Policy/Position Statements

Abstract: In continued support of establishing and maintaining a foundation for standards of care, our organizations remain committed to periodic review and revision of this position statement. This latest revision was created based on a structured review of the National Model EMS Clinical Guidelines Version 2.2 in order to identify the equipment items necessary to deliver the care defined by those guidelines. In addition, in order to ensure congruity with national definitions of provider scope of practice, the list is differentiated into BLS and ALS levels of service utilizing the National Scope of Practice-defined levels of EMR and EMT as BLS, and AEMT and Paramedic as ALS. Equipment items listed within each category were cross-checked against recommended scopes of practice for each level in order to ensure they were appropriately dichotomized to BLS or ALS levels of care. Some items may be considered optional at the local level as determined by agency-defined scope of practice and applicable clinical guidelines. In addition to the items included in this position statement our organizations agree that all EMS service programs should carry equipment and supplies in quantities as determined by the medical director and appropriate to the agency’s level of care and available certified EMS personnel and as established in the agency’s approved protocols.

There are many roles for medical directors in the EMS arena. Most commonly, EMS system medical directors have an operational role overseeing the medical care delivered by an EMS agency. Another important role is EMS education program medical direction, by which the medical directors oversee the clinical and educational aspects of initial EMS clinician education.

Parental consent generally is required for the medical evaluation and treatment of minor children. However, children and adolescents might require evaluation of and treatment for emergency medical conditions in situations in which a parent or legal guardian is not available to provide consent or conditions under which an adolescent patient might possess the legal authority to provide consent. In general, a medical screening examination and any medical care necessary and likely to prevent imminent and significant harm to the pediatric patient with an emergency medical condition should not be withheld or delayed because of problems obtaining consent. The purpose of this policy statement is to provide guidance in those situations in which parental consent is not readily available, in which parental consent is not necessary, or in which parental refusal of consent places a child at risk of significant harm.

NAEMSP position statement affirming that pediatric patients have unique needs that every EMS program must ensure are appropriately and reasonably met. NAEMSP believes that if the EMS medical director does not inherently possess knowledge and experience in pediatric-related EMS healthcare needs, they should engage with stakeholders that can provide EMS-appropriate guidance related to pediatric EMS healthcare needs. An EMS Pediatric Emergency Care Coordinator or an EMS System Pediatric Advisory Committee can augment and advise the EMS medical director(s) for the system or for individual EMS programs.

Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children. In this policy statement, ACEP, the AAP, and the ENA recommend methods to Improve Entry Into the Emergency Care System, Pediatric Prehospital Care, and Emergency Department Care for Children and Adolescents.

This multiorganizational literature review was undertaken to provide an evidence base for determining whether recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic cardiopulmonary arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care because the evidence suggests that either death or a poor outcome is inevitable.

The National Association of EMS Physicians and the then National Association of State EMS Directors (now National Association of State EMS Officials) created a position statement on emergency medical vehicle use of lights and siren in 1994. This document updates and replaces this previous statement and is now a joint position statement.

Resource availability and pediatric readiness across EMS agencies are variable. Providing high-quality EMS care to children requires an infrastructure designed to support the care of pediatric patients and their families. Therefore, it is important that EMS physicians, administrators, and EMS personnel collaborate with pediatric acute care experts to optimize EMS care through the development of care models to minimize morbidity and mortality in children as a result of illness and injuries.