Strengthening the Safety Net: Insights from the First National Assessment of EMS Pediatric Readiness

Introduction and Context

When a child faces a life-threatening emergency, the first few minutes of care provided by Emergency Medical Services (EMS) are often the most critical. However, for decades, pediatric care has been viewed as a ‘low-frequency, high-stakes’ challenge for prehospital providers. Children account for only about 10% of EMS calls, making it difficult for many agencies to maintain specialized skills, equipment, and protocols. To address this, the National Pediatric Prehospital Readiness Project (PPRP) was established, aiming to ensure that every EMS agency in the United States is prepared to provide high-quality care to pediatric patients.

This landmark study, ‘The National Pediatric Prehospital Readiness Project: First Comprehensive Assessment of United States Emergency Medical Services Agencies,’ represents the first-ever national ‘report card’ on how ready our EMS systems truly are. The assessment matters now because, despite advances in pediatric emergency medicine, significant variability exists in how agencies across different states and jurisdictions manage pediatric emergencies. By identifying these gaps, the PPRP provides a roadmap for policy changes, resource allocation, and clinical training that can directly save young lives.

New Assessment Highlights

The PPRP assessment evaluated over 6,900 EMS agencies across the U.S. using a weighted scoring system (0-100) based on established national guidelines. The results provide a nuanced view of the current landscape of prehospital pediatric care. Key findings include:

• Median Readiness Score: The national median score was 65.5 out of 100, indicating a moderate level of readiness but highlighting substantial room for improvement.
• The ‘PECC’ Effect: Agencies with a designated Pediatric Emergency Care Coordinator (PECC)—a person responsible for overseeing pediatric-specific training and equipment—scored significantly higher across all domains.
• Resource Gaps: While equipment and safety scores were generally high, areas such as family-centered care and quality improvement programs lagged significantly.
• Response Rate: With a 46% response rate from over 15,000 agencies, the study provides a statistically robust foundation for future healthcare policy.

Updated Recommendations and Key Changes

This assessment serves as a baseline for a new era of EMS standards. Unlike previous localized surveys, this national assessment shifts the focus from simple equipment checklists to a holistic view of ‘system readiness.’

| Domain | Score Performance | Focus of Recommendations |
| :— | :— | :— |
| **Equipment** | High (Median 12/12) | Ensure all sizes (neonatal to adolescent) are available and weight-based dosing tools are utilized. |
| **Pediatric Coordination** | Variable | Every agency must appoint a PECC (nurse, paramedic, or physician). |
| **Quality Improvement** | Low (Median 5.7/12) | Implementation of pediatric-specific metrics in regular peer reviews and clinical audits. |
| **Family-Centered Care** | Low (Median 5.8/10) | Protocols for allowing family presence during resuscitation and better communication strategies. |
| **Policies** | High (Median 11.5/13) | Standardization of pediatric-specific treatment protocols across regional systems. |

Evidence driving these updates stems from the realization that clinical excellence is not just about having the right tools, but about the ‘readiness culture’—the training, the leadership, and the systematic review of pediatric cases that many agencies currently lack.

Topic-by-Topic Recommendations

1. The Role of the Pediatric Emergency Care Coordinator (PECC)

Expert consensus strongly recommends that every EMS agency, regardless of size or volume, designate a PECC. The PECC is not necessarily a new hire; they can be an existing staff member who takes on the responsibility of ensuring the agency meets pediatric standards. Their duties include:

• Ensuring all personnel are trained in pediatric skills (e.g., airway management, IO access).
• Overseeing the availability of pediatric-specific medications and equipment.
• Advocating for the inclusion of pediatric needs in agency-wide policies.

2. Education and Skill Maintenance

Because pediatric calls are rare, ‘skill decay’ is a major risk. The PPRP recommends frequent, low-dose, high-frequency training rather than a single annual session. This includes simulation-based training for high-stress scenarios like pediatric cardiac arrest or severe respiratory distress.

3. Quality Improvement (QI) and Patient Safety

Agencies must move beyond general QI and implement pediatric-specific indicators. This involves tracking outcomes for pediatric patients and reviewing every pediatric ‘high-acuity’ call. Recommendation Grade: Strong. Experts emphasize that you cannot improve what you do not measure.

4. Family-Centered Care (FCC)

One of the lowest-scoring domains, FCC involves treating the family as part of the care unit. Guidelines suggest:

• Allowing parents to remain with the child during transport and resuscitation when safe.
• Using clear, non-jargon language to explain procedures to guardians.
• Implementing culturally and linguistically appropriate services.

Expert Commentary and Insights

Members of the PPRP steering committee have expressed that the median score of 65.5 is a ‘call to action.’ Dr. Kathleen Adelgais, the lead author, noted that the presence of a PECC was the single most influential factor in an agency’s readiness. ‘A PECC is the ‘champion’ who ensures that the specific needs of children are never an afterthought,’ she stated during the report’s release.

One area of controversy remains the ‘volunteer’ vs. ‘career’ agency gap. Rural volunteer agencies often face significant funding hurdles in achieving high readiness scores. Experts argue that regionalized ‘hub-and-spoke’ models—where a larger hospital or EMS system provides PECC support to smaller neighboring agencies—could bridge this gap. Future research will focus on linking these readiness scores directly to patient outcomes, such as survival rates and neurological recovery after pediatric emergencies.

Practical Implications

For the average EMS clinician, these findings mean that pediatric readiness is no longer just a ‘good idea’—it is becoming the national standard. To apply these recommendations:

1. **Identify your PECC:** If your agency doesn’t have one, advocate for the role. It is the most effective way to raise your agency’s readiness score.
2. **Check your Equipment:** Ensure that weight-based dosing systems (like the Broselow tape or Handtevy system) are not just present, but that every provider is proficient in using them under pressure.
3. **Engage with Families:** Recognize that managing a pediatric patient also involves managing the family’s anxiety, which can improve the overall safety and efficacy of the intervention.

In a hypothetical scenario, consider ‘Alex,’ a 4-year-old in anaphylactic shock. An EMS agency with a high readiness score would have a PECC who ensured the paramedics practiced pediatric IM epinephrine dosing recently, used a weight-based tape to immediately confirm the dose, and had a policy allowing Alex’s mother to sit in the front of the ambulance to keep the child calm. This integrated approach, validated by the PPRP, transforms pediatric care from a chaotic event into a streamlined, high-quality clinical process.

References

1. Adelgais KM, Remick KE, Hewes HA, et al. The National Pediatric Prehospital Readiness Project: First Comprehensive Assessment of United States Emergency Medical Services Agencies. *Annals of Emergency Medicine*. 2026;87(2):145-158.
2. American Academy of Pediatrics, American College of Emergency Physicians, Emergency Nurses Association. Joint Policy Statement: Pediatric Readiness in the Emergency Department. *Pediatrics*. 2018;142(5):e20182459.
3. Remick K, Gausche-Hill M, et al. Pediatric Readiness in the Prehospital Setting: An Educational Toolkit. *National Prehospital Pediatric Readiness Project*. 2021.
4. Gausche-Hill M, Ely M, Schmuhl P, et al. A National Assessment of Pediatric Readiness of Emergency Departments. *JAMA Pediatrics*. 2015;169(6):527-534.