Care Team Competencies Guide

Develop a robust pediatric competency program that ensures staff maintain the knowledge, skills, and abilities necessary to safely and effectively manage critically ill and/or injured children.

This flow diagram is designed to help one think about how to break down this focus area into small steps. The questions in this flow diagram align with the environmental scan worksheet in the next section. Consider the primary drivers of a pediatric competency program as you review the following process map:

1. Communication
2. Education
3. Policies & Procedures
4. Resources & Tools
5. Funding
6. Culture

Children account for only 10% of EMS calls and 20-25% of emergency department visits every year in the United States [1, 2]. This translates to less than 3 pediatric emergencies per month for EMS practitioners and less than 15 children per day in emergency departments, on average [3, 4]. Given that fewer than 5% of these children ultimately require tertiary care, the opportunity for EMS practitioners, nurses, physicians, and other healthcare professionals to reinforce pediatric competencies is limited[5].

In the absence of frequent practice and continuing education, critical pediatric skills and knowledge can be difficult to maintain. Most national accreditation programs require pediatric competencies be demonstrated upon initial training and CE requirements for maintenance of certification or licensure supports maintenance of pediatric competencies[4]. Pediatric advanced life support courses have been shown to immediately increase provider knowledge, yet in the absence of regular opportunities to apply the knowledge, competency returns to baseline levels within 6-12 months[4]. While nationally registered EMS practitioners report that CE is the main source of knowledge and skills in pediatrics, cost, availability, and travel distance are often barriers to obtaining pediatric CE. Furthermore, pediatrics may account for only a small component if CE required—depending on the specialty or certification. Similarly, skills maintenance or demonstration of competency is not consistently included in re-certification processes[4]. As an example most EMS practitioners report having fewer than 8 CE hours in pediatric topics over the preceding 2 years[3].

While most national training courses do a thorough job of teaching the cognitive aspect of pediatric competencies (the knowledge of what needs to be done in a given situation) as well as the skill (physically performing the task correctly). However, to be fully competent includes not only the knowledge and skill (how to physically perform the task) but also ability. Ability includes the behavioral aspects of a task such as a calm, confident, reassuring manner, employing family-centered care, and anticipating potential complications being able to minimize or prevent those risks.

The development of a robust pediatric competency program within an organization can help ensure that staff maintain critical knowledge, skills, and behaviors to meet the needs of children throughout their individual professional practice as a physician, nurse, EMS practitioner or other healthcare provider.

1. Gausche-Hill, M., et al., A National Assessment of Pediatric Readiness of Emergency Departments. JAMA Pediatrics, 2015. 169(6): p. 527-534.
2. Shah, M.N., et al., The Epidemiology of Emergency Medical Services Use by Children: An Analysis of the National Hospital Ambulatory Medical Care Survey. Prehospital Emergency Care, 2008. 12(3): p. 269-276.
3. Stevens, S.L. and J.L. Alexander, The impact of training and experience on EMS providers' feelings toward pediatric emergencies in a rural state. Pediatr Emerg Care, 2005. 21(1): p. 12-7.
4. Remick, K., S. Caffrey, and K. Adelgais, Prehospital Provider Scope of Practice and Implications for Pediatric Prehospital Care. Clinical Pediatric Emergency Medicine, 2014. 15(1): p. 9-17.
5. Cabalatungan, S.N., H.C. Thode, and A.J. Singer, Emergency medicine physicians infrequently perform pediatric critical procedures: a national perspective. Clinical and experimental emergency medicine, 2020. 7(1): p. 52-60.

See key drivers and change strategies below.