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  • Children account for approximately 10% of the total patients treated by prehospital providers, thus making it difficult for prehospital providers to maintain and reinforce life-saving pediatric assessment and management skills.

  • Prehospital care consists of either basic or advanced life support. Basic life support (BLS) is provided by emergency medical responders (EMRs) and emergency medical technicians (EMTs), while advanced emergency medical technicians (AEMTs) and paramedics provide advanced life support (ALS) care.

  • Rural emergency medical service (EMS) providers face many challenges when caring for children. They have longer transport times and care for fewer children in general, limiting pediatric-specific skills retention.

  • Prehospital protocols are developed and approved by EMS medical directors, are limited by a paucity of prehospital literature, and should be linked to provider education, performance metrics, and quality improvement strategies.

  • Standardized ambulance equipment checklists addressing the specific needs of children have been derived under a collaborative effort of multiple stakeholder organizations.

  • Offline, or indirect, medical oversight involves the development, implementation, monitoring, and iterative improvement of medical policies and protocols used by field personnel. Online, or direct, medical oversight is the provision of real-time medical direction to field personnel by a medical director or his/her delegate.

  • Regionalization is the geographical organization of services, including transport, to ensure access to care at a level appropriate to patient needs while maintaining efficient use of available resources and avoiding redundant emergency department (ED) care. It has improved outcomes for certain conditions (e.g., trauma, burns, stroke, and pediatric critical care).

  • Emergency care without parental consent can be provided regardless of age. Although minors cannot refuse treatment and transport in an emergency situation, if a legal guardian is present, he/she can make an informed decision to refuse transport; refusal of EMS care for children occurs in about 5% of all EMS runs.

  • For EMS providers interacting with children with end-of-life issues, signed Do Not Resuscitate (DNR) orders must be present in written form, acknowledged verbally by the family as still active, identified as belonging to the patient, and must occur in a state that includes children in DNR laws.



The importance of prehospital care became evident after the Korean and Vietnam wars demonstrated that mortality decreased when patients were stabilized in the field and transported expediently to a well-equipped emergency facility.1 EMS systems were formally established in the United States in 1966 when the National Highway Traffic Safety Act mandated that states develop EMS systems. Direct funding for these systems became available when Congress passed the Emergency Medical Services Act in 1973.2 With its origins in the military and its civilian focus on cardiac and trauma care, the nation’s EMS systems were slow to consider the needs of children. In 1984, the federal government recognized this need by approving legislation for the creation of the EMS for Children (EMSC) program ...

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