Prehospital pediatrics and emergency medical services (EMS)
- Paul E Sirbaugh, DO
Paul E Sirbaugh, DO
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Garth Meckler, MD, MSHS
Garth Meckler, MD, MSHS
- Division Head Pediatric Emergency Medicine
- BC Children's Hospital
- Associate Professor of Pediatrics
- University of British Columbia (UBC)
- 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 concept of EMS encompasses many areas of emergency care, including the evaluation, management, and transport of patients from the scene of an injury or illness to their arrival at an emergency care facility (the out-of-hospital or prehospital care), as well as the management within the emergency department.
EMS systems date back to the 18th century when Napoleon’s surgeon-in-chief, Barron Larrey, decreased mortality by transporting wounded soldiers rapidly to field hospitals . In the United States, the EMS system formally began in 1966 with passage of the National Highway Traffic Safety Act that focused on the emergency care of trauma victims from motor vehicle crashes and tied federal funding for highway construction to development of state EMS systems.
Recognizing that children have unique anatomic, physiologic, developmental, and medical needs, the federal government passed legislation in 1984 that allocated funds for the purpose of improving the system for providing EMS for children , creating the Emergency Medical Services for Children Program (EMSC website) [3,4]. EMSC is a collaborative program between Health Resources and Services Administration (HRSA), the Maternal and Child Health Bureau (MCHB), and the National Highway Traffic Safety Administration and provides funding to all 50 states and United States territories .
In the United States, all states have EMS legislation, providing the basis for statewide systems. However, state agencies and local jurisdictions (eg, municipalities or counties) have established local regulations regarding the extent of services that can be provided by prehospital personnel and the procedures that they may perform on children .
The EMS system, prehospital personnel and their capabilities, proper preparation and equipment for prehospital care of children, and advantages and disadvantages of different modes of transport will be reviewed here. The general approach to providing online medical direction and pediatric prehospital care considerations, including management, field triage, and transport decisions are discussed separately. (See "Pediatric considerations in prehospital care".)
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- ROLE OF THE LAYPERSON
- THE EMS SYSTEM
- Types of EMS systems
- - City/county (regional)
- - Private
- - Volunteer
- - International EMS
- DISPATCH PERSONNEL
- Base station personnel
- EMS direction
- TRANSPORT PERSONNEL
- Scope of practice
- - First responders
- - EMT-Basic
- - EMT-Intermediate
- - EMT-Paramedic
- PREPARATION AND EQUIPMENT
- AIR VERSUS GROUND TRANSPORT
- Ground transportation
- Air transportation
- - Special considerations
- QUALITY IMPROVEMENT AND SAFETY
- TRANSPORT REFUSAL
- INTER-FACILITY TRANSPORT