RT Book, Section A1 Shah, Manish I. A2 Schafermeyer, Robert A2 Tenenbein, Milton A2 Macias, Charles G. A2 Sharieff, Ghazala Q. A2 Yamamoto, Loren G. SR Print(0) ID 1105688357 T1 Prehospital Care T2 Strange and Schafermeyer's Pediatric Emergency Medicine, 4e YR 2014 FD 2014 PB McGraw-Hill Education PP New York, NY SN 978-0-07-182926-7 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1105688357 RD 2024/03/28 AB Children account for approximately 10% of the total patients treated by prehospital providers, thus, limiting reinforcement of pediatric assessment and life-saving skills.There are two levels of response in the prehospital setting: Basic life support is provided by emergency medical responders (EMRs) and emergency medical technicians (EMTs); advanced emergency medical technicians (AEMTs) and paramedics provide advanced life support care.Rural EMS providers face many challenges when caring for children as they have longer transport times and care for fewer children in general (limiting pediatric-specific skills retention).Prehospital protocols are approved by agency medical directors and are limited in development by a paucity of pertinent prehospital literature. With implementation, they 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 concurrent clinical direction provided to field personnel by a medical director or his/her delegate.Regionalization is the geographical organization of services to ensure access to care (including transport) at a level appropriate to patient needs while maintaining efficient use of available resources and the avoidance of duplicative ED visits. For certain conditions (e.g., trauma, burns, stroke, pediatric critical care), it has been shown to improve outcomes.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, Do Not Resuscitate (DNR) orders must be present in written form, acknowledged verbally by the family as still in effect, link to correct identification of the child as the recipient of the DNR order, and occur in a state that includes children in DNR laws.