Pediatric emergency medicine trisk 4630 4630
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Traffic Safety
Administration
National Registry
of Emergency
Medical
Technicians
Pediatric
Life
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Support
(PALS)
Pediatric Trauma
Society
The reports stated that the federal government should support the development of national standards for
emergency care performance measurement, the categorization of all emergency care facilities, and protocols for
the treatment, triage, and transport of prehospital patients, with emphasis on using evidence-based practices.
NHTSA has supported the development of evidence-based guidelines (EBGs) for prehospital care, discussed
further in a later section of this chapter. A gap analysis of EMS-related research was completed after the
recommendation of the IOM reports. The EMSC program supported pediatric regionalization by providing grants
to six states to fund regionalization demonstration programs in 2012.
To address standardization in EMT competency, the report recommended that all states adopt a common scope
of practice for EMS personnel. The EMS Scope of Practice Model and Education Standards maintained by the
DOT were discussed in detail earlier in this chapter. Medical direction standardization has been addressed by the
recognition of an EMS physician subspecialty.
Specifically addressing pediatric emergency care, the report stated “If there is one word to describe pediatric
emergency care in 2006, it is uneven. ” More details of the recommendations specific to pediatrics are listed here:
The emergency care workforce should receive pediatric knowledge and skills training
Pediatric competencies should be defined; EMS providers should be required to maintain those competencies
Each EMS provider organization should have a pediatric emergency care coordinator
Pediatric priorities in emergency preparedness should be enhanced
The evidence base for pediatric emergency care should be supported
Family-centered care should be fostered
An evidence-based approach should be used to improve pediatric patient safety
While many of the 2006 IOM recommendations have not been realized, significant strides have been made.
The EMS Agenda 2050, developed in 2018, and available at , continues to strive
toward the vision of a people-centered EMS system that is equitable, efficient, and evidence based.
EMS RESEARCH
It is challenging to perform quality clinical research in the EMS system. There are few large-scale, randomized
clinical studies that have been undertaken in the pediatric EMS population. The uncontrolled environment and the
urgency of injury and illness treatment often make quality data collection and informed consent more
complicated than in the ED setting. Additional barriers include monitoring adherence to study protocols,
providing ethical research training to EMS personnel, randomizing patients to treatment groups, and measuring
patient outcome data that occur once patient care has been transitioned to a hospital. In addition, a significant
amount of funding, which has been lacking, is required to overcome these barriers. Even with well-designed
research, it may be difficult to generalize the findings outside the study population and locale due to the high
level of variability within EMS systems across the United States. No two systems are designed to operate in
exactly the same way with regard to staffing, protocols, oversight, demographics, or training. This further
emphasizes the large amount of funding required to complete multicentered research that will be required to
obtain sufficient sample sizes and make results generalizable.
