Since the early 1990s, a number of efforts have been made to improve pediatric training opportunities for EMTs. Among the earliest courses designed specifically for EMTs was the Prehospital Trauma Life Support course, developed in 1990 by the National Association of EMTs in cooperation with the American College of Surgeons’ (ACS) Committee on Trauma. This continuing education course incorporates material on prehospital pediatric assessment and stabilization. It is an intensive 16- to 20-hour course attended by all levels of EMTs.

In 1992, the first national consensus curriculum on prehospital pediatrics was published by the California Pediatric Emergency and Critical Care Coalition, the California Emergency Medical Services for Children (EMS-C) Project, and the American College of Emergency Physicians (ACEP). The initiative grew, and in 1995 a task force produced the Pediatric Education for Paramedics (PEP) course, which built on the work of several state projects funded by the federal EMS-C program (AAP, 2005a). That course was eventually expanded by a steering committee assembled by the American Academy of Pediatrics (AAP) to serve both BLS and ALS EMTs. The result was the Pediatric Education for Prehospital Providers (PEPP) course. The BLS course consists of a minimum of 7 hours, while the ALS course is a minimum of 13 hours. In developing course recommendations, the steering committee reviewed the most current data on efficacy, safety, and feasibility. Where scientific data were not available, the steering committee used expert opinion and clinical experience in hospitals, emergency departments (EDs), and pediatric ambulatory settings to shape the course content. The course is subject to the steering committee’s ongoing review (AAP, 2005a). The first edition of the PEPP manual sold more than 100,000 copies, and the program extends into nine countries and includes more than 5,000 instructors worldwide (PEPP Program, 2006).

In the 1990s, the Maternal and Child Health Bureau (MCHB) worked with and supported NHTSA in revising the Department of Transportation’s (DOT) National Standard Curricula to ensure that the needs of children would be addressed during initial EMT education and refresher courses. The curricula for first responders, EMT-Bs, EMT-Is, and EMT-Ps were all revised. Table 4-1 shows the content of the National Standard Curricula specific to pediatrics for first responders, EMT-Bs and EMT-Is. It should be noted that there are more cognitive, affective, and psychomotor objectives related to pediatrics included in other parts of the curriculum. For example, a module on assessment-based management may include instruction related to pediatrics. Still, the number of hours dedicated to pediatrics appears low.

The National Standard Curriculum for Paramedics was developed in 1998, but the hours specific to each module are not specified. Instead, the curriculum emphasizes meeting educational objectives. The curriculum

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