Definitions and Assessment Approaches for Emergency Medical Services for Children

Abstract

Pediatric Life Support (PLS) courses and instructional programs are educational tools developed to teach resuscitation and stabilization of children who are critically ill or injured. A number of PLS courses have been developed by national professional organizations for different health care providers (eg, pediatricians, emergency physicians, other physicians, prehospital professionals, pediatric and emergency advanced practice nurses, physician assistants). PLS courses and programs have attempted to clarify and standardize assessment and treatment approaches for clinical practice in emergency, trauma, and critical care. Although the effectiveness of PLS education has not yet been scientifically validated, the courses and programs have significantly expanded pediatric resuscitation training throughout the United States and internationally. Variability in terminology and in assessment components used in education and training among PLS courses has the potential to create confusion among target groups and in how experts train educators and learners to teach and practice pediatric emergency, trauma, and critical care. It is critical that all educators use standard terminology and patient assessment to address potential or actual conflicts regarding patient evaluation and treatment. This article provides a consensus of several organizations as to the proper order and terminology for pediatric patient assessment. The Supplemental Information provides definitions for terms and nomenclature used in pediatric resuscitation and life support courses.abstract

Initial assessment, level of care and outcome among children who were seen by emergency medical services: a prospective observational study

“…This indicates that the RETTS-p is not feasible in the pre-hospital setting for all patients since it is not applied systematically. Other instruments such as the Patient assessment triangle (PAT) may be a viable alternative in the pre-hospital setting together with an A-E survey [ 48 ]. The PAT is a less complex tool and has shown to be reliable, accurate and easy to use at the initial assessment to evaluate the clinical status [ 49 – 51 ].…”

Assessment of Inadequate Use of Pediatric Emergency Medical Transport Services: The Pediatric Emergency and Ambulance Critical Evaluation (PEACE) Study

“…“Medically indicated” was defined as “A sudden and usually unforeseen event that calls for immediate measures to minimize its adverse consequences” (18, 19). Immediate means that 95% of the emergency patients have to be seen by EMTS within 20 min of receipt of emergency call.…”

National guideline for the field triage of injured patients: Recommendations of the National Expert Panel on Field Triage, 2021

“…The panel included “respiratory distress” to facilitate EMS training on important examination findings that precede the need for respiratory support, particularly in children. 53 – 55 …”

“…Because hypotension is a late finding of pediatric shock (decompensated shock), EMS training on the use of visual cues (e.g., pallor, mottling, cyanosis) is encouraged, as represented in the Pediatric Assessment Triangle. [53][54][55] • New criterion: "Respiratory distress or need for respiratory support" replaces "need for ventilatory support" and "respiratory rate <20 in infant aged <1 year." Rationale: The criterion "need for ventilatory support" was added in 2011 6 based on three studies showing that need for airway management and assisted ventilation was highly predictive of serious injury and death.…”

“…The panel included "respiratory distress" to facilitate EMS training on important examination findings that precede the need for respiratory support, particularly in children. [53][54][55] • New criterion: Room-air pulse oximetry <90% Rationale: Pulse oximetry is widely available on portable monitors used by EMS and has been evaluated in five studies, with most using a cut point of <90%. 35 Pulse oximetry had AUROC values of 0.59 to 0.76 for identifying patients with serious injury, similar to the respiratory rate criterion.…”