EIIC: Emergency Medical Services for Children | Innovation and Improvement Center

Pediatric Equipment Toolbox

Without the necessary pediatric medical equipment and supplies, healthcare professionals are limited in the quality of care they can provide to our nation’s children. It is thus imperative that prehospital emergency care providers, emergency department (ED) personnel, and office-based pediatricians/physicians have the appropriate equipment and supplies to provide care for the critically ill and injured children they may encounter in their practice.

A number of professional organizations and government agencies have addressed this issue through the development of essential and/or recommended equipment and supply lists for inclusion in basic life support (BLS) and advanced life support (ALS) ambulances, EDs, and physicians’ offices. The following toolbox identifies the most recent guidelines, resources, position papers, and journal articles on pediatric equipment guidelines.

Healthcare Provider Resources

EIIC

Implementation Manual for State Partnership Grantees (2017 edition) 2017 Implementation Manual Cover
This is the updated version of the Implementation Manual for State Partnership Grantees to meet the revised Perfomrance Measures. The mission of the EMSC program is to reduce child and youth mortality and morbidity resulting from illness or trauma. Long-term success is measured by assessing the quality of pediatric emergency care provided in the prehospital and hospital settings, and integrating pediatric emergency care within the larger emergency medical service (EMS) system. In 2012, the federal EMSC Program initiated development of a second generation of PMs. Three new EMS-based measures, developed by HRSA, the National EMSC Data Analysis Resource Center, and subject matter experts, and following two rounds of public comment, become active in 2017 and are contained herein..
Government Performance Results Act (GPRA)
To measure the effectiveness of federal grant programs, the Health Resources and Services Administration (HRSA) requires grantees to report on specific performance measures related to their grant-funded activities. EMSC Program performance measures (PMs) address operational capacity to provide pediatric emergency care, including the availability of essential pediatric equipment on ambulances (See PM #73). Each performance measure is hyperlinked to HRSA’s Discretionary Grant Information System (DGIS). The DGIS contains the most recent reporting data for each performance measure. Data is supplied in aggregate form only. Note that all EMSC performance measures align with Healthy People 2020 objectives (see Healthy People 2020 Crosswalk to EMSC Performance Measures). (Accessed January 2015)
Emergency First Aid Guidelines for California Schools
The Emergency First Aid Guidelines for California Schools’ document was initially developed by San Diego and Alameda Counties, funded in part by a grant from the California Emergency Medical Services (EMS) Authority. The Guidelines were originally based on the second edition of the Ohio Emergency Guidelines for Schools, 2000. The Emergency First Aid Guidelines for California Schools manual is meant to provide recommended procedures for school staff in responding to medical emergencies when the school nurse is not available and until emergency medical services responders arrive on scene. (2014)
NE Emergency Guidelines for Schools
First developed by the Ohio EMSC Program, the Emergency Guidelines for Schools Manual is meant to provide recommended procedures for school staff that have little or no medical/nursing training to use when the school nurse is not available. Included is a list of recommended first aid equipment and supplies for schools. Although designed for a school environment, this resource is equally appropriate for a child care or home setting. (Revised 2012)
EMSC Webcasts
This section of the EMSC National Resource Center (NRC) website includes links to upcoming and archived webcasts, including the following:
Building a Foundation for Pediatric Emergency Care: Equipment for Ground Ambulances
This February 17, 2015 webinar is the second in the two-part series on the 2014 Joint Policy Statement: Equipment for Ground Ambulance. This presentation discusses the importance of a national standard for ambulance equipment and the process for the development and subsequent revisions of the Joint Policy Statement: Equipment for Ground Ambulances. Speakers describe the inherent value of the recommendations for children and those who care for them in the prehospital setting, summarize changes in the recommendations in the 2014 revision, discuss challenges in implementation at the state and local level, and list provider opportunities and implications.
Introduction to Pediatric Equipment for Ground Ambulances
On Tuesday January 20, 2015 the EMSC National Resource Center hosted the first of a two part series on the updated 2014 Joint Policy Statement: Equipment for Ground Ambulances. Part one provides an overview of the recommendations, a review of pediatric equipment carried on ambulances, and implementation strategies.
State of Emergency Department Preparedness for Children: Release of Joint Statement – A Consensus on the Essentials
This February 23, 2010, online presentation provides additional information relevant to the 2009 Guidelines for Care of Children in the Emergency Department endorsed by the American Academy of Pediatrics (AAP), the American College of Emergency Physicians (ACEP), and the Emergency Nurses Association (ENA).
Best Practices: A Guide for State Partnership Grantees on the Implementation of EMSC Performance Measures
This downloadable document contains additional information regarding the EMSC State Partnership performance measures, and includes best practices from state activities related to pediatric equipment availability. (June 2009)
Performance Measure FAQ for Recommended Pediatric Equipment for BLS and ALS Ambulance
Written in response to the American College of Surgeon’s Equipment for Ambulances document, this EMSC resource provides additional information and clarifications on recommended pediatric equipment lists for BLS and ALS ambulances in a question-and-answer format. (February 2010)

Joint Policy Statements

Joint Policy Statement: Equipment for Ground Ambulances

On January 1, 2014, the American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons Committee on Trauma, Emergency Medical Services for Children, Emergency Nurses Association, National Association of EMS Physicians, and National Association of State EMS Officials coauthored a joint policy statement, “Equipment for Ground Ambulances” (Prehosp Emerg Care. 2014;18[1]:92–97). The document was written to serve as a standard for the equipment needs of emergency ground ambulance services both in the United States and Canada. The current guidelines provide a recommended core list of supplies and equipment that should be stocked on ground ambulances to provide the accepted standards of patient care.

Equipment for Ground Ambulances: Summary of Changes 2009–2014
This article summarizes changes made in the 2014 revision of the ground ambulance equipment list subsequent to when the list was last published in 2009. The current list represents a consensus by the organizations listed to the left, all of which appointed members to a joint task force to assist with defining the current standard for ground ambulances in the United States. The Equipment for Ground Ambulances Joint Policy Statement was published in Prehospital Emergency Care 18(1):92-97, 2014.
Joint Policy Statement: Guidelines for Care of Children in the Emergency Department

Endorsed by the AAP Committee on Pediatric Emergency Medicine, the ACEP Pediatric Committee, and the ENA Pediatric Committee, these guidelines outline the essential resources (medications, equipment, policies, and education) and staff to ensure that hospital emergency departments are prepared to care for and – when necessary – transfer children of all ages, from neonates to adolescents. The guidelines are consistent with the recommendations of the Institute of Medicine’s (IOM) 2006 report Future of Emergency Care in the United States Health System, and are also available online through the ACEP website. (Approved April 2009, published in Pediatrics September 2009)

AAP News: Policy Offers Blueprint for Care of Children in the ED
This commentary piece provides background information and a concise summary of the key recommendations contained in the 2009 Guidelines for Care of Children in the ED, which was endorsed by the AAP, ACEP, and the ENA. (November 2009)
Guidelines Checklist
In accordance with the AAP, ACEP, and ENA 2009 Guidelines for Care of Children in the ED, this checklist allows healthcare facilities to assess their own preparedness to manage pediatric emergencies. (February 2010)

American Academy of Pediatrics

Policy Statements

The AAP website includes a number of policy statements that relate to recommended pediatric equipment. These include:

Pediatric Care Recommendations for Freestanding Urgent Care Facilities
This document lists the recommended emergency equipment and supplies for pediatric patients seen in freestanding urgent care centers (May 2014).
ED_Preparedness_Checklist
In accordance with the AAP, ACEP, and ENA 2009 Guidelines for Care of Children in the ED, this checklist allows healthcare facilities to assess their own preparedness to manage pediatric emergencies. (February 2010)
Preparation for Emergencies in the Offices of Pediatricians and Pediatric Primary Care Providers
Recognizing that pediatricians may be called upon to stabilize and/or arrange transport for pediatric patients experiencing health emergencies, this policy statement speaks to the necessary equipment, medications, and provider skill sets for emergency preparedness in primary care settings. (July 2007; Reaffirmed June 2011)
Facilities and Equipment for the Care of Pediatric Patients in a Community Hospital
This document includes guidance to community hospitals on essential equipment for pediatric care, support services, continuing education, and referral networks and transfer of pediatric patients. (May 2003; Reaffirmed August 2013)
Patient Safety in the Pediatric Emergency Care Setting
Specific recommendations to improve pediatric patient safety in the emergency department, including equipment sizing and medication dosing, are provided in this policy statement. (December 2007; Reaffirmed July 2014)

Illinois EMSC

Pediatric Prehospital Equipment Recommendations
This document contains lists that identify pediatric equipment items recommended for inclusion on BLS and/or ALS ambulances. The equipment is classified as essential or desirable. (Accessed January 2015)

National Center for Health Statistics

Availability of Pediatric Services and Equipment in Emergency Departments: United States 2002-2003
Beginning in 2001, the EMSC Program collaborated with the CDC’s National Center for Health Statistics to develop, test, and apply the Emergency Pediatric Services and Equipment Supplement (EPSES) to the National Hospital Ambulatory Medical Care Survey instrument. The purpose of the brief 30-minute supplement was to allow for a larger and more general sample than the previous National Electronic Injury Surveillance System studies. This paper, based on the EPSES 2002-2003 data, appeared in CDC Advance Data Report 367. (2006)

National EMSC Data Analysis Resource Center

National Data
All EMSC Grantees are required to enter the results from their performance measure data collection and analysis in the HRSA Electronic Handbook (EHB). States and territories collected data during 2010-11 and again in 2013-2014. This page provides links to aggregate national data including EMSC Performance Measure #73, the percentage of patient care units (EMS transport ambulances) in the State/Territory that have essential pediatric equipment and supplies as outlined in national guidelines.

Example Practices

Florida EMSC

The goal of Florida’s Department of Health (DOH) is to promote and protect the health and safety of its citizens through the delivery of quality public health services and promotion of health care standards. The Florida EMSC program partnered with the Florida EMS Advisory Council to ensure the inclusion of essential pediatric equipment and supplies in the administrative rules. By working together, sections 64E-2.002 and 64E-2.003 of the Florida Administrative Code now include recommend regulatory language that ensures availability of pediatric equipment on all ambulances. Required equipment is reviewed and updated regularly.

Inclusion of pediatric equipment and supplies into administrative rules further allowed for state inspection of all licensed EMS provider agencies biannually to ensure compliance with equipment availability. The inspection process also entails corrective action plans for all deficiencies; all corrective plans have defined time limitations for implementation, corresponding to the severity of the infringement. As part of the DOH’s regulatory authority, the rules also sanction disciplinary action, if necessary.

For more information on this process, including challenges to implementation, strategies to overcome difficulties, and key partnerships, see Best Practices: A Guide for State Partnership Grantees on the Implementation of EMSC Performance Measures. (June 2009)Missouri EMSC

In Missouri, administrative rules require ambulances to carry both pediatric and adult equipment and supplies. However, individual equipment pieces and supplies are not clearly defined; it is the medical director of each agency who is responsible for making such specifications.

To encourage ambulance services to voluntarily carry all recommended equipment and supplies listed in ACEP guidelines, the state’s EMSC Advisory Committee developed and implemented a voluntary ambulance equipment incentive program. This program is designed to publicly recognize ambulance services that have gone above and beyond the service medical director’s requirements by obtaining and carrying ACEP’s recommended pediatric equipment.

A community EMS representative performs a visual inspection to ensure all recommended equipment is available on patient care units at participating ambulance services. For services with multiple ambulances, a visual inspection is done on one ambulance, and the service director signs an affidavit attesting to the number of ambulances equipped in the same manner.

All participating services meeting ACEP requirements are then given stickers to place on each ambulance carrying the equipment. The stickers are intended to serve as public symbols of being equipped to care for children. Publicity is encouraged, and local reporters are invited to a formal ceremony that recognizes services participating in the equipment incentive program. Today, the majority of ambulance services in Missouri are recognized.For more information on the program, including challenges to implementation, strategies to overcome difficulties, lessons learned, and key partnerships, see Best Practices: A Guide for State Partnership Grantees on the Implementation of EMSC Performance Measures. (June 2009)

Pennsylvania EMSC

As part of the comprehensive Pediatric Voluntary Recognition Program for emergency medical services (EMS), Pennsylvania ambulances can be recognized at one of four levels for pediatric readiness, including Basic, Intermediate, Advanced, and Master. Each level builds on lower levels so that the Master level must include all of the requirements of each previous level.

EMSC Performance Measure #73, the percentage of patient care units (EMS transport ambulances) in the State/Territory that have essential pediatric equipment and supplies as outlined in national guidelines, is an essential component of the recognition program. To achieve Basic Level recognition, ambulances are required to have specific pediatric equipment beyond current Pennsylvania requirements based on the 2009 Joint Policy Statement: Equipment for Ground Ambulances and the 2013-2014 EMSC reassessment of EMS agencies.

Each recognized EMS agency is provided with an official Certificate of Recognition and specially designed “Prepared For Pediatrics” decals to display on their ambulances. In the first year of implementation, 84 EMS agencies were officially recognized with more than half at the Master Level. See Overview of the Pennsylvania EMS for Children Pediatric Voluntary Recognition Program.

Family And Caregiver Resources

EMSC National Resource Center

Getting Started, Staying Involved: An EMSC Toolkit for Family Representatives
This publication, developed for EMSC family representatives, includes sections addressing the importance of hospital recognition for pediatrics. It also contains advice for families on how to work with state EMSC project managers and community organizations to ensure that all patient care units responding to 9-1-1 calls have the essential pediatric equipment and supplies needed to save a child’s life. (2008)
Emergency Information Form (EIF) for Children with Special Health Care Needs
This form was developed by the American Academy of Pediatrics, American College of Surgeons, and EMS for Children to provide ready access to medical information to emergency care providers for children with special health care needs. It includes history, physician contact information, special physical needs, and medications. This is an ideal way to detail special equipment needs such as tracheostomy sizes or normal oxygen or ventilator settings. The form is available in English and Spanish.

American Academy of Pediatrics

When Your Child Needs Emergency Medical Services
This tip sheet for families and caregivers provides information on how to react to pediatric healthcare emergencies, including what to bring to the emergency department, and how to communicate with emergency care providers. (Accessed April 2010)

American College of Emergency Physicians

Home First Aid Kits
This section of ACEP’s website encourages parents and caregivers to create home first aid kits in case of accidental emergencies. Lists of specific supplies that should be included in the kits, along with storage information, are provided. (Accessed July 2015)