediatric equipment on ambulances.

Conclusions: This is the first comparative national analysis of EMS capabilities to care for children.  Robust data collection from across time shows online medical direction is consistently available with pediatric protocols becoming increasingly available. Certain gaps in availability of equipment exist and need to be addressed through educational campaigns, collaborative partnerships, and identification of financial resources.