About the PECCLC
Emergency medical service (EMS) responses for pediatric patients represent thirteen percent of total EMS responses in the United States, but because call volume is highly variable, nearly 40% of all EMS agencies in the United States see fewer than thirteen pediatric patients per year on average.(1,2) The pediatric training requirements for EMS provider licensure and re-licensure vary, from 4-9 hours for emergency medical technicians (EMTs) and 7-34 hours for paramedics, often combining pediatrics into a ‘special populations’ domain (e.g., geriatrics, obstetrics, etc.).(3) The infrequency of seeing pediatric patients in the field means that pediatric care training does not become ‘hard-wired’ into EMS providers’ ‘muscle memory’. Because many EMS agencies have such a limited chance to exercise their pediatric skills in real-life settings, the responding EMS providers don’t feel confident in providing appropriate care.(4) In addition, educational opportunities and even best-practice guidelines are very limited in the prehospital setting, further exacerbating the quality of care gap between high- and low-resource settings.
In 2007, the Institute of Medicine (IOM) released Emergency Care for Children: Growing Pains which specifically recommends that EMS agencies designate a pediatric emergency coordinator to ensure that training and guidelines are available to field providers to maintain competence in the emergent care of children.(5) This role is now commonly referred to as a pediatric emergency care coordinator (PECC). The IOM report suggests the individual(s) filling this role would serve as a resource to oversee any pediatric care quality improvement initiatives in the agency; provide skills based training to agency staff; and assuring that all medications, equipment and supplies needed for a child are stocked and available in all responding vehicles. Potential benefits of having a PECC described in the report are:
- Identifying gaps and ensuring that resources to care for children are available
- Maintaining a relationship with the state EMS for Children infrastructure
- Working with state and local authorities and regional coalitions to develop strategies for addressing pediatric needs in the event of a disaster
- Establishing and maintaining offline and online pediatric EMS protocols
- Establishing quality improvement plans with pediatric-specific indicators
- Coordinating with dispatch to provide evidence–based, pre-arrival instructions for children and/or caretakers
- Reviewing on a regular basis the medications and devices available for prehospital care of children
- Liaising with hospitals to improve pediatric readiness of emergency departments
- Assisting in education and training of EMS providers in the care of children and principles of family centered care.(6)
In the resource document, Coordination of Pediatric Emergency Care in EMS Systems, Remick et al. point out that emergency departments that have a nurse or physician PECC have a higher rate of compliance with national guidelines for the care of children than those that do not.(7) It is expected that EMS agencies who have a PECC would have similar results. In addition to these findings, and acting on the recommendations from the IOM report, the Health Resources and Services Administration’s (HRSA) Emergency Medical Services for Children (EMSC) program has set as a performance measure for the EMSC State Partnership Program that 90% of all EMS agencies have a PECC by 2026. This collaborative is designed to assist all selected participants in achieving this goal.
References
- Shah MN, Cushman JT, Davis CO, Bazarian JJ, Auinger P, Friedman B. The epidemiology of emergency medical services use by children: an analysis of the National Hospital Ambulatory Medical Care Survey. Prehosp Emerg Care. 2008;12(3):269-76.
- EMSC Innovation and Improvement Center (EIIC). NEDARC Data Collection Results for Performance Measures 02 and 03. EMSC Meeting Austin, Texas 2018. Available at: https://emscimprovement.center/categories/measurement/. Accessed 8.30.2018.
- Ngo TL, Belli K, Shah M. EMSC Program Manager Survey on Education of Prehospital Providers. Prehospital Emergency Care. 2014; 18(3):424-8.
- Cushman JT, Fairbanks RJ, O’Gara KG, et al. Ambulance personnel perceptions of near misses and adverse events in pediatric patients. Prehospital Emergency Care. 2010;14(4):477-484.
- Institute of Medicine. 2007. Emergency Care for Children: Growing Pains. Washington, DC: The National Academies Press. https://doi.org/10.17226/11655.
- Gausche-Hill M, Ely M, Schmuhl P, et al. A national assessment of pediatric readiness of emergency departments. JAMA Pediatr. 2015; 169(6):527-534.
- Remick K, Gross T, Adelgais K, Shah MI, Leonard JC, Gausche-Hill M. Resource document: Coordination of pediatric emergency care in EMS systems. Prehosp Emerg Care. 2017; 21(3):399-407.
