Pediatric Protocols and Guidelines Resources

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.

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

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

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

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

(Last updated: August 14, 2023)

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.

Pediatric Status Epilepticus Algorithm co-developed by EIIC and TREKK (Canada)

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.

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.

Reference card from New York EMSC (March 2003)

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.

Click "Open Resource" to view access options.

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)

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

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.

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).

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.