The Pediatric Emergency Care Coordinator Guide

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The concept of a pediatric emergency care coordinator (PECC) has been around for some time. In 1983, Los Angeles’ Emergency Departments Approved for Pediatrics (EDAP) program has required that emergency departments (EDs) have a pediatric liaison nurse (PdLN) on staff.

However, increased focus on the importance of the role is commonly attributed to the 2006 Institute of Medicine’s (IOM, now the National Academy of Medicine) report: Emergency Care for Children: Growing Pains. Noting significant inadequacies in the nation’s emergency care system’s capacity to manage ill or injured children, this report called for both hospitals and EMS systems to identify qualified coordinators of pediatric emergency care. In line with the Growing Pains report, the Health Resources and Services Administration (HRSA) Emergency Medical Services for Children (EMSC) Program has established a Performance Measure that by 2026, 90% of all EMS agencies will have a PECC.

It is increasingly being demonstrated that the presence of a PECC within an EMS agency, ED, or hospital is one of—if not the—strongest driver of improved quality of emergency care for children. The results of both the 2003 and 2013 National Pediatric Readiness Assessments indicate that the presence of a PECC is strongly correlated with enhanced pediatric readiness, independent of other factors. Correspondingly, a higher level of pediatric readiness in EDs has been shown to be associated with decreased morbidity and mortality in critically ill and injured children, regardless of trauma designation. It is expected that EMS agencies who have a PECC would show similar improvements.

The purpose of a PECC is to ensure that children receive the same quality of emergency care as their adult counterparts. While EMS, ED, or hospital leadership’s commitment to the appointment of one dedicated individual to this role is likely to have a greater, long-standing impact, the PECC role need not be filled as a full-time position by one individual. The simple acknowledgment that the position holds value and identifying one or multiple people to act as a pediatric champion within the EMS agency, ED or hospital is a powerful initial step.

The role can be within a single EMS agency, ED or hospital or a single individual may be shared across multiple agencies, a hospital network, or region. Depending on the pediatric volume of the EMS agency, ED, or hospital, this person may take on the PECC duties in addition to other responsibilities (e.g., educator, trauma coordinator, etc.). Similarly, more than one individual may work collaboratively to ensure pediatric needs are well integrated into the system of care. Individuals interested in serving as a PECC within an EMS agency, ED or hospital may have relatively little guidance on the roles, responsibilities, and skill set to be effective.

See key drivers and change strategies below.

Note: Focus Area 6 will specifically focus on communication and collaboration across systems of care. This driver and set of change strategies is specifically focused on advocating for the establishment or formalization of the PECC role.

Crosscutting Change Strategies

1.1. Identify an individual with expertise and/or interest in pediatrics to serve as the PECC.

1.2. Perform a stakeholder analysis of your EMS agency, ED, or hospital. Who are the relevant people that you will need support from and keep informed for the PECC to work effectively?

1.3. Survey staff (formally or informally) on their level of comfort in caring for pediatric patients of various triage levels. This can be done with a specific emphasis on certain skills (e.g., intubation) or through discussing recent experiences. Communicate findings back to staff and to relevant stakeholders to make the case for enhanced focus on pediatric skills training.

1.4. Raise awareness of the importance of high-quality pediatric emergency care using data.

  • Estimate your annual pediatric volume. What percentage of total runs/visits does this account for? How does this compare to the number of children in your catchment area?
  • How many pediatric cases result in a safety issue or near miss (more on this in Focus Area #2).
  • Obtain your organization’s score on the 2021 National EMSC Survey (prehospital) or the 2021 National Pediatric Readiness Assessment (hospital) to determine how your agency/hospital compares to national and local averages.

Crosscutting Change Strategies

2.1. Pursue additional education in pediatric emergency care. (Note: Focus Area #5 is entirely devoted to pediatric competency training and testing).

  • Prehospital: Pediatric Advanced Life Support (PALS), Advanced Pediatric Life Support (APLS), NAEMT- Emergency Pediatric Care (EPC), AAP-Pediatric Education for Prehospital Providers (PEPP), AHA-Pediatric Emergency Assessment, Recognition and Stabilization (PEARS®), Neonatal Resuscitation Program (NRP).
  • Hospital: Pediatric Advanced Life Support (PALS), Advanced Pediatric Life Support (APLS), Emergency Nurse Pediatric Course (ENPC), Emergency Nurse certification (CPEN, CEN), Trauma Nursing Core Course (TNCC), other nurse certification (CCRN, CPN).

2.2. Develop a system to ensure the PECC can adequately fulfill duties/expectations and identify challenges that may hinder successfully achieving duties.

EMSC State Partnership Programs

2.3. Regularly communicate pediatric training opportunities to both prehospital- and hospital-based PECCs in your state/territory.

2.4. Provide resources that will support the varied roles of the job.

2.5. Work with the EMSC Advisory Committee to create a generic job description for EMS agency and hospital PECCs.

Crosscutting Change Strategies

3.1. Create a job description based on the key responsibilities of the PECC detailed in “Pediatric Readiness in Emergency Medical Services Systems”, “Pediatric Readiness in the Emergency Department”, as well as the EMSC Performance Measures Implementation Manual for State Partnership Grantees.

Children’s Hospitals

3.2. Develop a roles and responsibilities list for a children’s hospital PECC; consider including:

  • Create a system to communicate and develop an educational forum with community hospitals.
  • Work with local education experts on how to translate content to community settings.
  • Education toolbox that can be vetted at the children’s hospital and then disseminated to the community.

Crosscutting Change Strategies

4.1. Identify dedicated hours per week needed for the PECC to work effectively (average or approximate).

4.2. Develop a budget justification to advocate for funding to be spent on materials that support the PECC role (e.g., training materials, equipment, supplies, medications, software, etc.).

4.3. Identify agency or institutional stakeholders that will support the work of the PECC in working within the region.

4.4. Champion outreach activities, such as leveraging current departments/systems, to “sponsor” a PECC as a champion or liaison within the region.

EMSC State Partnership Programs

4.5. Create onboarding materials to support new PECCs.

4.6. Compile and provide resources that will support the varied roles of the job.