Text Box: pediatric coordinators, that was also recommended, and to just make sure that kids get remembered.” Disaster Preparedness: Planning for Children Emergency Medical Services has received only about 4 percent of preparedness funds expended since September 11, 2001, although emergency care providers are the first line of response during incidents. Moreover, most state preparedness plans lack a pediatric component. To resolve these deficiencies, the pediatric report recommended increased funding, and that federal agencies work with state and regional planners and emergency care providers to develop strategies to meet the special needs of pediatric patients during disasters, including: Minimizing parent-child separation and improving methods to reunite families; Improving the level of pediatric expertise on Disaster Medical Assistance Teams and among other disaster responders; Improving access to medical and mental health therapies for children; Developing disaster plans that address pediatric surge capacity; and Ensuring disaster drills include a pediatric mass causality incident at least once every two years. Evidence-Based Practices All of the pediatric-specific recommendations made by subcommittee members were offered within the context of the need to improve the data base and develop evidence-based clinical practice guidelines and standards of care. “What we’re saying is we want to establish a system of evaluation, Text Box: While tremendous improvements have been made in the delivery of pediatric emergency care, shortcomings persist, concluded Emergency Care for Children: Growing Pains, a new report from the Institute of Medicine. The study is comprehensive in its documentation of the current state of care and the actions required to remediate the system’s inadequacies. Many obstacles to quality pediatric emergency care would be overcome when systemic problems in the emergency care system, addressed in the two companion IOM reports, are resolved, but only if infants and children are incorporated, emphasized Pediatric Emergency Care Subcommittee members. Among the pediatric-specific recommendations likely to have the greatest impact on EMS providers were those addressing workforce skill development for providers of pediatric care, the inclusion of pediatric patients in disaster preparedness planning and improving pediatric care research. Improving Workforce Skills Children represent 27 percent of ED visits and fewer than 10 percent of EMS calls. This limited exposure challenges the ability of emergency providers to retain the knowledge and skills required to care for infants and children. “There needs to be ongoing updates and some way to document their ability,” said David Sundwall, M.D., the pediatric subcommittee Chairman and Executive Director of the Utah State Department of Health. “Though there are recommendations, there’s no apparent expectation they have ongoing CMEs in pediatric care. So I think the ongoing medical education relating to pediatrics is essential across the spectrum.” To improve pediatric care Text Box: skills, the subcommittee recommended that every credentialing and certification body define pediatric emergency care competencies and require practitioners to receive the level of initial and continuing education necessary to achieve and maintain those competencies. Pediatric Care Coordinators Another recommendation that would directly affect EMS services was to require that EMS providers appoint one pediatric coordinator (hospitals would appoint two) so someone at each agency would be responsible for paying attention to children’s needs. These coordinators would ensure pediatric skills were maintained; pediatric medications, supplies and equipment were stocked; and pediatric quality improvement initiatives were ongoing. Subcommittee member Marianne Gausche-Hill, M.D., Director of Prehospital Care at Harbor-UCLA Medical Center, said pediatric coordinators would make a dramatic contribution to pediatric emergency care. “If there is a commitment by agencies, hospitals, EMS providers, regional agencies and federal agencies to include pediatric representation in planning, in the initial stages of planning of anything, then children ‘s issues will be addressed. If not, they will not,” she said. Subcommittee member and Chief EMS Operations Officer with the City of Baton Rouge Thomas Loyacono, M.P.A., NREMT-P, said that while large EMS providers might hire someone, smaller services could identify a person with an interest in pediatric care. “It could be as simple as identifying one person and saying, ‘Your responsibility will be to develop the liaisons in our community with the pediatric community, the physicians,’ to hopefully develop relationships with those in-hospital Text Box: intervention and measurements,” said subcommittee member and Director of the Center for Pediatric Emergency Medicine at Bellevue Hospital George Foltin, M.D. “The quality of emergency care for children varies throughout the country so the big challenge is to get every child in America to have the same level of care ... If we accomplished that, we would make a huge amount of progress in terms of decreasing morbidity and mortality for children.” The committee recommended that pediatric-specific data be collected and shared among registries and researchers, and that emergency care research, including pediatric care, be funded and expanded. The Emergency Medical Services for Children (EMS-C) program would continue to play a critical role under subcommittee’s vision of better care for children, and they would fund the agency at $37.5 million annually over five years. A report brief summarizing all three IOM reports is at http://www.iom.edu/File.aspx?ID=35014.

STATE OF PEDIATRIC EMERGENCY CARE: CRITICAL