A statewide evaluation of pediatric prehospital and hospital emergency services
A. Zaritsky, J. P. French, R. Schafermeyer and D. Morton
Department of Pediatrics, University of North Carolina, Chapel Hill.
OBJECTIVE: To evaluate the extent of pediatric emergency training and the
availability of pediatric equipment and patient care protocols in the
prehospital and hospital settings. DESIGN: Statewide surveys developed by
the North Carolina Provisional Committee on Pediatric Emergency Medical
Services and by the Office of Emergency Medical Services. SETTING AND
PARTICIPANTS: Surveys were mailed to all 572 prehospital Emergency Medical
Service (EMS) agencies and separately to all 125 acute-care hospitals in
North Carolina. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Surveys
were returned by 335 (58.6%) of the prehospital providers, including all 45
paramedic and 14 advanced-intermediate provider agencies. One hundred (80%)
of the acute-care hospitals returned surveys. Only 10.8% of the prehospital
EMS agencies provided more than 10 hours of basic training in pediatric
emergency care; 18% provided more than 5 hours of continuing education in
pediatric emergencies over a 3-year period. Pediatric-specific equipment
was available in many prehospital vehicles, although some deficiencies were
noted. Written pediatric management, bypass, and helicopter transport
protocols were absent in most prehospital programs. Paramedic programs
generally were much better in all areas, although deficiencies were
present. Only 14% of the responding hospitals had more than 20 pediatric
beds; 13% reported seeing more than 100 patients per day in the emergency
department. Deficiencies were identified in pediatric patient care
protocols, triage and transport agreements, pediatric training of nurses
and physicians, and equipment. Equipment deficiencies were more marked in
the intensive care units than in the emergency departments. CONCLUSIONS:
These survey data are inexpensive to obtain and demonstrate EMS system
deficiencies. The survey information provides a baseline measurement that
can lead to measurable, targeted changes in the state's EMS system for
children.
