Pediatric emergency medicine trisk 4632 4632
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inform decisions regarding policy and funding priorities, while also guiding the EMS researcher toward topics in
need of attention.
EVIDENCE-BASED GUIDELINES
NHTSA responded to the IOM report recommendation to “convene a panel … to develop evidence-based model
prehospital care protocols for the treatment, triage, and transport of patients, including children.” In 2008, the first
National EMS EBGs conference was attended by EMS stakeholders and experts in EMS, research, and EBGs.
With funding from NHTSA and EMSC, a model process for the development, implementation, and evaluation of
EMS EBGs was drafted and subsequently implemented. Using the Grading of Recommendations Assessment,
Development, and Evaluation (GRADE) process, a rigorous, validated appraisal tool to assess quality of
evidence, multidisciplinary teams embarked on creating several prehospital EBGs. In 2014, a description of the
process and three EBGs were published in Prehospital Emergency Care: prehospital seizure management,
prehospital analgesia in trauma, and air medical transportation of prehospital trauma patients.
NHTSA and EMSC have offered further funding to the NASEMSO as well as a targeted issue grant to evaluate
EMS system utilization of EBGs. Due to the labor-intensive nature of the process and the relative paucity of
strong evidence for many prehospital practices, EBGs for all conditions treated by prehospital providers may not
be available for some time. Additional efforts to promote uniformity and quality of prehospital care include the
development of Model EMS Clinical Guidelines, made public in 2014 ( ). While these guidelines do not use the same rigorous GRADE methodology, they were
developed by multidisciplinary teams of EMS experts and reviewed by multiple EMS stakeholders. They are
based on the most current standards of practice and evidence. They are available to EMS systems for adoption
and customization to address specific needs.
SUMMARY
U.S. EMS systems were initially developed to primarily treat adults with cardiovascular disease and injuries from
motor vehicle crashes; however, many advances have been made, and the prehospital needs of children are being
recognized and addressed through the leadership of the EMSC program and its strong relationship with NHTSA.
EMS systems are variable without a federal lead agency for prehospital care, but the FICEMS aims to coordinate
funding and regulations across three federal agencies. National education and scope of practice standards exist for
four levels of EMS provider. EMS systems function well with strong medical direction, and the appointment of a
pediatric coordinator within each system will ensure the best care for children in the prehospital setting. EBGs
represent a significant step toward improving quality of prehospital care through standardization and are a
tangible response to the IOM reports on emergency care in the United States.
Suggested Readings and Key References
EMS Epidemiology
Carlson JN, Gannon E, Mann NC, et al. Pediatric out-of-hospital critical procedures in the United States. Pediatr
Crit Care Med 2015;16(8):e260–e267.
Federal Interagency Committee on EMS. 2011 National EMS Assessment. (Report No. DOT HS 811 723).
Washington, DC: National Highway Traffic Safety Administration; 2012. Available online at
/>id=vpdL22iKszd4DxK9BgzOzv1k_I_3XclTyLOFol . Accessed August 10, 2015.
Hansen M, Lambert W, Guise JM, et al. Out-of-hospital pediatric airway management in the United States.
Resuscitation 2015;90:104–110.
Shah MN, Cushman JT, Davis CO, et al. The epidemiology of emergency medical services use by children: an
analysis of the National Hospital Ambulatory Medical Care Survey. Prehosp Emerg Care 2008;12(3):269–276.
Suruda A, Vernon DD, Reading J. Pre-hospital emergency medical services: a population based study of pediatric
utilization. Inj Prev 1999;5(4):294–297.
EMS Providers
National Association of State EMS Officials. National EMS Scope of Practice Model 2019 (Report No. DOT HS
812-666). Washington, DC: National Highway Traffic Safety Administration. Available online at
. Accessed March, 2020.
