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The evolution and current status of emergency medical services for children
1Johns Hopkins University Hospital, Baltimore, MD 21205, USA. amancalled@mindspring.com
Insights
Comprehensive pediatric emergency care, including trauma and illness, requires regional organization. This system evolved from adult trauma care, emphasizing specialized components for children
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care Systems
- Public Health Policy
Background:
- Emergency medical systems (EMS) initially focused on adult trauma care.
- The need for comprehensive pediatric emergency care became evident in the 1970s.
- Children require specialized emergency medical services tailored to their unique needs.
Purpose of the Study:
- To outline the essential components of a comprehensive regional emergency medical system for children.
- To advocate for the integration of pediatric emergency care into existing medical infrastructures.
- To improve the management of life-threatening injuries and illnesses in pediatric populations.
Main Methods:
- Review of the evolution of EMS from adult trauma care to pediatric-focused systems.
- Identification of key components for a pediatric emergency medical system.
- Emphasis on the collaborative role of pediatric surgeons, general surgeons, and emergency physicians.
Main Results:
- Regional organization of pediatric emergency care enhances management of life-threatening conditions.
- Successful pediatric trauma programs are often integrated within broader EMS.
- Essential components include communication, specialized transport, training, designated trauma centers, pediatric intensive care units, neuro/neurosurgery units, and rehabilitation services.
Conclusions:
- A comprehensive, inclusive regional emergency medical system for children is crucial for managing all life-threatening conditions, including trauma and serious illness.
- The development of such systems requires leadership from various surgical and medical specialists.
- Integration and regional organization ensure the highest quality of care for critically ill and injured children.
Abstract:
Emergency physicians have come to believe that comprehensive pediatric emergency care should be integrated into an overall medical system and organized regionally to address the special needs of children. Since our emergency medical systems have evolved in the care of adult trauma victims, we must look to that development for the origin of our present emergency medical services for children. Not until the 1970s did it became obvious that children, just as adults, should be included in an comprehensive emergency medical system for the care of their life threatening injuries. Since there is considerable overlap in the basic principles of trauma resuscitation and management of shock in children and adults, most children's regional trauma program developed as a part of an overall emergency medical system. The sharing of trauma facilities made it possible to utilize the special expertise of a very small number of pediatric surgeons who had trauma experience and to incorporate their skills into the broader concept of comprehensive regional trauma centers for children and adults. With further experience we soon realized that such emergency medical services for children's systems should include the following components: A two way communication system, a transport system with special equipment for the management of small children, a training program for first responders at the trauma site, a designated pediatric trauma center, a pediatric intensive care unit at the regional trauma center, a neurology/neurosurgery intermediate care unit at the regional center, a pediatric trauma rehabilitation unit and finally a pediatric trauma longterm rehabilitation and management unit for those with residual disabilities. With the further development of this concept of trauma units for children, pediatric surgeons, general surgeons involved in trauma care and pediatric emergency physicians have offered leadership to expand the emergency medical system for children to include life-threatening illness, as well as injuries. Thus, the organization of regional emergency medical services for children permits the highest quality management of children with life-threatening injuries and illness. This then is the final product: an inclusive, comprehensive emergency medical system for children for all life threatening conditions, both trauma and serious illness.