Policies, Procedures, & Protocols

Child Maltreatment, A Sample Policy for the Care of Children in the ED (includes information on how EMS providers can gather data to report to ED)

The PDTree is an evidence based guideline to suggest the type of pediatric hospital which can meet a child’s definitive needs. The PDTree defines four levels of pediatric care; designated trauma/burn centers, comprehensive pediatric facility (with pediatric ICU and surgical services), regional pediatric facility (with pediatric inpatient care or 24/7 pediatric specialists in the ED) and local pediatric ready facility.

Abstract: There are 12 million children in the United States with special health care needs. Improvements in medical technology, managed care, and changing social views about the institutionalization of children have all contributed to an increasing number of children with special health care needs (CSHCN) residing primarily in their home communities. Because of the dynamic and fragile nature of the medical conditions typically borne by CSHCN, the need for emergency care is not uncommon and prehospital providers are increasingly likely to encounter this population. Few states have initiated emergency medical services (EMS) protocols addressing field assessment, management, and stabilization of CSHCN and existing model protocols have not yet incorporated a distinct CSHCN component. With the support of grant funding from the federal Emergency Medical Services for Children (EMSC) program, a project was undertaken by investigators in the Center for Prehospital Pediatrics at Children's National Medical Center to develop prehospital protocols for CSHCN. This report details the protocol development process, discusses suggestions for their use, and presents the detailed protocols. The protocols are intended to serve as a resource template for the development and/or revision of jurisdiction-specific, customized practice guidelines.

Singh T, Wright JL, Adirim, TA. Prehosp Emerg Care. Jul-Sep 2003;7(3):336-51.

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ACEP Board-approved policy statements highlight the scope of issues being addressed in emergency medicine.

This group provides a few with pediatric-relevance.

NAEMSP Position Statement: Prehospital Emergency Care. DOI: 10.1080/10903127.2016.1229826. (Published online 06 Oct 2016.)

There is an ever-growing population of children with special health care needs ranging from children with pervasive developmental disorders to technology-dependent children. The prehospital provider, local emergency medical services agencies, and the state and federal entities involved in the prehospital care of children require focused programs to ensure safe and effective care and transport of these children. This article discusses the key factors involved in the prehospital care of these children including the use of registries to identify these patients in the community, the use of caregivers and emergency information forms as resources, and the existence of specialized training programs to educate prehospital providers about the special care needs of this population. Additional discussion includes the importance of medical homes for these children and special considerations regarding their transport. Finally, we will discuss the issues that arise in this community during a disaster and show how all the previously discussed aspects of care can be integrated into a comprehensive disaster plan.

Kaziny, BD. Clinical Pediatric Emergency Medicine. Volume 15, Issue 1, March 2014, Pages 89-95.

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Example protocols and guidelines. Evidence-based included/noted when available.

Review guide for those studying for board certification exam and participating in EMS fellowship education.

A few topics relevant to the pediatric population and the PPRP Checklist includes: The Special Needs of Children (page 103); Pediatric Medical Priorities (page 105); Pediatric Trauma Priorities (page 107); Technology Dependent Children (page 108); Child Maltreatment (page 121); Ethical Challenges, Treatment of Minors (page 123); Families & Bystanders (page 128); Culture of Patient Safety (page 132); Medical Oversigh of EMS Systems (page 164); EMS-Public Health Interface (page 182).

Background: Prehospital care providers are in a unique position to provide initial unadulterated information about the scene where a child is abusively injured or neglected. However, they receive minimal training with respect to detection of Child Abuse and Neglect (CAN) and make few reports of suspected CAN to child protective services.

Gunjan Kamdar Tiyyagura, Marcie Gawel, Aimee Alphonso, Jeannette Koziel, Kyle Bilodeau & Kirsten Bechtel (2017) Barriers and Facilitators to Recognition and Reporting of Child Abuse by Prehospital Providers, Prehospital Emergency Care, 21:1, 46-53.

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