A statewide evaluation of pediatric prehospital and hospital emergency services.

Abstract

To evaluate the extent of pediatric emergency training and the availability of pediatric equipment and patient care protocols in the prehospital and hospital settings. Statewide surveys developed by the North Carolina Provisional Committee on Pediatric Emergency Medical Services and by the Office of Emergency Medical Services. Surveys were mailed to all 572 prehospital Emergency Medical Service (EMS) agencies and separately to all 125 acute-care hospitals in North Carolina. None. 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. 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.