Pediatric emergency medicine trisk 4601 4601
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ambulance. EMS agencies transport 89% of the pediatric calls they respond to; although, this varies between
regions.
For pediatric patients transported by EMS, basic life support (BLS) interventions, such as oxygen
administration or spinal motion restriction, occur in nearly 40% to 50%. ALS interventions occur less frequently,
with IV access noted in 14% and airway management occurring in 0.6% to 2.5%. The National Emergency
Medical Services Information System (NEMSIS), developed and maintained by the National Highway Traffic
Safety Administration Office of EMS, is a national database that stores EMS data submitted by states and
territories. While the database does not contain every single EMS activation that occurs in the United States,
analysis of NEMSIS data has shown that as recently as 2011, only 7% of EMS responses involved children, and
that critical procedures were performed in 10 per 1,000 pediatric cases, with an 81% success rate. Specifically
examining airway procedures, the 2012 NEMSIS data demonstrated that 4.5% of pediatric patient care events
involved airway management procedures, with invasive airway management or ventilation procedures taking
place in only 1.5% of patient care events. Endotracheal intubation (ETI) success rate was reported to be 81%;
however, success was not reported in 14% of cases.
According to data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2016, 4.4% of
patients under the age of 15 years visiting an ED arrived via EMS, which is significantly lower than the
percentage of adults arriving to an ED by ambulance. Previous surveys have demonstrated that children
transported by EMS were four times more likely to be admitted to the hospital, with a 16% compared to a 4%
admission rate among non–EMS transported ED patients. Certain patient characteristics were associated with
EMS use, including nonwhite race, urban residence, visit due to injury or poisoning, and lack of insurance.
Governance of EMS Systems
There is no nationally standardized definition of what constitutes an EMS system. In all 50 states, legislation
exists to provide a statutory basis for individual EMS agencies to exist and operate. After the EMS Act of 1973,
all states identified lead agencies that coordinate EMS activities within the state. In most states, the lead agency is
headed by an EMS medical director who reports to the state department of health. Often, state-level advisory
councils exist to direct and assist in the development of protocols and minimum standards of operation.
In addition to control at the state level, local government may regulate the organization and authorization of
services provided by EMS personnel. States are frequently divided into EMS regions, at which level prehospital
care becomes operational, and where local government, hospitals, and ambulance services interact with each
other. Regional advisory councils may exist as well.
While all EMS agencies are regulated at a state and/or regional level, different types of EMS agencies exist,
depending upon the governing structure. Physicians are likely most familiar with municipal agencies, like a city
or county fire department that contains an EMS section, or a free-standing municipal EMS agency that functions
separately from fire services. EMS agencies may also be part of a hospital or healthcare system, with providers
and administrators functioning as employees of the hospital. Other privately owned EMS agencies may contract
with hospitals or municipal fire services to provide interfacility or scene medical transports. Volunteer agencies
(often with limited experience in pediatrics) are prevalent in rural areas of the United States.
This patchwork of governance over EMS systems may make it very difficult to speak with a unified voice
when it comes to patient care, training, and certification, and makes it difficult for EMS professionals to move
between communities. The National Registry of Emergency Medical Technicians (NREMTs) serves as a
centralized credentialing group, but this organization does not authorize an EMT to practice in a state or region,
and there is little consistency around the issue of states granting reciprocity for EMS providers.
Components of Prehospital Care Systems
The prehospital component of EMSC is an architecture that involves a variety of personnel and equipment, only
some of which is standardized and regulated. To understand the extent of the services provided by prehospital
care systems, it is important to understand the training, capabilities, and scope of practice of prehospital personnel
and the equipment available to them.
EMS Providers
The National Highway Traffic and Safety Administration (NHTSA) developed the first National Standard
Curricula for prehospital providers in 1977. Four levels of care provider were clearly outlined: emergency
medical responders (EMRs), emergency medical technicians (EMTs), advanced emergency medical technicians
