ported mandated pediatric continuing education, approximately half said there were no barriers to obtaining this training. However, 23 percent of EMT-Bs, 21 percent of EMT-Is, and 13 percent of EMT-Ps said that continuing education was not available. Other common barriers cited included costs of continuing education courses, which are frequently borne by the EMTs themselves rather than their EMS agency, and the distance to the courses. Only a small percentage of EMTs said their medical director was not interested in increasing pediatric continuing education or that pediatric facilities were not cooperative (Glaeser et al., 2000).

Maintenance of Pediatric Skills

Exercising skills in real life is important to reinforce training (Wood et al., 2004). One of the challenges faced by EMTs in keeping their pediatric skills sharp is that they rarely have the opportunity to practice lifesaving procedures in real situations (Gausche-Hill, 2000). Children represent only 5–10 percent of all prehospital calls (Seidel et al., 1984; Federiuk et al., 1993); of those pediatric calls, only 12 percent involve the need for pediatric ALS (PALS) (Seidel et al., 1984). Only a small percentage of EMTs identify field experience as the main source for their pediatric knowledge and skills. This is not surprising considering that fewer than 3 percent of all EMTs care for more than 15 pediatric patients during a typical month, and perhaps only 1 of these patients needs ALS care. In one survey, 87 percent of EMT-Bs, 84 percent of EMT-Is, and 60 percent of EMT-Ps said they treated fewer than 4 pediatric patients per month (Glaeser et al., 2000).

Several studies have revealed how infrequently EMTs have the opportunity to practice certain interventions in the field. In an analysis of ALS prehospital provider calls in Boston, Massachusetts, Babl and colleagues (2001) found that ALS providers delivered on average one bag mask ventilation every 1.7 years, one intubation every 3.3 years, and one intraosseous access (placement of a needle into a bone to give fluid for resuscitation) every 6.7 years (Babl et al., 2001). Similarly, Gausche (1997) concluded that it would take at least 20 years for every paramedic in 11 counties in California to perform bag-valve-mask ventilation at least once on a pediatric patient (Seidel et al., 1991).

Quality of Care

Lack of initial and continuing pediatric education, coupled with the low frequency with which EMTs encounter critical pediatric patients, results in a lower level of care than should be expected of the nation’s prehospital emergency care system. Several studies have documented deficiencies in treatment for pediatric patients. In the 1980s, Seidel and colleagues (1984) found

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