New study highlights need to improve Pediatric Readiness at all trauma centers

AUSTIN, TEXAS, Feb. 25, 2025 – When children experience major injuries, timely surgical assessment and care is essential for survival. A new study published in JAMA Pediatrics underscores ongoing challenges in ensuring injured children, especially those in rural areas, have access to this life-saving care.

The study, led by a team at University of California, San Francisco (UCSF), found that 92% of children can reach any high-level trauma center within an hour. But significantly fewer have access to pediatric trauma centers or adult trauma centers considered “Pediatric Ready” as measured by the National Pediatric Readiness Project (NPRP), an initiative of the federal Emergency Medical Services for Children Program in partnership with the American Academy of Pediatrics, American College of Emergency Physicians and Emergency Nurses Association.

“Gaps in access to pediatric-specific trauma care are essential to address because they indicate potential gaps in survival,” says lead author and UCSF surgeon Caroline Melhado, MD, MS. “Our prior research has shown that children treated at Pediatric-Ready centers have a 15-20% reduction in mortality compared to those treated at centers with lower levels of pediatric readiness.”

The researchers found that only 65% of children are within an hour from a pediatric-specific trauma center (under ideal conditions with the use of air transport), while 73% are within an hour from an adult trauma center that meets most NPRP criteria. Children in rural areas had disproportionately lower access, with 50% lacking timely access compared to 18% of children in urban areas. Additionally, these numbers drop even further if conditions (such as bad weather) do not allow helicopters to fly.

"This work suggests that there is significant opportunity to improve access to high-quality trauma care for children, particularly in rural areas where only 22% of children have reliable and prompt access to a pediatric-ready trauma center," says Avery Nathens, MD, PhD, FACS, medical director, American College of Surgeons Trauma Quality Programs and professor of surgery, University of Toronto. "We know that children living in a rural community experience twice the risk of death due to injury compared to children living in urban areas and this is likely an important contributor to the higher death rate. Our standards for trauma center verification require centers to assess their Pediatric Readiness and address any deficiencies, which will go a long way to saving the lives of severely injured children."

Study authors say efforts to incorporate Pediatric Readiness at all trauma centers have improved access for 5.5 million children nationally – while emphasizing that work remains.

“If all high-level adult trauma centers, particularly in rural areas, were to become Pediatric Ready, it could improve access for an additional 14 million children nationally,” says Melhado. “We owe it to these children to continue prioritizing this work.”

About the NPRP

The NPRP is a federally funded initiative of the Health Resources and Services Administration’s (HRSA) Emergency Medical Services for Children Program in partnership with the American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons Committee on Trauma, and the Emergency Nurses Association. The project empowers emergency departments and trauma centers to improve their “Pediatric Readiness” or capability to care for acutely ill and injured children. Learn more at www.pediatricreadiness.org.

This research and the NPRP are supported by the HRSA of the U.S. Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $2.74M with 0 percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS or the U.S. government. For more information, visit HRSA.gov.