This EMS Education Toolkit for Pediatrics is the result of a collaborative effort of the National Association of State EMS Officials (NASEMSO), the American Academy of Pediatrics (AAP), the EMSC National Resource Center (NRC), National EMSC Data Analysis Resource Center (NEDARC), the National Association of EMS Educators (NAEMSE), and the National Association of EMTs (NAEMT) with support from our federal partners at the National Highway Traffic Safety Administration (NHTSA) and the Health Resources and Services Administration EMS for Children Program (HRSA).
The toolkit is intended as a resource that can be used to inform the state EMS license renewal process to improve evaluation and performance related to pediatric skills competency although EMS Educators, EMS agencies, EMS practitioners, and others seeking information to improve pediatric education in emergency medical services will also find the information useful. If you have additional resources to share in any of the categories listed below or if you discover a broken link, please contact NASEMSO Program Manager Rachael Alter. Information will be updated periodically, so please check back.
Several recommendations emerged from the interdisciplinary Working Group that can help improve pediatric patient care through the commitment to education by all EMS practitioners:
- The primary goal should be that children of all ages, circumstances, and needs receive appropriate assessment and care from EMS personnel consistent with their scope of practice and local protocols. This is best accomplished through:
- effective entry level and continuing education for EMS and on-line medical control personnel;
- valid and reliable competency measurement tools;
- model evidence based guidelines that serve as a foundation for EMS care across states and jurisdictions; and
- a robust quality management process that spans the entire career of each practitioner.
- Medical science and technology are constantly improving therefore clinical competency requires a lifelong commitment by the practitioner, the EMS agency, EMS medical director, and the regulatory body to ensure that EMS practitioners remain proficient to provide safe, effective, and high quality patient care. A competent practitioner is personally accountable for the knowledge, attitudes, skills, and ability needed to proficiently and compassionately care for patients and possess a solid understanding of the expected and unexpected consequences of clinical interventions.
- Essential components of EMS pediatric practice that lie outside the scope of the Education Standards may include, but are not limited to:
- Pediatric Readiness Guidelines
- Performance measures to improve pediatric infrastructure, such as:
- Availability of EMS online and off line pediatric medical direction,
- Availability of pediatric equipment on ambulances,
- EMS pediatric continuing education requirements,
- Inter facility pediatric transfer guidelines,
- Inter facility pediatric transfer agreements, and
- Hospital pediatric facility recognition.
- Several current barriers were identified to effective pediatric EMS education:
- Most programs have not allocated sufficient time to pediatric-related didactic content, labs, or clinical experiences.
- EMS Programs often rely heavily on instructor-centered teaching methods and do not gain the benefit of simulations (high fidelity or low tech) or contact with “real” children or clinical time in a pediatric care setting.
- It is unclear to many instructors how to design lesson plans and educational strategies that fully address the needed depth and breadth of pediatric instruction.
- Educator time may be very limited for curriculum development, especially if it involves sophisticated simulations and/or AV aids.
- Resources are available to assist educators improve EMS instructional competencies. For example, the National Association of EMS Educators offers a 2-day workshop with an online pre-course component that is approximately four hours in length. The following topics are addressed:
- Affective Evaluation
- Simulations & Scenario Oral Evaluation
- Clinical / Internship Evaluation
- Developing a Portfolio Competency Package
- General Item Analysis and Review of Acceptable Reporting
- Principles of Student Evaluation
- Constructing an Evaluation Strategy/Case Studies
- Written Evaluation Tools
- Item Analysis of Written Exams
- Cut Score Determination
- Suggested topics intended to augment the learning objectives included in the Education Standards include:
- Apparent Life-Threatening Events (ALTE)
- Pediatric pain management
- Safe transport in ambulances (newborns, infants and children)
- Safe removal from car seats
- Acute stress disorders in children
- Unique forms of trauma, recognition of shock (all forms) in children
- Mild head injury recognition and management in children (updated concussion guidelines)
- Response to children in multiple patient incidents;
- Jumpstart triage
- Greater emphasis on pediatric assessments
- Much more practice on pediatric cardiac arrest management
- Pediatric drug administration:
- dose calculation and drawing up correct amount to deliver
- vascular access
- IM injections in children
- Recognition and management of severe allergic reaction
- Toxic exposures
- Children with special healthcare needs
- Autism and autism spectrum disorders
- Care of extremely premature newborns
- Identification of children at risk for sexual assault
- Identification of suspected victims of human trafficking
National EMS Education Standards
- National EMS Education Standards (National Highway Traffic Safety Administration) — released in 2009, the National EMS Education Standards reflect the minimal terminal objectives for entry-level EMS personnel to achieve within the parameters outlined in the National EMS Scope of Practice Model.
- National EMS Education Standards-Pediatrics — NASEMSO matrix extracts the pediatric content from the NEMSES for ease in referencing.
- National EMS Education Standards Instructional Guidelines-Pediatrics — NASEMSO document highlights areas of the NEMSES Instructional Guidelines that contain pediatric content at the EMR, EMT, AEMT, and paramedic levels, including referenced page numbers.
- EMS Instructor Qualifications Template — NASEMSO document was used to advise the Pediatric Education Working Group in an effort to develop instructor qualifications for EMS-related pediatric education.
Pediatric Education Gap Analysis
- Pediatric Gap Analysis Template — a companion document to the 2009 Gap Analysis Template, the resource collates information related to pediatric content contained in the NEMSES and NEMSES Instructional Guidelines, while outlining pediatric considerations for implementing the National EMS Education Standards.
- Appendix A- Writing Educational Goals and Objectives — the document serves as a tutorial on writing educational goals, including an overview of Bloom’s Taxonomy as it relates to cognitive, affective, and psychomotor domains.
- 2009 National EMS Education Standards Gap Analysis Template — intended for use by States, educators and others to define the specifics of what will be different at the state and local level between current EMS education delivery and future EMS education delivery. States will find this useful to consider “gaps” between an existing scope of practice compared to what may be implemented under the new SOP model and the Education Standards, to begin identifying educational content that will need to be accounted for in the transition of existing EMS personnel, as well as the delivery of new programs in the future.
- 2014 EMSC Program Manager Survey on Education of Prehospital Providers (free abstract, subscription required for full access)
Measuring Competency in Pediatrics
Adapted from THE AMERICAN ACADEMY OF PEDIATRICS
Joint Policy Statement — Guidelines for Care of Children in the Emergency Department
American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, American College of Emergency Physicians, Pediatric Committee, Emergency Nurses Association Pediatric Committee
CLINICAL AND PROFESSIONAL COMPETENCY
Demonstration and maintenance of pediatric clinical competency may be achieved through a number of continuing education mechanisms including participation in local educational programs, professional organization conferences, and national life-support programs (ie, Pediatric Advanced Life Support [PALS], Advanced Pediatric Life Support [APLS]: The Pediatric Emergency Medicine Course, Emergency Nursing Pediatric Course [ENPC], Emergency Pediatric Course [EPC]) or through scheduled mock codes or patient simulation, team training exercises, or experiences in other clinical settings such as the emergency department (ie, airway management).
Potential areas for the development of pediatric competency and professional performance evaluations may include but should not be limited to:
- Illness and injury assessment and management
- Pain assessment and treatment, including sedation and analgesia
- Airway management
- Vascular access
- Critical care monitoring
- Neonatal and pediatric resuscitation
- Trauma care
- Burn care
- Mass-casualty events
- Patient- and family-centered care
- Medication delivery and device/equipment safety
- Team training and effective communication
Annual Implementation Survey
- 2014 Report to the National EMS Advisory Council (NEMSAC) on Statewide Implementation of the Education Agenda (based on data collected in 2013) The report includes benchmarking information related to pediatric continuing education and competency.
- Arkansas Children’s Hospital Pediatric Understanding & Learning through Simulation Education (PULSE)
- Boston Children’s Hospital Simulator Program
- Children’s Hospitals and Clinics of Minnesota Children’s Mobile Simulation Training
- Cincinnati Children’s Hospital Center for Simulation and Research
- Idaho EMS for Children Program Pediatric Education Resources
- Illinois Pediatric Educational Resources
- Nebraska Pediatric Emergency Training Simulator Class (PETS)
- Stanford Center for Advanced Pediatric and Perinatal Education (CAPE)
- University of New Mexico EMS for Children On-Line Education
- Texas Children’s Hospital Pediatric Simulation Center
- EMSC Innovation and Improvement Center (EIIC)
- NHTSA Office of EMS
- Pediatric Emergency Care Applied Research Network (PECARN)
- National EMSC Data Analysis Resource Center (NEDARC)
Institute of Medicine (IOM) The Future of Emergency Care in the United States Health System Series: Emergency Care for Children Growing Pains.
From the American Academy of Pediatrics
Advanced Pediatric Life Support (APLS) – jointly sponsored with the American College of Emergency Physicians (ACEP). APLS features an innovative modular curriculum designed to present the information physicians, nurses, and allied health professionals need to assess and care for critically ill and injured children during the first few hours in the emergency department or office-based setting.
Neonatal Resuscitation Program – jointly sponsored with the American Heart Association (AHA). The course has been designed to teach an evidence-based approach to resuscitation of the newborn to hospital staff who care for newborns at the time of delivery, including physicians, nurses and respiratory therapists.
Pediatric Education for Prehospital Professionals (PEPP) – a complete source of prehospital medical information for the emergent care of infants and children. Developed by the American Academy of Pediatrics, PEPP is an exciting curriculum designed specifically to teach prehospital professionals how to better assess and manage ill or injured children.
From the American Heart Association
Pediatric Advanced Life Support (PALS)– classroom-based course uses a scenario-based, team approach to teach pediatric emergency management of patients approaching or already in respiratory or cardiac arrest.
Pediatric Emergency Assessment, Recognition and Stabilization (PEARS) – Students who do not regularly treat critically ill children will develop skills in recognizing certain pediatric distress signs and symptoms using several unique visual cues and working at learning stations.
HeartCode PALS Part 1 – computer-based lessons where students “virtually” assess and formulate treatment for pediatric cardiopulmonary arrest patients through 12 interactive hospital-based cases. This course also includes a pre-course self-assessment of ECG recognition and pharmacology.
Learn: Rhythm Pediatric – online course that introduces healthcare providers to normal pediatric cardiac rhythms and prepares them to recognize basic pediatric cardiac arrhythmias in clinical practice. The course features animation, interactive activities, and self-assessment portions.
From the Emergency Nurses Association
Emergency Nursing Pediatric Course (ENPC) – 16-hour course designed to provide core-level pediatric knowledge and psychomotor skills needed to care for pediatric patients in the emergency setting. The course presents a systematic assessment model, integrates the associated anatomy, physiology and pathophysiology and identifies appropriate interventions. Triage categorization and injury prevention strategies are included in the course content. ENPC is taught using a variety of formats including, online learning, lectures, videos, group discussion and hands-on skill stations that encourage participants to integrate their psychomotor abilities into a patient situation in a risk-free setting.
Pediatric ITLS – This one-day course is designed to teach all levels of EMS personnel including first responders, EMTs, paramedics, trauma nurses, emergency nurses, and emergency physicians the skills necessary to recognize mechanisms of injury, assess and perform critical interventions, then package and transport the injured infant or child. Pediatric ITLS uses principles of prehospital trauma care and refines them for specific use on infants and children.
Emergency Pediatric Care (EPC) – a comprehensive education program for EMS practitioners on the care of sick and injured children, addressing a full spectrum of emergency illnesses, injuries and scenarios that an EMS practitioner might encounter.
Endorsed by the March of Dimes
The S.T.A.B.L.E. Program – a neonatal education program to focus exclusively on the post-resuscitation/pre-transport stabilization care of sick infants. Based on a mnemonic to optimize learning, retention and recall of information, S.T.A.B.L.E. stands for the six assessment and care modules in the program: Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support. A seventh module, Quality Improvement, stresses the professional responsibility of improving and evaluating care provided to sick infants.
- Prehospital Emergency Care 2014, Vol. 18, No. Supplement 1, Pages 35-44: An Evidence Based Guideline for the Air Medical Transportation of Prehospital Trauma Patients
Systematic and transparent methodology was used to develop an evidence-based guideline for the transportation of prehospital trauma patients. The recommendations provide specific guidance regarding the activation of GEMS and HEMS for patients of varying acuity. Future research is required to strengthen the data and recommendations, define optimal approaches for guideline implementation, and determine the impact of implementation on safety and outcomes including cost. Included are:
- Appendix A Literature Search Strategies
- Appendix B- Evidence Tables
- Appendix C- Recommendations and Grade Tables
- Pediatric Disaster Preparedness Resource Kit – AAP developed The Pediatric Preparedness Resource Kit in response to the 2009 H1N1 pandemic. This resource allows for pediatricians, public health leaders and other pediatric care providers to assess what is already happening in their community or state, and help determine what needs to be done before an emergency or disaster. The kit will promote collaborative discussions and decision making about pediatric preparedness planning.
Model EMS Clinical Guidelines
- Equipment for Ground Ambulances-A Joint Policy Statement from 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 the National Association of State EMS Officials
- Targeted Issue Grants Related to Prehospital Education
- Current Literature – Under development
- JumpSTART Pediatric MCI Triage Tool
- Emergency Severity Index (ESI) A Triage Tool for Emergency Department Care Version 4(includes new pediatric section)
- Randomized Trial Comparing Two Mass Casualty Triage Systems (JumpSTART versus SALT) in a Pediatric Simulated Mass CasualtyEvent (free abstract; subscription required for full access)