Pediatric Equipment Guidelines 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

EMSC National Resource Center

  • EMSC State Partnership Performance Measures. 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 performance measures (PMs) address operational capacity to provide pediatric emergency care, including the percent of patient care units in the state/territory that have essential pediatric equipment and supplies as outlined in national guidelines (see PM 73) . (Accessed April 2010)

More details about this and other health provider resources

 

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.

More details about this and other example practices

DATABASE SEARCHES

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)

More details about this and other family resources

 

HEALTHCARE PROVIDER RESOURCES

EMSC National Resource Center

American Academy of Pediatrics

  • Joint Policy Statement for 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)

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

  • Emergency Readiness of Pediatric Offices. This report presents findings from Periodic Survey #27.  This exercise explored the state of readiness for common emergencies among office-based pediatric practices.  The report includes information on the availability of equipment/medications necessary to handle emergencies. (Accessed April 2010)

American College of Surgeons

  • Equipment for Ambulances. This document provides a list of equipment that the American College of Surgeons (ACS) believes to be necessary on all ambulances in order to provide sufficient patient care in the prehospital setting.  It is endorsed by the ACS’s Committee on Trauma along with the ACEP, the National Association of EMS Physicians (NAEMSP), the EMSC Partnership for Children Stakeholder Group, and the AAP.  (April 2009)

Florida EMSC

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 April 2010)

National Association of School Nurses

  • Preparing for School Emergencies. This position statement outlines the levels of care providers must have and the necessary equipment needed to provide emergency care to children in a school setting. (2003)

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

  • Pediatric Equipment Data Collection Form for ALS Ambulances. This survey template was designed to assist EMSC State Partnership grantees in the gathering of data regarding the availability of essential pediatric equipment on BLS and ALS ambulances (Performance Measure 73). The equipment list may be altered so that it reflects only those items of equipment that fall within the scope of practice and that are authorized for use. (Accessed April 2010)

Wisconsin EMSC

  • Required Pediatric Equipment and Recommended Pediatric Kit. Developed by Wisconsin EMSC’s Equipment, Transport and Treatment Guideline Committee, this document identifies the pediatric equipment required by Wisconsin legislation for BLS and ALS ambulances.  It also lists the equipment and supplies to be included in a recommended pediatric response kit. (January 2000)

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.

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)

South Dakota EMSC. The South Dakota EMSC program conducted a survey of all ambulance agencies in 2005 to assess the availability of pediatric equipment as outlined within the 1996 ACEP guidelines.  The survey also collected “reasons for missing items.”  Data revealed that the majority of the equipment was available, but that ambulances lacked select sizes and/or more expensive items.  Lack of funds was often cited as the reason for the missing pieces.

Survey data was presented to the director of the state’s Bioterrorism Hospital Preparedness Program.  Thanks to the success of several poison control initiatives, South Dakota EMSC already had an established relationship with HPP, and was able to leverage that relationship to launch a new initiative designed to ensure the availability of equipment by providing it in a Pediatric Emergency Response Bag. Every agency that received a bag would also be trained in its use.

HPP funded the purchase of the Pediatric Emergency Response Bags for all ambulances, and Broselow/Hinkle systems for all ALS providers and rural hospitals.  Large hospitals received Broselow/Hinkle crash carts.  Ambulance agencies and hospitals that previously reported having some or most of the recommended equipment now had duplicates.  This “extra” equipment enabled ambulances and hospitals to prepare for a mass casualty incident.

For two years, Pediatric Education for Prehospital Providers (PEPP) courses were held twice a month at a variety of locations across the state.  Each PEPP course included information about the new equipment.  Funding also supported an Advanced Pediatric Life Support course for physicians and hospital providers.  The South Dakota EMSC staff also worked with the state’s Office of EMS to provide two hours of continuing education (specific to the Pediatric Emergency Response Bags) to every ambulance service through the state’s EMS education program.  Finally, Brose low/Hinkle training DVDs were provided to all directors of nursing to assist in educating emergency department staff on the new equipment system.

In partnership with the EMSC Advisory Subcommittee, the Office of EMS, and the Governor’s EMS Advisory Committee, the EMSC program was also able to update the current ambulance equipment list to reflect the ACEP equipment requirements.  The new requirement list is an established Administrative Rule, meaning that all equipment is mandatory in the inspection process for ambulance licensure.

For more information on this process, see Best Practices: A Guide for State Partnership Grantees on the Implementation of EMSC Performance Measures. (June 2009)


FAMILY AND CAREGIVER RESOURCES

EMSC National Resource Center

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 April 2010)