A new national study shows that while many emergency medical services (EMS) agencies across the United States are well-equipped to care for children, important gaps remain in training, quality improvement, and coordination of care before young patients reach the hospital.
The study, published this week in Annals of Emergency Medicine, is part of the National Prehospital Pediatric Readiness Project (PPRP), a nationwide effort to improve emergency care for children in ambulances and other out-of-hospital settings.
“There has never been a survey as comprehensive as this and that’s why we feel it is so impactful,” said the study’s lead author Kathleen Adelgais, MD, MPH, professor of pediatrics and emergency medicine at the University of Colorado Anschutz. She is also co-lead of the PPRP Steering Committee and an EMS and emergency physician at Children’s Hospital Colorado.
One major finding, noted Adelgais, was that agencies with a pediatric emergency care coordinator or PECC had higher levels of readiness per the national guidelines as compared to those agencies without a PECC even among low-resources and low-volume EMS agencies. One area targeted for improvement is to increase the number of agencies that have a PECC as, nationally, only 38% of agencies reported having one.
Overall, children make up a small percentage of EMS calls.
“But when emergencies happen, readiness makes all the difference,” Adelgais said.
What the Study Looked At
Researchers surveyed 911-response EMS agencies across all 50 states and several U.S. territories. Nearly 7,000 agencies responded — about 46% of those invited — making this the first comprehensive national assessment of how prepared EMS systems are to care for children.
Agencies completed a detailed online survey covering eight key areas of pediatric readiness, including:
- Staff education and training
- Equipment and supplies
- Patient and medication safety
- Family-centered care
- Policies and protocols
- Quality improvement efforts
- Coordination with hospitals and public health systems
- Designated pediatric leadership
Each agency received a Pediatric Readiness Score on a 0–100 scale.
Key Findings
- The median Pediatric Readiness Score was 65.5 out of 100, suggesting moderate readiness overall.
- Agencies performed best in:
- Having the right pediatric equipment and supplies
- Established safety policies
- Clear procedures and protocols
- Agencies scored lowest in:
- Quality improvement and performance tracking
- Coordination with broader health systems
- Family-centered care
Three of four EMS agencies reported seeing fewer than eight pediatric patients per month, making it harder to maintain skills and systems focused on children.
The Impact of Pediatric Leadership
Agencies with a pediatric emergency care coordinator — a designated person responsible for improving pediatric care — consistently scored higher across all areas.
Only 38% of agencies reported having someone in this role.
Agencies with a pediatric coordinator were:
- Five times more likely to achieve top scores in quality improvement
- More than five times more likely to excel in coordination with health systems
- Significantly stronger in family-centered care
This suggests that having a dedicated pediatric leader within an EMS agency can make a measurable difference.
Why This Matters
Children have different medical needs than adults. They require specialized equipment, medication dosing, communication approaches, and coordination with families and hospitals.
While emergency departments have improved pediatric readiness over the past decade, this study shows that the out-of-hospital setting — where many emergencies begin — needs strengthening.
Stronger pediatric readiness, the study said, may lead to safer care, fewer medication errors, better disaster preparedness and better outcomes for sick and injured children.
What’s Next
Future efforts will focus on:
- Expanding the pediatric emergency care coordinator role
- Improving pediatric quality measurement and performance tracking
- Strengthening disaster preparedness for children
- Increasing family-centered policies
- Studying how readiness scores relate to patient outcomes
The study marks the first phase of a national effort to raise the standard of emergency care for children before they arrive at the hospital.
