Assessing Infrastructure to Care for Pediatric Patients in the Prehospital Setting
Michael Ely1, Elizabeth A Edgerton2, Russell Telford3
1From the National Emergency Medical Services for Children Data Analysis Resource Center, Department of Pediatrics, University of Utah and University of Utah School of Medicine, Salt Lake City, UT.
Insights
Emergency medical services (EMS) agencies show improved pediatric care capacity, yet gaps persist, especially for basic life support and rural areas. Continuous infrastructure focus is vital for enhancing pediatric emergency treatment.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Healthcare Systems
Background:
- Pediatric patients constitute a small fraction of emergency medical services (EMS) calls, posing challenges for provider skill maintenance.
- Adequate structural capacity for diagnosing and treating pediatric patients is critical within EMS.
- Assessing the availability of medical direction and essential pediatric equipment in EMS agencies is crucial for quality care.
Purpose of the Study:
- To measure the availability of off-line and on-line medical direction for pediatric care.
- To assess the availability of recommended pediatric equipment in EMS agencies.
- To identify disparities in resources based on agency type (BLS/ALS) and location (urban/rural/frontier).
Main Methods:
- A web-based survey was administered to EMS agencies across 32 states in 2010 and 2013.
- Data analysis focused on the availability of medical direction (off-line and on-line) and recommended pediatric equipment.
- Response rates exceeded 80%, with approximately 5000 agencies participating.
Main Results:
- Availability of off-line medical direction increased from 78% (2010) to 85% (2013), with higher rates in ALS and urban agencies.
- On-line medical direction remained consistently high (90%), showing slight increases for BLS and urban/rural agencies.
- While most agencies carried some pediatric equipment, less than one-third had all recommended items; agencies with medical direction were more likely to carry all equipment.
Conclusions:
- EMS agencies demonstrate a developing structural capacity for pediatric emergency care, with documented improvements over time.
- Significant gaps in resources and preparedness remain, particularly for Basic Life Support (BLS) and non-urban agencies.
- Sustained attention to infrastructure and the implementation of national performance measures are essential for advancing pediatric emergency care quality.
Objectives:
Pediatric patients represent a small proportion of emergency medical services (EMS) calls, challenging providers in maintaining skills in treating children. Having structural capacity to appropriately diagnose and treat pediatric patients is critical. Our study measured the availability of off-line and on-line medical direction and recommended pediatric equipment at EMS agencies.
Methods:
A Web-based survey was sent to EMS agencies in 2010 and 2013, and results were analyzed to determine availability of medical direction and equipment.
Results:
Approximately 5000 agencies in 32 states responded, representing over 80% response. Availability of off-line medical direction increased between years (78% in 2010 to 85% in 2013), was lower for basic life support (BLS) (63% and 72%) than advanced life support (ALS) agencies (90% and 93%), and was generally higher in urban than rural or frontier locations. On-line medical direction was consistently available (90% both years) with slight increases for BLS agencies (87% to 90%) and slightly greater availability for urban and rural compared with frontier agencies. The majority of agencies carried most recommended equipment; however, less than one third of agencies reported carrying all equipment. Agencies with off-line medical direction, on-line medical direction, and with both off-line and on-line medical direction were respectively 1.69, 1.31, and 2.21 times more likely to report carrying all recommended equipment.
Conclusions:
Basic structural capacity exists in EMS for treating children, with improvements seen over time. However, gaps remain, particularly for BLS and nonurban agencies. Continuous attention to infrastructure is necessary, and the recent development of national performance measures should further promote quality emergency care for all children.
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