This section includes example protocols and guidelines, and evidence-based medicine resources.
Last updated: October 19, 2022
If you have content to add to the Toolkit, please email the PPRP team.
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
Pediatric information integrated throughout the model guidelines.
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: August 14, 2023)
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.
The Prehospital Guidelines Consortium (PGC) maintains a comprehensive list of evidence-based guidelines (EBGs). This link takes you directly to their pediatric EBGs. As of August 2023, topics included:
- Neonatal Resuscitation
- Pediatric ALS
- Pediatric BLS & CPR Quality
- Pediatric Seizures
- Traumatic Brain Injury in Infants, Children, & Adolescents
- Pediatric Cervical Spine Injuries
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
In this document the California EMS Authority (EMSA), informed by the EMSC-Technical Advisory Committee, recommends local EMS agencies address specific issues in the development of pediatric protocols. In addition, this document provides references for protocols from other states and from within California as examples for local EMS agencies that wish to update their protocols or that have not yet initiated protocol development for children.
December 2011
These Highlights summarize the key issues and changes in the 2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). The 2020 Guidelines are a comprehensive revision of the AHA’s guidelines for adult, pediatric, neonatal, resuscitation education science, and systems of care topics. They have been developed for resuscitation providers and AHA instructors to focus on the resuscitation science and guidelines recommendations that are most significant or controversial, or those that will result in changes in resuscitation training and practice, and to provide the rationale for the recommendations.
(see pages 16-25 for Pediatric Basic and Advanced Life support)
(see pages 25-27 for Neonatal Life Support)
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.
Singh T, Wright JL, Adirim, TA. Prehosp Emerg Care. Jul-Sep 2003;7(3):336-51.
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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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Abstract: The Pediatric Assessment Triangle (PAT) has become the cornerstone for the Pediatric Education for Prehospital Professionals course, sponsored by the American Academy of Pediatrics. This concept for emergency assessment of children has been taught to more than 170,000 health care providers worldwide. It has been incorporated into most standardized American life support courses, including the Pediatric Advanced Life Support course, Advanced Pediatric Life Support course, and the Emergency Nursing Pediatric Course. The PAT is a rapid and simple observational tool suitable for emergency pediatric assessment regardless of presenting complaint or underlying diagnosis. This article describes the PAT and its role in emergency pediatric assessment.
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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.
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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.
