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 — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- 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".)
- Skandalakis PN, Lainas P, Zoras O, et al. "To afford the wounded speedy assistance": Dominique Jean Larrey and Napoleon. World J Surg 2006; 30:1392.
- Seidel JS. Emergency medical services and the pediatric patient: are the needs being met? II. Training and equipping emergency medical services providers for pediatric emergencies. Pediatrics 1986; 78:808.
- Gausche M, Lewis RJ, Stratton SJ, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial. JAMA 2000; 283:783.
- Ludwig S, Selbst S. A child-oriented emergency medical services system. Curr Probl Pediatr 1990; 20:109.
- Woodward GA, King BR, Garrent AL, Baker MD. Prehospital care. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM. (Eds), Lippincott, Williams, & Wilkins, Philadelphia 2006. p.93.
- 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; 12:269.
- Richard J, Osmond MH, Nesbitt L, Stiell IG. Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system. CJEM 2006; 8:6.
- Tsai A, Kallsen G. Epidemiology of pediatric prehospital care. Ann Emerg Med 1987; 16:284.
- Weiss SJ, Ernst AA, Phillips J, Hill B. Visits to home environments by emergency medical services: a statewide study. Prehosp Emerg Care 2001; 5:19.
- Seidel JS, Henderson DP, Ward P, et al. Pediatric prehospital care in urban and rural areas. Pediatrics 1991; 88:681.
- Yamamoto LG, Wiebe RA, Maiava DM, Merry CJ. A one-year series of pediatric prehospital care: I. Ambulance runs; II. Prehospital communication; III. Interhospital transport services. Pediatr Emerg Care 1991; 7:206.
- Sapien RE, Fullerton L, Olson LM, et al. Disturbing trends: the epidemiology of pediatric emergency medical services use. Acad Emerg Med 1999; 6:232.
- Scribano PV, Baker MD, Holmes J, Shaw KN. Use of out-of-hospital interventions for the pediatric patient in an urban emergency medical services system. Acad Emerg Med 2000; 7:745.
- Cummins RO, Ornato JP, Thies WH, Pepe PE. Improving survival from sudden cardiac arrest: the "chain of survival" concept. A statement for health professionals from the Advanced Cardiac Life Support Subcommittee and the Emergency Cardiac Care Committee, American Heart Association. Circulation 1991; 83:1832.
- Ritter G, Wolfe RA, Goldstein S, et al. The effect of bystander CPR on survival of out-of-hospital cardiac arrest victims. Am Heart J 1985; 110:932.
- Cummins RO, Eisenberg MS. Prehospital cardiopulmonary resuscitation. Is it effective? JAMA 1985; 253:2408.
- Roth R, Stewart RD, Rogers K, Cannon GM. Out-of-hospital cardiac arrest: factors associated with survival. Ann Emerg Med 1984; 13:237.
- Cummins RO, Eisenberg MS, Hallstrom AP, Litwin PE. Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am J Emerg Med 1985; 3:114.
- Berg RA, Hilwig RW, Kern KB, Ewy GA. "Bystander" chest compressions and assisted ventilation independently improve outcome from piglet asphyxial pulseless "cardiac arrest". Circulation 2000; 101:1743.
- Andazola JJ, Sapien RE. The choking child: what happens before the ambulance arrives? Prehosp Emerg Care 1999; 3:7.
- The pediatrician's role in advocating life support courses for parents (RE9424). American Academy of Pediatrics. Committee on Pediatric Emergency Medicine. AAP News, 1994. (www.aap.org/policy/570.html).
- Single European emergency call number 112. http://ec.europa.eu/echo/civil_protection/civil/prote/112/112_en.htm (Accessed on December 06, 2011).
- Triple zero (000). Australian Government. http://www.triplezero.gov.au (Accessed on December 06, 2011).
- Moore B, Sapien R, Committee on Pediatric Emergency Medicine. The role of the pediatrician in rural emergency medical services for children. Pediatrics 2012; 130:978.
- Sasser S, Varghese M, Kellermann A, Lormand J. Prehospital trauma care systems. 2005. http://www.who.int/violence_injury_prevention/publications/services/39162_oms_new.pdf (Accessed on May 03, 2012).
- Husum H, Gilbert M, Wisborg T, et al. Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia. J Trauma 2003; 54:1188.
- Al-Shaqsi S. Models of International Emergency Medical Service (EMS) Systems. Oman Med J 2010; 25:320.
- MacFarlane C, van Loggerenberg C, Kloeck W. International EMS systems in South Africa--past, present, and future. Resuscitation 2005; 64:145.
- Symons P, Shuster M. International EMS Systems: Canada. Resuscitation 2004; 63:119.
- Black JJ, Davies GD. International EMS systems: United Kingdom. Resuscitation 2005; 64:21.
- Adnet F, Lapostolle F. International EMS systems: France. Resuscitation 2004; 63:7.
- Langhelle A, Lossius HM, Silfvast T, et al. International EMS Systems: the Nordic countries. Resuscitation 2004; 61:9.
- NHS Modernisation Agency, Department of Health. The Emergency Care Practitioner Report: Right Skill, Right Time, Right Place. Crown Copyright. COI Communications for the Department of Health 2004. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4093086 (Accessed on May 09, 2012).
- Kupas DF, Schenk E, Sholl JM, Kamin R. Characteristics of statewide protocols for emergency medical services in the United States. Prehosp Emerg Care 2015; 19:292.
- Model pediatric protocols. EMSC partnership for children. National Association of EMS Physicians, 2003. http://www.kdheks.gov/cphp/download/cacs_template/ModelPediatricProtocols.pdf (Accessed on April 24, 2012).
- Emergency Medical Services. Subspecialty Certification. American Board of Emergency Medicine http://www.abem.org/PUBLIC/portal/alias__rainbow/lang__en-US/tabID__4142/DesktopDefault.aspx (Accessed on May 10, 2012).
- Fleischmann T, Fulde G. Emergency medicine in modern Europe. Emerg Med Australas 2007; 19:300.
- http://www.ems.gov/education/EMSCoreContent.pdf (Accessed on September 20, 2016).
- United States Department of Transportation, National Highway and Traffic Safety Administration, National EMS Education and Practice Blueprint.
- United States Department of Transportation, National Highway and Traffic Safety Administration, National Standard Curriculum.
- EMS Education Agenda for the Future: A Systems Approach www.nhtsa.gov/people/injury/ems/FinalEducationAgenda.pdf (Accessed on May 08, 2012).
- Hoekstra JW, Banks JR, Martin DR, et al. Effect of first-responder automated defibrillation on time to therapeutic interventions during out-of-hospital cardiac arrest. The Multicenter High Dose Epinephrine Study Group. Ann Emerg Med 1993; 22:1247.
- American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons Committee on Trauma, et al. Equipment for ground ambulances. Prehosp Emerg Care 2014; 18:92.
- Argall JA, Wright N, Mackway-Jones K, Jackson R. A comparison of two commonly used methods of weight estimation. Arch Dis Child 2003; 88:789.
- Black K, Barnett P, Wolfe R, Young S. Are methods used to estimate weight in children accurate? Emerg Med (Fremantle) 2002; 14:160.
- Hofer CK, Ganter M, Tucci M, et al. How reliable is length-based determination of body weight and tracheal tube size in the paediatric age group? The Broselow tape reconsidered. Br J Anaesth 2002; 88:283.
- Gausche M, Seidel JS. Out-of-hospital care of pediatric patients. Pediatr Clin North Am 1999; 46:1305.
- Samuels MP. The effects of flight and altitude. Arch Dis Child 2004; 89:448.
- Sirbaugh PE, Pepe PE, Shook JE, et al. A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest. Ann Emerg Med 1999; 33:174.
- Cushman JT, Fairbanks RJ, O'Gara KG, et al. Ambulance personnel perceptions of near misses and adverse events in pediatric patients. Prehosp Emerg Care 2010; 14:477.
- Institute of Medicine. To Err is Human: Building A Safer Health System. Washington, DC: Institution of Medicine of the National Academies, 1999.
- Institute of Medicine. Future of Emergency Care Series, Emergency Care for Children: Growing pains. Washington, DC: Institution of Medicine of the National Academies, 2006.
- Institute of Medicine. Future of Emergency Care Series, Emergency Medical Services at the Crossroads. Washington, DC: Institution of Medicine of the National Academies, 2006.
- Guise JM, Meckler G, O'Brien K, et al. Patient Safety Perceptions in Pediatric Out-of-Hospital Emergency Care: Children's Safety Initiative. J Pediatr 2015; 167:1143.
- Lammers RL, Willoughby-Byrwa M, Fales WD. Errors and error-producing conditions during a simulated, prehospital, pediatric cardiopulmonary arrest. Simul Healthc 2014; 9:174.
- Orr RA, Felmet KA, Han Y, et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics 2009; 124:40.
- Edge WE, Kanter RK, Weigle CG, Walsh RF. Reduction of morbidity in interhospital transport by specialized pediatric staff. Crit Care Med 1994; 22:1186.
- Stroud MH, Trautman MS, Meyer K, et al. Pediatric and neonatal interfacility transport: results from a national consensus conference. Pediatrics 2013; 132:359.
- McPherson ML, Graf JM. Speed isn't everything in pediatric medical transport. Pediatrics 2009; 124:381.
- 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