State Spotlight: Maryland EMSC leads the way in pediatric prehospital High-Performance CPR
- Published April 30, 2025
More than 10 years ago, Maryland introduced High-Performance CPR (HPCPR) for adults. This approach uses a “Pit Crew” model, where each EMS team member has a specific role during resuscitation. Maryland also started a Resuscitation Academy to train EMS clinicians in this technique. After seeing strong results with adults, Maryland EMSC and the Pediatric Emergency Medical Advisory Committee (PEMAC) realized that pediatric CPR wasn’t getting the same focus. So in 2017, Maryland EMSC began developing a special HPCPR training for children. By 2018, pediatric HPCPR was officially added to Maryland’s statewide EMS protocols.
The biggest challenge was adapting the traditional pediatric CPR method of 15 chest compressions and two breaths to fit with Maryland’s adult CPR training, which emphasizes nonstop compressions with a breath every six seconds. Maryland EMSC developed a new style of pediatric HPCPR, nicknamed the “Maryland Hiccup.” It uses a quick pause for breaths during compressions 14 and 15, giving just enough time for ventilation without slowing down compressions.
With help from a new group of pediatric EMS champions (also called pediatric emergency care coordinators or PECCs), Maryland EMSC created hands-on training in 2018. They also trained local instructors in each of Maryland’s 28 EMS jurisdictions and provide HCPR training packages. Manikins for infant and child CPR are available for loan through the pediatric EMS champions, making it easier for local teams to run drills.
The pediatric HPCPR training package includes:
- Instructions for different CPR manikins
- Skills checklists for both infants and children
- Practice scenarios
- A video lecture recorded at the Maryland Resuscitation Academy
This package can be used in EMS courses, conferences, or regular training drills. Email pepp@miemss.org for information.
In 2021, Maryland EMSC studied how well EMS teams performed pediatric HPCPR using the standard American Heart Association (AHA) method (15:2) compared to the Maryland Hiccup method. Led by Jennifer Anders, MD, FAAP, Associate State EMS Medical Director for Pediatrics and a pediatric emergency physician at Johns Hopkins, that research was published in February.
Today, Maryland EMSC is working to make sure every EMS clinician in the state is trained in pediatric HPCPR. They are also encouraging EMS agencies to include regular drills.
“One Maryland EMS Agency conducts CPR just in time drills for all on-duty staff every Friday morning, meaning every EMS clinician refreshes their pediatric CPR psychomotor skills at least every two months” says Cyndy Wright-Johnson, MSN, RN, and Director of Maryland EMSC for more than 30 years. “Another rural EMS Region includes pediatric HPCPR in every initial EMS training course and all refresher sessions for EMR, BLS and ALS Clinicians. In fact, they’ve used their infant manikin so much that it wore out! The manikins provide real-time feedback on compression depth, rate, and ventilation, helping EMS clinicians sharpen a critical skill that’s rarely used but can save a life.”
Maryland EMSC’s Data and Research Team (DART) is tracking survival outcomes for children who suffer cardiac arrest outside of hospitals. They are also partnering with researchers to find new ways to improve pediatric CPR. Quality improvement efforts are ongoing, with regular data shared with EMS leaders across the state.