Introduction and Context
For decades, the phrase “children are not small adults” has been a cornerstone of pediatric medicine. In the high-stakes environment of prehospital emergency care, this mantra is more than a cliché—it is a matter of life and death. Children account for approximately 10% of Emergency Medical Services (EMS) calls, but because critical pediatric events are relatively rare for the average paramedic or EMT, maintaining proficiency in pediatric-specific skills, dosages, and equipment can be a daunting challenge.
The National Prehospital Pediatric Readiness Project (NPPRP) was established to address this challenge. Following the success of hospital-based readiness initiatives, the NPPRP sought to create a standardized framework to assess how prepared US EMS agencies are to care for children. The newly published assessment, “The National Pediatric Prehospital Readiness Project: First Comprehensive Assessment of United States Emergency Medical Services Agencies,” provides the first national baseline for pediatric readiness. This landmark study identifies where the American prehospital system excels and, more importantly, where it falls short in protecting its youngest patients.
New Guideline Highlights
The assessment used a scored web-based survey based on national guidelines for out-of-hospital care. Key highlights from the assessment include:
- The Readiness Gap: The median Prehospital Pediatric Readiness Score was 65.5 out of 100, indicating significant room for improvement across the board.
- The “PECC” Effect: The presence of a Pediatric Emergency Care Coordinator (PECC) was the single strongest predictor of high readiness scores.
- Equipment vs. Process: While most agencies are well-equipped with physical tools (median score 12/12), they struggle with administrative and procedural domains like quality improvement and family-centered care.
Case Study: A Prehospital Challenge
Consider “Liam,” a 5-year-old in status epilepticus. When the EMS crew arrives, they must quickly calculate a weight-based dose of midazolam, select the correct size of airway adjunct, and manage a frantic family. In an agency with high pediatric readiness, the crew has practiced this scenario, the medications are stored in a way that minimizes calculation errors, and a dedicated PECC has ensured that the specific pediatric protocols are up-to-date. In an agency with a low readiness score, these steps are fraught with potential for error, leading to “pediatric anxiety” among providers and potentially suboptimal outcomes for Liam.
Topic-by-Topic Recommendations and Assessment Results
The assessment broke down readiness into eight distinct domains. Understanding these domains is essential for agencies looking to improve their performance.
1. Education and Competency
Maintaining pediatric skills requires frequent, high-fidelity training. The guidelines recommend that agencies provide regular pediatric-specific psychomotor skill evaluations and case reviews. The assessment found that while many agencies offer pediatric education, it is often not standardized or frequent enough to prevent skill decay.
2. Equipment and Supplies
This was the highest-scoring domain (Median 12/12). Most US EMS agencies have successfully integrated pediatric-sized equipment (e.g., small blood pressure cuffs, pediatric masks, and weight-based dosing aids like the Broselow tape). However, having the equipment is only half the battle; ensuring providers know how to use it under pressure remains a priority.
3. Pediatric Emergency Care Coordinators (PECCs)
The recommendation is for every EMS agency to have a designated individual (or individuals) responsible for pediatric oversight. The study found that only 38% of agencies currently have a PECC. However, those that did have a PECC were associated with significantly higher scores across all other domains. A PECC serves as the “pediatric champion,” ensuring that pediatric needs are not overlooked in general agency operations.
4. Quality Improvement (QI)
One of the lowest-scoring domains (Median 5.7/12), QI involves the systematic review of pediatric calls to identify errors and improve care. Many agencies lack pediatric-specific indicators in their QI programs. The consensus is that agencies must move beyond simple data collection and implement active review processes for pediatric cases.
5. Family-Centered Care
Emergency care does not happen in a vacuum; it involves the child’s caregivers. Guidelines recommend policies that allow for family presence during resuscitation and clear communication strategies for parents. This domain scored a median of 5.8/10, suggesting that many EMS systems still view the family as a hurdle rather than a partner in care.
6. Policies and Safety
This includes protocols for pediatric medication dosing, transport safety (using appropriate child restraints in ambulances), and child abuse reporting. While equipment was strong, specific policies regarding safe pediatric transport showed variability across the nation.
Expert Commentary and Insights
Experts in the field of pediatric emergency medicine emphasize that the results of this assessment should serve as a wake-up call. Dr. Kathleen Adelgais and her colleagues noted that the disparity between equipment availability and procedural readiness (like QI and PECC presence) suggests that the challenge is not financial, but organizational.
“The fact that equipment scores were so high shows that agencies are willing to invest in pediatric care,” says one consensus member. “But the low scores in Quality Improvement and Systems Interaction suggest we need a cultural shift. We need to move from ‘having the right stuff’ to ‘having the right systems’.”
There is also a significant debate regarding the barriers to appointing PECCs, especially in small or rural volunteer agencies. Experts suggest that a “hub and spoke” model, where one PECC oversees multiple small agencies, may be a viable solution to the personnel shortage.
Practical Implications for EMS Systems
For EMS directors and medical oversight boards, the implications of this first national assessment are clear:
- Appoint a PECC: If an agency does nothing else, appointing a pediatric champion is the most effective way to raise readiness levels.
- Formalize Pediatric QI: Agencies should integrate pediatric-specific metrics (e.g., frequency of weight-based dosing errors) into their existing quality improvement frameworks.
- Focus on Family: Training should include the psychological and logistical aspects of managing caregivers during a pediatric crisis.
- Advocate for System Integration: EMS agencies must work more closely with local hospitals and pediatric specialty centers to ensure a seamless continuum of care.
By addressing these gaps, the EMS community can ensure that when the next “Liam” calls for help, the system is fully prepared to respond with the highest standard of pediatric care.
References
1. Adelgais KM, Remick KE, Hewes HA, et al. The National Pediatric Prehospital Readiness Project: First Comprehensive Assessment of United States Emergency Medical Services Agencies. Annals of Emergency Medicine. 2026; (41721808).
2. American Academy of Pediatrics, American College of Emergency Physicians, National Association of EMS Physicians. Joint Policy Statement: Pediatric Readiness in the Emergency Medical Services System. Pediatrics. 2020;145(1):e20193308.
3. Remick K, Gausche-Hill M, et al. Pediatric Readiness in the Emergency Department. Annals of Emergency Medicine. 2018;72(6):e123-e136.
