Pediatric Readiness in Emergency Medical Services Systems

Brian Moore; Manish I. Shah; Sylvia Owusu-Ansah; Toni Gross; Kathleen Brown; Marianne Gausche-Hill; Katherine Remick; Kathleen Adelgais; John Lyng; Lara Rappaport; Sally Snow; Cynthia Wright-Johnson; Julie C. Leonard; and the AMERICAN ACADEMY OF PEDIATRICS COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE AND SECTION ON EMERGENCY MEDICINE EMS SUBCOMMITTEE; AMERICAN COLLEGE OF EMERGENCY PHYSICIANS EMERGENCY MEDICAL SERVICES COMMITTEE; EMERGENCY NURSES ASSOCIATION PEDIATRIC COMMITTEE; NATIONAL ASSOCIATION OF EMERGENCY MEDICAL SERVICES PHYSICIANS STANDARDS AND CLINICAL PRACTICE COMMITTEE; NATIONAL ASSOCIATION OF EMERGENCY MEDICAL TECHNICIANS EMERGENCY PEDIATRIC CARE COMMITTEE

doi:10.1542/peds.2019-3307

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RE: Pediatric Readiness in Emergency Medical Services Systems
Richard H. Flyer, MD, FAAP

Published on: 20 January 2020

Published on: (20 January 2020)

RE: Pediatric Readiness in Emergency Medical Services Systems
Richard H. Flyer, MD, FAAP, general pediatrician, retired, AAP--NJ chapter
To the Editor, The recent policy statements1,2,3 on pediatric readiness in EMS systems and emergency departments restate what has been obvious for the last seventy years, namely, that we as a nation have failed our sickest children.
While individual elements of a system of emergency medical care for children exist in our country, they need to be coordinated in a seamless fashion. For those children who are identified as critically ill or injured, a single call should assure them a prehospital and hospital response that is appropriate to their needs. Here is a possible solution to the problem, an outline for creating a system of emergency medical care for pediatric patients using telemedicine.
A call to 911 will bring a police officer (or other first responder) to the child patient within seconds to minutes. That officer will wear a body camera that transmits real-time audio and video feeds to a virtual pediatric emergency medicine command center. The pediatric emergency physician at the command center will, according to the latest science on pediatric prehospital care, direct the officer’s first acts to treat the child. When the EMTs and paramedics arrive, the officer’s body camera will continue to serve as a broadcaster of the scene; and the officer will continue as a conduit of the physician’s instructions.
The command center will have current data about travel times. The center physician will also know the capabilities of area hospitals with respec...
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To the Editor, The recent policy statements1,2,3 on pediatric readiness in EMS systems and emergency departments restate what has been obvious for the last seventy years, namely, that we as a nation have failed our sickest children.
While individual elements of a system of emergency medical care for children exist in our country, they need to be coordinated in a seamless fashion. For those children who are identified as critically ill or injured, a single call should assure them a prehospital and hospital response that is appropriate to their needs. Here is a possible solution to the problem, an outline for creating a system of emergency medical care for pediatric patients using telemedicine.
A call to 911 will bring a police officer (or other first responder) to the child patient within seconds to minutes. That officer will wear a body camera that transmits real-time audio and video feeds to a virtual pediatric emergency medicine command center. The pediatric emergency physician at the command center will, according to the latest science on pediatric prehospital care, direct the officer’s first acts to treat the child. When the EMTs and paramedics arrive, the officer’s body camera will continue to serve as a broadcaster of the scene; and the officer will continue as a conduit of the physician’s instructions.
The command center will have current data about travel times. The center physician will also know the capabilities of area hospitals with respect to critically ill or injured child patients. Once the patient has been stabilized, the pediatric emergency medicine physician will make a decision about the most appropriate mode of transport, ground or air, and transport destination.
Our hospitals must be made transparent about their capabilities to treat the sickest children. They must be categorized and regulated so that no child is knowingly brought for critical care to a building that is incapable of optimally delivering that care. If a child is brought to a hospital that is not part of the EMS system for children, that emergency department will be linked via telemedicine to the virtual pediatric emergency medicine command center, and that child then stabilized and transported as needed.
There are currently companies working on the telecommunications systems necessary to realize that portion of the EMS system for children. And our country will soon have a 5G data highway4 dedicated to first responders’ use. The telemedicine elements of the EMS system for children will be ours for the asking. New Jersey had the first EMS for Children law in 19925. Using that law we are presently working to create the first comprehensive statewide EMS system for children. And we are beginning to educate the public about our project, for without the public’s support we will have less of a chance of succeeding at this most urgent and important task.
I exhort all in the EMS and pediatric emergency medicine communities to embrace these concepts for saving children’s lives—our child patients are waiting.

R. H. Flyer, MD, FAAP 20 January 2020

1Moore B, Shah MI, Owusu-Ansah S, et al. AAP and the AMERICAN ACADEMY OF PEDIATRICS COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE AND SECTION ON EMERGENCY MEDICINE EMS SUBCOMMITTEE, AAP AMERICAN COLLEGE OF EMERGENCY PHYSICIANS EMERGENCY MEDICAL SERVICES COMMITTEE, AAP EMERGENCY NURSES ASSOCIATION PEDIATRIC COMMITTEE, AAP NATIONAL ASSOCIATION OF EMERGENCY MEDICAL SERVICES PHYSICIANS STANDARDS AND CLINICAL PRACTICE COMMITTEE, AAP NATIONAL ASSOCIATION OF EMERGENCY MEDICAL TECHNICIANS EMERGENCY PEDIATRIC CARE COMMITTEE. Pediatric Readiness in Emergency Medical Services Systems. Pediatrics. 2020;145(1):e20193307

2Remick K, Gausche-Hill M, Joseph MM, et al; AMERICAN ACADEMY OF PEDIATRICS Committee on Pediatric Emergency Medicine and Section on Surgery, AMERICAN COLLEGE OF EMERGENCY PHYSICIANS Pediatric Emergency Medicine Committee, EMERGENCY NURSES ASSOCIATION Pediatric Committee. Pediatric Readiness in the Emergency Department. Pediatrics. 2018;142(5):e20182459

3Owusu-Ansah S, Moore B, Shah MI, et al. AAP COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE, SECTION ON EMERGENCY MEDICINE, AAP EMS SUBCOMMITTEE, SECTION ON SURGERY. Pediatric Readiness in Emergency Medical Services Systems. Pediatrics. 2020;145(1):e20193308

4“firstnet.gov/about” FirstNet First Responder Network Authority, United States Department of Commerce
5NJSA 26: 2K—48 et seq.
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Competing Interests: None declared.