New Research Links Declines in ED Pediatric Readiness to Thousands of Child Deaths

Findings come as new national center launches to strengthen emergency care for children

A new study published in JAMA Pediatrics provides compelling evidence that being prepared to care for children in an emergency—and staying prepared over time—can be a matter of life and death.

Researchers followed more than 2.4 million children treated at 759 hospitals over 10 years. Children treated at hospitals that lost or never achieved high Pediatric Readiness in their emergency departments (EDs) were significantly more likely to die. Losing or lacking pediatric inpatient services was also independently linked to higher mortality.

The findings come as the federal Health Resources and Services Administration Emergency Medical Services for Children (EMSC) Program launches a new National Pediatric Readiness Coordinating Center (NPRCC) to strengthen emergency care for children nationwide—from EMS agencies responding to 911 calls to the EDs that receive them.

When Readiness Declines, Children Are at Risk

Pediatric Readiness means having the people, training, policies, equipment and processes in place to provide high-quality emergency care to children.

Using data from national Pediatric Readiness assessments conducted in 2013 and 2021, researchers found that only 13% of EDs maintained high readiness across both assessments. About 10% lost it, while nearly two-thirds never achieved it.

The consequences were substantial:

• EDs that lost high Pediatric Readiness were associated with an estimated 1,727 excess deaths over 10 years.
• EDs that never achieved high Pediatric Readiness were associated with an estimated 3,776 excess deaths.

Hospitals that lost or never had pediatric inpatient services experienced thousands of additional excess deaths.

"These findings show that Pediatric Readiness is not static—hospitals can gain it, and they can lose it, and both directions carry real consequences for children," says Craig D. Newgard, MD, MPH, the study's lead author, who is based University of California, San Francisco, Zuckerberg San Francisco General Hospital. "Health systems need to address both ED readiness and inpatient capacity if we want to save lives."

Previous research has estimated that raising every U.S. ED to high Pediatric Readiness could save more than 2,100 children's lives each year. And the cost is minimal: one study found that achieving high readiness costs between $4 and $48 per patient each year, depending on overall patient volume.

Building Readiness from EMS to the ED

For years, the federal EMSC Program has led national efforts to improve Pediatric Readiness across emergency care. The program coordinates the National Pediatric Readiness Project (NPRP), which focuses on EDs, while the Prehospital Pediatric Readiness Project (PPRP) helps EMS agencies assess and improve their ability to care for children.

Together, the projects have engaged thousands of emergency care clinicians nationwide: a record 4,593 EDs participated in the 2026 NPRP Assessment, while more than 7,000 EMS agencies participated in the 2024 PPRP Assessment. While engagement is strong, the results of the assessments suggest opportunity for improvement. The last assessment of EDs in 2021 found a median score of 70 out of 100 (2026 results are forthcoming). The 2024 assessment of EMS agencies found a median score of 66.

The new NPRCC will provide a single national coordinating center for this work, building on the longstanding efforts of the EMSC Program and its partners. Through the NPRP and PPRP, the center will advance national efforts to measure Pediatric Readiness, identify opportunities for improvement, and support sustained progress across both EMS systems and EDs.

"Evidence that Pediatric Readiness saves lives has existed for nearly a decade,” says Katherine Remick, MD, a study co-author and national Pediatric Readiness leader. “This research adds a new dimension to the work, emphasizing that Pediatric Readiness is not a one-time effort or achievement. It requires continuous quality improvement and an ongoing commitment to saving children’s lives."

Remick, of The University of Texas at Austin Dell Medical School, will serve as principal investigator of the NPRCC. Co-principal investigators are Hilary Hewes, MD, of the University of Utah School of Medicine, and Charles Macias, MD, MPH, of University Hospitals Rainbow Babies & Children's Hospital.

Together, the research and the new center point to a simple goal: an emergency care system that is ready for every child, every day.

Learn more

Read the full study in JAMA Pediatrics. To learn more about Pediatric Readiness, visit pediatricreadiness.org.