Pediatric Protocols and Guidelines Resources

Clinical care algorithm co-created by EIIC and TREKK on identifying and caring for the agitated pediatric patient in the emergency department.

The purpose of this document is to provide healthcare professionals with key facts and recommendations for treating pain in children. This summary was co-produced by the pain content advisors for TREKK, Dr. Samina Ali of the Stollery Children’s Hospital, Dr. Naveen Poonai of the London Health Sciences Centre (LHSC): Children’s Hospital, Dr. Amy Drendel of the Medical College of Wisconsin, and content advisor for EIIC Dr. Corrie Chumpitazi of Baylor College of Medicine and uses the best available knowledge, at the time of publication.

June 2023

These guidelines are intended to facilitate the creation of state and local EMS system clinical guidelines, protocols, or operating procedures. System medical directors and other leaders are invited to harvest content as will be useful. These guidelines are either evidence-based or consensus-based and have been formatted for use by field EMS professionals.

Pediatric information is integrated throughout the document.

Pediatric-specific guidelines start on page 144 (BRUE, Bronchiolitis, Croup, Neonatal Reususcitation, Childbirth).

Additional pediatric-specific information includes: Pediatric Vitals/GCS (page 16); Pediatric Glasgow Coma Scale (page 17); Pediatric Syncope & Presyncope (page 26).

Guidelines of interest: Patient Refusals --> Special Considerations - Minors (page 24); Abuse & Maltreatment (page 55).

The American College of Surgeons (ACS) Field Trauma Triage Guidelines (FTTG), for use by clinicians nationwide, provide evidence-based criteria in making care and transport decisions for patients with traumatic injuries in the prehospital setting.

This model protocol incorporates elements of an evidence-based guideline for prehospital analgesia in trauma and evidence-based guidelines for prehospital pain management created using the National Prehospital Evidence-Based Guideline Model Process.

EIIC: Pediatric Status Epilepticus Algorithm

Example guidelines/protocols from state EMS offices & local EMS agencies.

(Last updated: December 18, 2025)

Prehospital Evidence Based Practice (PEP) is a collaborative effort of Canadian and international EMS clinicians (paramedics, physicians, nurses and other allied health professionals). PEP is sponsored and managed by the Dalhousie University Department of Emergency Medicine Division of EMS, and Emergency Health Services Nova Scotia.

Click on "Open Resource" and scroll down to "Pediatric" in the alphabetized list.

Topics include: Advanced Airway Management, Airway Emergency; Allergic Reaction; Altered Mental State; Burns; Cardiac Arrest & Arrhythmia; Environmental Emergency; Respiratory Distress; Shock; Trauma; Perinatal Care.

The purpose of this website is to promote openness, discussion and collaboration among system directors in the development of EMS protocols, with the goal to help improve all EMS protocols to the current state of the science using evidence-based medicine.

The list of available protocols is a work in progress.

No pediatric-specific document, would need to access each state/agency guideline to find pediatric resources.

PowerPoint presentation by Dr. Manish Shah.

Objectives:
1) To provide an overview of the past, present and future of national prehospital evidence-based guideline (EBG) development
2) To describe critical considerations in developing, implementing and assessing outcomes for prehospital guidelines
3) To define how prehospital guidelines relate to pediatric readiness in emergency departments

These guidelines are based on the most current and comprehensive review of resuscitation science, systems, protocols, and education.

Guidelines include Neonatal Resuscitation, Pediatric Basic Life Support, Pediatric Advanced Life Support, and Pediatric Special Circumstances of Resuscitation.

Abstract: Because of the dynamic and fragile nature of the medical conditions typically borne by children with special health care needs (CSHCN), the need for emergency care is not uncommon and prehospital providers are increasingly likely to encounter this population. With the support of grant funding from the federal 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.

Abstract only – full article available for purchase.

Pediatric Life Support (PLS) courses and instructional programs are educational tools developed to teach resuscitation and stabilization of children who are critically ill or injured. A number of PLS courses have been developed by national professional organizations for different health care providers (eg, pediatricians, emergency physicians, other physicians, prehospital professionals, pediatric and emergency advanced practice nurses, physician assistants). PLS courses and programs have attempted to clarify and standardize assessment and treatment approaches for clinical practice in emergency, trauma, and critical care. Although the effectiveness of PLS education has not yet been scientifically validated, the courses and programs have significantly expanded pediatric resuscitation training throughout the United States and internationally. Variability in terminology and in assessment components used in education and training among PLS courses has the potential to create confusion among target groups and in how experts train educators and learners to teach and practice pediatric emergency, trauma, and critical care. It is critical that all educators use standard terminology and patient assessment to address potential or actual conflicts regarding patient evaluation and treatment. This article provides a consensus of several organizations as to the proper order and terminology for pediatric patient assessment. The Supplemental Information provides definitions for terms and nomenclature used in pediatric resuscitation and life support courses.

Pediatrics December 2016; 138 (6): e20161073. 10.1542/peds.2016-1073.

Click "Open Resource" to view access options.

This is a sample ED policy, but includes prehospital references:

How EMS providers can gather data to report to ED: Sections III.D.13. and, V.B.2.)

Reference card from New York EMSC (March 2003)

The Pediatric Decision Tree (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.

This toolkit provides practical information about the development and use of evidence-based guidelines for prehospital care, and addresses the implementation of guidelines related to any clinical or operational topic relevant to EMS. Resources contained herein include tips on education of EMS personnel as part of guideline implementation and methods for evaluating whether a guideline was successfully implemented and improved patient care. Additional resources on the evaluation of EBG implementation are included.

Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emer- gency medical experience and can have a lasting effect on a child’s and family’s reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction. Pediatrics 2012;130:e1391–e1405

(focus on emergency departments, but some valuable information for prehospital, too)

State prehospital protocols & guidelines for pediatric medical and traumatic conditions.

2023 Abstract: Airway management is a cornerstone of emergency medical care. This project aimed to create evidence-based guidelines based on the systematic review recently conducted by the Agency for Healthcare Research and Quality (AHRQ). A technical expert panel was assembled to review the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The panel made specific recommendations on the different PICO (population, intervention, comparison, outcome) questions reviewed in the AHRQ review and created good practice statements that summarize and operationalize these recommendations. The recommendations address the use of ventilation with bag-valve mask ventilation alone vs. supraglottic airways vs. endotracheal intubation for adults and children with cardiac arrest, medical emergencies, and trauma. Additional recommendations address the use of video laryngoscopy and drug-assisted airway management. These recommendations, and the associated good practice statements, offer EMS agencies and clinicians an opportunity to review the available evidence and incorporate it into their airway management strategies.