Pediatric emergency medicine trisk 4599 4599
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CHAPTER 134 ■ PREHOSPITAL CARE
TONI K. GROSS, THERESA A. WALLS, GEORGE A. (TONY) WOODWARD
EMS SYSTEMS
The term Emergency Medical Services (EMS) is used to refer to emergency or lifesaving care that takes place out
of the hospital. This could represent the entry point into the continuum of emergency care, interfacility transports,
and medical care delivered in austere environments. This chapter will cover prehospital EMS care, encompassing
the initial response to emergency calls, the dispatch of personnel, as well as the triage, treatment, and transport of
patients. EMS operates at the intersection between health care, public health, and public safety ( Fig. 134.1 ), but
its primary mission is emergency medical care.
EMS systems in the United States were initially developed primarily to treat medical problems that are
prevalent in adults, with limited attention to the special needs of children. Despite this, many sick or injured
children will enter the EMS system for initial evaluation, treatment, and transport to the hospital. Acutely ill
pediatric patients may represent a challenge to many EMS systems and providers. They represent a lowfrequency, high-intensity patient population. They may be too small for conventionally available EMS
equipment. They may be one part of a large family unit needing care, and may present an emotional challenge to
the provider. Despite these difficulties, the goal is to seamlessly integrate the care of children in the prehospital
environment into EMS systems that were originally designed to care for adults.
EMS for children (EMSC) is a concept for an all-encompassing, multidisciplinary care system that includes
parents, primary care providers, prehospital care providers and transport systems, community hospital and tertiary
care referral center emergency departments (EDs), and pediatric inpatient units, including critical care facilities.
The elements of this system should be linked by effective communication and transportation systems and
governed by well-established policies and procedures. The provision of pediatric EMS, although a single link in
this chain, is a critical component. EMS providers are continually balancing the need for rapid transport to the
hospital with the ability to recognize and stabilize the sick or injured child in the field. This must all be done with
the patient’s best interest in mind, being mindful that prehospital care is only one portion of the patient’s medical
management.
FIGURE 134.1 EMS is at the intersection of health care, public health, and public safety.
History of EMS Systems
The first organized prehospital transport systems were developed and organized by the military. During the late
18th century, a system of field triage and transport provided that the most seriously wounded soldiers were
