A STATEWIDE EVALUATION OF PEDIATRIC PREHOSPITAL AND HOSPITAL EMERGENCY SERVICES

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 devel oped by the North Carolina Provisional Committee on Pediatric Emergenc y Medical Services and by the Office of Emergency Medical Services. Se tting and Participants: Surveys were mailed to all 572 prehospital Eme rgency Medical Service (EMS) agencies and separately to all 125 acute- care hospitals in North Carolina. Interventions: None Measurements/Mai n Results: Surveys were returned by 335 (58.6%) of the prehospital pro viders, including all 45 paramedic and 14 advanced-intermediate provid er agencies. One hundred (80%) of the acute-care hospitals returned su rveys. Only 10.8% of the prehospital EMS agencies provided more than 1 0 hours of basic training in pediatric emergency care; 18% provided mo re than 5 hours of continuing education in pediatric emergencies over a 3-year period. Pediatric-specific equipment was available in many pr ehospital vehicles, although some deficiencies were noted. Written ped iatric management, bypass, and helicopter transport protocols were abs ent in most prehospital programs. Paramedic programs generally were mu ch better in all areas, although deficiencies were present. Only 14% o f the responding hospitals had more than 20 pediatric beds; 13% report ed seeing more than 100 patients per day in the emergency department. Deficiencies were identified in pediatric patient care protocols, tria ge and transport agreements, pediatric training of nurses and physicia ns, and equipment. Equipment deficiencies were more marked in the inte nsive care units than in the emergency departments. Conclusions: These survey data are inexpensive to obtain and demonstrate EMS system defi ciencies. The survey information provides a baseline measurement that can lead to measurable, targeted changes in the state's EMS system for children.