Pediatric considerations in prehospital care
- Paul E Sirbaugh, DO
Paul E Sirbaugh, DO
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Saranya Srinivasan, MD
Saranya Srinivasan, MD
- Assistant Professor of Pediatrics
- Baylor College of Medicine
- Pediatric Emergency Medicine Attending
- Texas Children's Hospital
- Section Editors
- Richard D Zane, MD
Richard D Zane, MD
- Section Editor — Emergency Medical Services/Disaster Medicine
- Professor and Chair of Emergency Medicine
- University of Colorado School of Medicine
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The general approach to providing online medical direction and pediatric prehospital care considerations, including management, field triage, and transport decisions will be reviewed here.
A general understanding of the components of an effective EMS system for children, including personnel roles and capabilities and necessary preparation and equipment for providing prehospital pediatric care are discussed separately. (See "Prehospital pediatrics and emergency medical services (EMS)".)
Appropriate prehospital assessment and management of children is challenging and requires dedicated resources to ensure the best outcomes . In the past, it was common for emergency medical service (EMS) agencies to employ the “load and go” philosophy when providing prehospital care to an ill or injured child without strong emphasis on the provision of pediatric-specific stabilization. More recently, many agencies have improved the level of prehospital pediatric care and invested in training and equipment for their prehospital providers (eg, emergency medical technicians, paramedics).
In the United States, the federally supported Emergency Medical Services for Children (EMSC) program has been a major factor in promoting more intensive prehospital care within existing EMS systems . The EMSC program has supported prehospital pediatric research, developed educational tools for prehospital providers, and assessed the availability of equipment, online medical direction, and offline protocols for pediatric patients . As a result, pediatric focused offline protocols where providers can reference assessment tools, management pathways, or pediatric medication dosing or equipment types and sizing are more widely available. In addition, online medical direction by pediatric emergency medicine specialists with expertise in prehospital care is occurring in selected EMS agencies within the United States. The EMS for Children program is integrating quality improvement methodology into its work through the EMS for Children Innovation and Improvement Center .
ONLINE MEDICAL CONTROL
Online medical control consists of physician direction, supervision, and authorization of prehospital treatment by phone, radio, or at the scene in real time. The physician is often located at a base station that often is not located at the facility that will eventually receive the patient. In some settings, online medical control implies 24-hour availability of physicians to provide prehospital medical direction. (See "Prehospital pediatrics and emergency medical services (EMS)", section on 'Base station personnel'.)
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- ONLINE MEDICAL CONTROL
- Medical direction training
- General approach
- OFFLINE MEDICAL CONTROL
- TIMING OF PREHOSPITAL INTERVENTIONS
- PREHOSPITAL INTERVENTIONS
- Medical and surgical emergencies
- Pediatric procedures
- Difficult situations
- - Disagreement with prehospital provider
- - Patient refuses treatment
- - Transport refusal by legal guardian
- - Advanced directives
- - Suspected child abuse
- - Withholding or stopping resuscitation in traumatic cardiopulmonary arrest
- FIELD TRIAGE AND TRANSPORT DECISIONS
- Ground versus air transport
- Hospital destination
- Safe transport
- - Lights and sirens
- - Child restraint
- Decision not to transport
- ADDITIONAL RESOURCES