TOPLINE:

The first national assessment of pediatric emergency medical services (EMS) in the US reported modest readiness. Gaps were noted in quality improvement, family-centered care, and coordination with systems of care. Agencies with a pediatric emergency care coordinator (PECC) had more than fivefold higher odds of achieving perfect readiness scores in the lowest-performing domains.

METHODOLOGY:

• Researchers conducted a cross-sectional analysis of data from 6989 EMS agencies across the US that responded to 911 emergency calls. Data were collected in 2024 as part of the first national assessment of the National Prehospital Pediatric Readiness Project.
• The assessment included 207 questions across eight domains of out-of-hospital readiness: education and competencies; equipment and supplies; patient and medication safety; patient- and family-centered care; policies, procedures, and protocols; quality improvement and performance improvement; interaction with systems of care; and coordination of pediatric emergency care.
• The survey was distributed to 15,293 EMS agencies, of which 46% responded. Approximately 75% of agencies reported low pediatric call volumes (≤ 12 pediatric calls annually) or medium pediatric call volumes (13-100 calls annually).
• The primary outcome was the overall and domain-specific prehospital pediatric readiness score (PPRS) across all participating EMS agencies. Researchers also assessed median scores by annual pediatric call volume and the association between having a PECC and achieving perfect domain scores.

TAKEAWAY:

• The median PPRS across all responding agencies was 65.5 out of 100 (IQR, 50.9-78.8).
• Median scores were highest in the domains of equipment (12.0; IQR, 12-12), policies (11.5; IQR, 10-12), and safety (11.9; IQR, 7-14) and lowest in the domains of family-centered care (5.8; IQR, 2-8), quality improvement (5.7; IQR, 3-9), and interaction with systems of care (4.9; IQR, 3-7).
• Agencies with a PECC had higher odds of achieving perfect domain scores, with the strongest associations in the lowest-scoring areas: interaction with systems of care (odds ratio [OR], 5.63; 95% CI, 4.38-7.31), quality improvement and performance improvement (OR, 5.00; 95% CI, 3.64-6.9), and patient- and family-centered care (OR, 3.09; 95% CI, 2.71-3.52).
• Only 38.1% of responding agencies reported having a PECC, and 51.6% reported conducting skill checks with pediatric equipment at least twice per year.

IN PRACTICE:

"We found that the overall Prehospital Pediatric Readiness Score among US EMS agencies is 65.5, with notable gaps in readiness in areas of quality improvement and broader interactions in systems of care. A critical next step is to conduct validation studies that examine the association between higher Prehospital Pediatric Readiness Score scores and patient outcomes," the authors wrote.

SOURCE:

The study was led by Kathleen M. Adelgais, MD, University of Colorado School of Medicine, Aurora, Colorado. It was published online on February 21, 2026, in the Annals of Emergency Medicine.

LIMITATIONS:

The study was limited by the fact that the PPRS was based on a consensus process from national experts and required further validation studies to examine its association with clinical outcomes among children with acute illness or injury. The assessment relied on self-reported responses, which may have represented only a single individual's perspective at each responding agency at a specific point in time. Notable differences existed between respondents and nonrespondents, with a higher proportion of advanced life support and transporting agencies in the sample, potentially overestimating true readiness. Not all EMS agencies that completed the assessment provided transport services, though some questions pertained to patient transport considerations. Scores were not normalized based on transport status, which may have resulted in lower scores for nontransporting agencies.

DISCLOSURES:

The study authors were funded by the Maternal and Child Health Bureau. No conflicts of interest were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.