Prehospital Pediatric Survey

1.Please enter your contact information

Name

Facility

County

Email Address

Phone Number

2.EDUCATION & COMPETENCIES FOR PROVIDERS (Check as many as necessary)

Process(es) for ongoing pediatric specific education
using one or more of the following modalities:
• Classroom/in-person didactic sessions
• Online/distributive education
• Skills stations with practice using pediatric
equipment, medication and protocols
• Simulated events

Process for evaluating pediatric-specific competencies
for the following types of skills:
Psychomotor skills, such as, but not limited to:
• Airway management
• Fluid therapy
• Medication administration
• Vital signs assessment
• Weight assessment for medication dosing
and equipment sizing
• Specialized medical equipment

Cognitive skills, such as, but not limited to:
• Patient growth and development
• Scene assessment
• Pediatric Assessment Triangle (PAT) to
perform assessment
• Recognition of physical findings in children
associated with serious illness

Behavioral skills, such as, but not limited to:
• Communication with children of various
ages and with special health care needs
• Patient and family centered care
• Cultural awareness
• Health care disparities
• Team communication

3.QUALITY IMPROVEMENT (QI)/
PERFORMANCE IMPROVEMENT (PI)

PI process includes pediatric encounters

Pediatric-specific measures are included in the PI
process

Submission of EMS agency data to the state’s
prehospital patient care database

Submitted data is compliant with the current version
of NEMSIS (version 3.x or higher)

Process to track pediatric patient centered outcomes
across the continuum of care, such as, but not limited
to:
• Transport destination
• Secondary transport destination
• ED and hospital disposition
• ED and hospital diagnoses
• Survival to hospital admission
• Survival to hospital discharge

4.EQUIPMENT AND SUPPLIES

Utilize national consensus recommendations to guide
availability of equipment and supplies to treat all
ages

Process for determining competency on available
equipment and supplies

5.PATIENT AND MEDICATION SAFETY

Utilization of tools to reduce pediatric medication
dosing and administration errors, such as, but not
limited to:
• Length based tape
• Volumetric dosing guide

Policy for the safe transport of children

Equipment necessary for the safe transport of children

6.PATIENT- AND FAMILY-CENTERED CARE IN EMS Partner with families to integrate elements of patient- and family-centered care in policies, protocols, and training, including:

Using lay terms to communicate with patients and
families

Having methods for accessing language services to
communicate with non–English speaking/nonverbal
patients and family members

Narrating actions, and alerting patients and
caregivers before interventions are performed

7.Policies and procedures that facilitate:

Family presence during resuscitation

The practice of cultural or religious customs

A family member or guardian to accompany a
pediatric patient during transport

8.INTERACTION WITH SYSTEMS OF CARE
Policies, procedures, protocols, and performance
improvement initiatives involve ongoing collaboration with:

Pediatric emergency care

Public health

Family advocates

9.Plans and exercises for disasters or mass casualty
incidents include:

Care of pediatric patients, such as, but not limited to:
• Pediatric mental health first aid
• Pediatric disaster triage
• Pediatric dosing of medications used as
antidotes
• Pediatric mass transport

Tracking of unaccompanied children

Family reunification

Collaborate with external personnel or have internal
staff focused on enhancing pediatric care, such as, but
not limited to:
• Pediatric emergency care coordinator (PECC)
• Regional PECC
• Pediatric advisory council(s)
• Medical director with pediatric knowledge
and experience

Understand pediatric capabilities at local and/or
regional emergency departments for children with
the following types of conditions:
• Medical emergency
• Traumatic injury
• Behavioral health emergency

Policies and/or procedures for transfer of
responsibility of patient care at destination

10.Does your agency offer Pediatric Advanced Life Support (PALS)

Yes

Other (please specify)

Current Progress,

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