Prehospital Education


In its series on the Future of Emergency Care (2007), the Institute of Medicine (IOM) reported deficiencies in the quality of prehospital pediatric emergency care resulting from the infrequent encounters with critical pediatric patients coupled with inadequate initial and continuing pediatric education. Furthermore, the report cited limited experience and training as a significant factor in previous studies indicating that prehospital providers are uncomfortable providing care for pediatric patients, particularly infants. Based on these findings, the IOM recommended that “every pediatric- and emergency care-related health professional credentialing and certification body should define pediatric emergency care competencies and require practitioners to receive the level of initial and continuing education necessary to achieve and maintain those competencies.”

Over the past decade, implementation of the National EMS Education Agenda for the Future: A Systems Approach (2000) has led to significant improvements in overall education standards for prehospital emergency providers, including the development of a National Scope of Practice Model, an accreditation program for the initial training of paramedic-level providers (the highest EMS certification recognized in most states), and the National EMS Education Standards that incorporates pediatric core content. However, pediatric –specific education for EMS providers remains uneven. Of 55 states and territories that submitted data to the Emergency Medical Services for Children (EMSC) Program in 2013, pediatric-specific continuing education for Basic Life Support (BLS) providers was not required for recertification or re-licensure in 12 states/territories or for Advanced Life Support (ALS) level providers in 10 states/territories. In those states and territories that did require pediatric continuing education, the number of hours required for recertification ranged from 0 (unstipulated) to 10 for BLS providers with an average of 4 hours, and from 0 (unstipulated) to 16 for ALS with an average of 8 hours.

This toolbox provides resources to assist EMSC program managers, prehospital emergency care professionals, and EMS educators and medical directors to identify educational needs, develop curricula, and establish policy and standards to ensure that prehospital professionals have the knowledge and skills necessary to provide safe, effective, family-centered emergency care for children.


HEALTHCARE PROVIDER RESOURCES

Center for Pediatric Emergency Medicine

More details about this and other provider resources

EXAMPLE PRACTICES: MODEL PROGRAMS

More details about these model programs

DATABASE SEARCHES

National Library of Medicine PubMed journal article database

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FAMILY AND CAREGIVER RESOURCES

Children's Hospital of Philadelphia 

  • AftertheInjury.org. This website has been designed to help parents learn what to expect and what they can do to help their child recover from an injury. This online parent resource provides healthcare professionals an alternative way to communicate to parents who, at the time of injury, may not be able to absorb all that there is to know. (2009)

More details about this and other family and caregiver resources

HEALTHCARE PROVIDER RESOURCES

American Academy of Pediatrics

  • PEPP: Pediatric Education for Prehospital Professionals. This curriculum instructs prehospital providers such as first responders, emergency medical technicians (EMTs), and paramedics in how to better assess and manage ill or injured infants and children.  The one- and two-day courses are designed to meet the minimum standards related to the pediatric portion of the U.S. Department of Transportation’s National Standard Curriculum. Additionally, hybrid courses are now available for ALS and BLS providers to combine online learning with hands-on practice in the classroom. While the PEPP website includes links to full course materials available for purchase, interested parties have the opportunity to view sample course material through free online previews of initial and renewal PEPP courses. (Accessed November 2013)

American Heart Association

  • Basic Life Support (BLS) Online Training Courses. The American Heart Association (AHA) offers two different online BLS courses to accommodate different learning styles. Both courses cover adult rescue breathing, adult bag-mask use, adult cardiopulmonary resuscitation (CPR)/automated external defibrillator (AED) - one rescuer, adult CPR/AED - two rescuers, adult relief of choking, child rescue breathing, child bag-mask use, child CPR, child relief of choking, infant rescue breathing and choking, infant bag-mask use, and infant CPR. (Accessed October 2013)

  • Pediatric Advanced Life Support (PALS). PALS is a classroom, video-based, Instructor-led course that uses a series of simulated pediatric emergencies to reinforce the important concepts of a systematic approach to pediatric assessment, basic life support, PALS treatment algorithms, effective resuscitation, and team dynamics. The goal of PALS is to improve the quality of care provided to seriously ill or injured children, resulting in improved outcomes. (Accessed October 2013)

  • Circulation: 2010 American Heart Association Guidelines for the Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science Guidelines for Cardio. The 2010 AHA guidelines for CPR build on half a century of modern cardiopulmonary resuscitation science. These guidelines are based on the 2010 International Liaison Committee on Resuscitation (ILCOR) International Consensus on CPR and ECC Science with Treatment Recommendation and include recommendations for both adult and pediatric resuscitation as well as a discussion of the science behind them. (November 2010)

Center for Pediatric Emergency Medicine

  • Child Abuse and Neglect: A Prehospital Continuing Education and Teaching Resource. Based on a national survey of what EMS providers need to know about child abuse and neglect, this resource is designed to assist instructors of prehospital personnel in providing students with the information they need to sensitively and confidently attend to the needs of this vulnerable population. This resource focuses on such topics as risk factors associated between the child, parents, and society; role of pre-hospital medical providers; high risk families and situations; importance of documentation; and medicolegal issues. (2003)
  • Teaching Resource for Instructors in Prehospital Pediatrics (TRIPP), Second Edition. This course supports instructors of prehospital personnel to provide comprehensive training in the assessment and treatment of critically ill and injured children. Second Edition TRIPP incorporates the most recent guidelines of the American Heart Association, and includes several new chapters addressing such topics as cultural competence and family-centered care, as well as expanded information on disaster management.  (2008)

  • Teaching Resource for Instructors in Prehospital Pediatrics for Paramedics. A sequel to the Teaching Resource for Instructors in Prehospital Pediatrics (TRIPP), the paramedic version expands the scope of prehospital practice from basic to advanced life support procedures for children. Neither a course nor a curriculum, the Paramedic TRIPP is an encyclopedic resource that empowers instructors of ambulance personnel to provide comprehensive training in the assessment and treatment of critically ill and injured children. (2008)

  • Pediatric Disaster Preparedness: A Resource for Planning, Management and Provision of Out-of-Hospital Emergency Care. This resource focuses on pediatric prehospital emergency care in EMS system planning for disasters and terrorism. It is designed for use by EMS agency and system medical directors and administrators, emergency managers, and other stakeholders who will be concerned with the functions and activities of EMS care providers during a disaster, terror event, or other public health emergency.  This resource can also be used by other pediatric health care providers, public health professionals, health administrators, and policy makers who are committed to ensuring that planning for terrorism and disasters includes the special needs of children. (2008)

Committee on Accreditation of Educational Programs for the Emergency Medical Services

  • The Committee on Accreditation of Educational Programs for the Emergency Medical Services (CAEPEMS). CAEPEMS works to advance the quality of EMS education through the Commission on Accreditation of Allied Health Education Programs (CAAHEP). CAAHEP and the American Academy of Pediatrics (AAP), the American College of Cardiology, the American College of Emergency Physicians, the American College of Osteopathic Emergency Physicians, the American College of Surgeons, the American Society of Anesthesiologists, the National Association of Emergency Medical Services Educators, the National Association of Emergency Medical Technicians, the National Association of State Emergency Medical Services Directors, and the National Registry of Emergency Medical Technicians cooperate to establish, maintain, and promote appropriate standards of quality for educational programs in the EMS professions and to provide recognition for educational programs that meet or exceed the minimum standards outlined in these accreditation standards. Lists of accredited programs are published for the information of students, employers, educational institutions and agencies, and the public.

EMSC National Resource Center

  • Education and Training. This section of the Emergency Medical Services for Children (EMSC) National Resource Center (NRC) website is geared towards individuals who are interested in obtaining EMSC-focused training online. The EMSC NRC has compiled a listing of all available EMSC webcasts, video/audio podcasts, and web-based training modules that were created using EMSC federal program funds. The various training opportunities address topics ranging from EMSC performance measures to pediatric medication safety and from family-centered care to pediatric disaster preparedness, to name a few.

Illinois Emergency Medical Services for Children

  • Pediatric Mild Traumatic Head Injury. This module targets all health care providers who care for children. The course addresses: principles and standards underlying safe and effective pediatric moderate sedation, reviews commonly used sedating/analgesic agents, reviews potential pediatric complications, and highlights adjuncts to sedation.(December 2010)

  • Pediatric Moderate Sedation. This module highlights the principles and standards underlying safe and effective pediatric moderate sedation. The module targets all health care providers who care for children. The course contains 10 narrated chapters along with appendices that contain additional resources. Key areas of focus include recommendations for appropriate triage/management of mild traumatic head injuries, guidelines for neuroimaging, child maltreatment screening, patient education, and head injury prevention strategies. (2009)

National Association of EMS Educators

  • National Association of EMS Educators (NAEMSE). NAEMSE is a 501 ( c ) non-profit educational association that has been incorporated since 1995. It is a professional membership organization that is made up of more than 3,000 EMS educators, both nationally and internationally, that include instructors, program directors, deans, training officers, EMS physicians, EMS nurses, and EMS state officials. It is governed by a board of directors and the home office headquartered in Pittsburgh, PA. The mission of tNAEMSE is to inspire and promote excellence in EMS education and lifelong learning within the global community.

National Association of Emergency Medical Technicians

  • Emergency Pediatric Care (EPC). This course focuses on the care of sick and injured children, addressing a full spectrum of emergency illnesses, injuries, and scenarios that an EMS practitioner might encounter. The course provides an in-depth understanding of the pathophysiology of the most common pediatric emergency issues, and stresses critical thinking skills to help practitioners make the best decisions for their patients. EPC is for all EMTs and paramedics committed to providing quality care for pediatric patients. (Accessed November 2013)

  • Prehospital Trauma Life Support (PHTLS). This course is recognized around the world as the leading continuing education program for prehospital emergency trauma care. The mission of PHTLS is to promote excellence in trauma patient management by all providers involved in the delivery of prehospital care through global education. PHTLS is developed by NAEMT in cooperation with the American College of Surgeons' Committee on Trauma. The Committee provides the medical direction and content oversight for the PHTLS program. PHTLS is available in traditional on-site and hybrid web-based courses.

National Disaster Life Support Foundation

The Foundation promotes the importance of specialized training for all healthcare providers. The group works to encourage educational institutions and professional societies to provide curricular materials for broad-based and well-supervised training. (All training accessed November 2013)

  • Core Disaster Life Support (CDLS). This 3.5 hour competency-based, awareness-level course introduces clinical and public health concepts and principles for the management of disasters and public health emergencies. The course incorporates the “all-hazards” approach to personal, institutional, and community disaster management through the use of two unique mnemonics, the PRE-DISASTER Paradigm™ (which applies to event mitigation and preparedness) and the DISASTER Paradigm™ (which applies to event recognition, response, and recovery).

  • Basic Disaster Life Support (BDLS). This 7.5 hour competency-based, awareness-level course introduces concepts and principles to prepare health professionals for the management of injuries and illnesses caused by disasters and public health emergencies. The course builds upon, applies, and reinforces information presented in CDLS. The primary focus of the BDLS course is incorporation of an “all-hazards” approach to mass casualty management and population-based care across a broad range of disasters. Measures to ensure and enhance health workforce readiness are emphasized throughout the course. This includes a consistent and scalable approach to workforce protection and casualty management, as well as, mass casualty triage and fatality management.

  • Advanced Disaster Life Support and Instructor Course (ADLS).  This intense 15-hour course allows participants to demonstrate competencies in mass casualty management. Core education elements include the ADLS manual and five interactive lectures (Disasters and Public Health Emergencies, Triage in Disasters and Public Health Emergencies, Health System Surge Capacity for Disasters and Public Health Emergencies, Community Health Emergency Operations and Response, and Legal and Ethical Issues in Disasters). Essential training components include population scenarios discussion, mass casualty triage tabletop and situational training exercises, surge tabletop scenario for a health care facility, personal protective equipment skills performance and decontamination video review, casualty management in small groups with simulated scenarios, and emergency operations center situational training exercise. ADLS requires learners to apply knowledge learned in CDLS and BDLS courses.

National Highway Traffic Safety Administration

  • Education. The National Highway Traffic Safety Administration's Office of EMS (OEMS) is dedicated to promoting a sufficient, stable, and well-trained EMS workforce, as well as enhancing the health and safety of all EMS providers. To this end, OEMS supports workforce research and develops resources designed specifically for EMS providers. This site includes the Education Agenda for the Future: A Systems Approach, National EMS Core Content, National Scope of Practice Model, National EMS Education Standards, and instructional guidelines for all EMS provider levels.

Tennessee Emergency Medical Services for Children

  • Pediatric Disaster Online Courses. Tennessee developed six courses targeting healthcare professions – Children with Special Needs: Considerations for Healthcare Professionals; Disaster Preparedness for Schools; Preparing for Explosion and Blast injuries; Responding to Bioterrorism; Responding to Chemical Incidents; and Responding to Radiation Disasters – and two courses targeting the general public – Family Preparedness and Family Preparedness Supplement: Children with Special Needs. (2012)

University of New Mexico, Department of Pediatric Emergency Medicine

  • A Multi-Systems Approach to Pediatric Trauma Course. This eight-module course targets all healthcare providers and addresses trauma to the head, neck, spine, abdomen, and chest, as well as multi-system trauma and multiple-patient incidents. (Accessed October 2013)

  • Pediatric Emergencies Course. This virtual online course for all healthcare providers presents pediatric medical emergency scenarios and their emergency medical management. (Accessed October 2013)

  • EMSC Partnership Course. This course primarily targets prehospital EMS personnel and includes 11 modules: Pediatric Seizures; Diabetes in Children Blunt Chest Trauma: Commotio Cordis; Methamphetamine in Children; Children with Special health care Needs (CSHCN): Down Syndrome; Child Abuse/Shaken Baby Syndrome; Children with Special Health Care Needs: Technological Dependent; ;Poisoning:Toxic Exposure; Adrenal Crisis and EMS; Safe Transportation of Children in EMS Vehicles: Part 1; and Safe Transportation of Children in EMS Vehicles: Part 2. (Accessed October 2013)


EXAMPLE PRACTICES: MODEL PROGRAMS


FAMILY AND CAREGIVER RESOURCES

Children's Hospital of Philadelphia

  • AftertheInjury.org.  This website has been designed to help parents learn what to expect and what they can do to help their child recover from an injury. This online parent resource provides healthcare professionals an alternative way to communicate to parents who, at the time of injury, may not be able to absorb all that there is to know. (Accessed November 2013)

American Heart Association

  • Family & Friends CPR Anytime Personal Learning Program. TThis resource allows families, friends, and the general public to learn the core skills of CPR in just 20 minutes using their own personal kit. The kit contains everything needed to learn basic CPR, AED skills, and choking relief from the comfort of a family home or in a large community group setting. This kit does not provide certification in CPR. (October 2013)

American Red Cross

  • Learn About Our Programs. The American Red Cross is a 501(c) (3) organization focused on preventing and relieving suffering, at home and around the world, in five key service areas: disaster relief; supporting military families; supplying blood and blood products; health and safety services, including CPR and first aid training; and global humanitarian services. Here you can learn about American Red Cross programs and find a variety of training classes

  • Infant CPR Anytime. This kist targets new parents, grandparents, family members and anyone who wants to learn lifesaving infant CPR and choking skills but does not need a course completion card. This kit also is used in hospitals to teach skills to new parents, while allowing nursing staff to focus on patient care. (October 2013)

EMSC National Resource Center

  • How to Get Help for A Sick or Injured Child (English) (Spanish). This resource helps families and caregivers learn the importance of knowing how to handle an emergency situation dealing with a sick or injured child. In this fact sheet, you will find information on types of emergencies, what are not emergencies, whether to dial local emergency number or 911, and other useful information. This document is also available in Spanish. (2006)

  • What to Do Until Help Arrives for A Child Medical Emergency (English) (Spanish). This fact sheet provides you with basic steps that could help save a child’s life. It includes information on what you should do and what you should not do in several types of emergencies, such as choking, eating or drinking a poison, severe bleeding, breathing problems, burns, seizures, loss of consciousness, falls, and crashes. (2006).

Tennessee Emergency Medical Services for Children

  • Family Preparedness Online Course. This course has been designed to help families in understanding why a family preparedness plan is vital by walking through the items needed for your family disaster supply kit. The course will assist in recognizing the significance of a pre-plan evacuation route and will even identify disaster preparedness concerns for your family pets. (2012)

  • Family Preparedness Supplement for Children with Special Needs. This course will assist you in understanding what necessities are beyond your family’s disaster preparedness plan. It will aid you in pre-planning for both evacuation and staying at home during a disaster event. (2012)