bilitating drugs or alcohol, language, culture, or apprehension and anxiety about the need for emergency care.

Less research has been conducted on threats to patient safety in the EMS environment (O’Connor et al., 2002), although that environment is similar to the ED in many ways (Fairbanks, 2004): the fast-paced nature of the work, the stressful environment for providers, and the shift work and round-the-clock coverage that contribute to provider fatigue. EMTs also lack complete and/or accurate medical histories of patients. However, EMS personnel must also contend with a different set of challenges. They often have to provide patient care in unusual locations, such as on the side of a road or highway or close to a crash scene. EMS personnel also have fewer options for backup. Many EDs have physicians to make diagnosis and develop treatment plans, nurses to start intravenous (IV) treatment and administer medications, technicians to take patients’ blood pressure and pulse, social workers to talk with families, a secretary to complete billing information, and specialists that can be called in to assist with complex interventions. EMTs and paramedics in the field, by contrast, have no backup, other than perhaps the muscle and moral support of first-responding firefighters or other rescue personnel. Sometimes EMTs perform all of these tasks alone as a first responder or in the back of an ambulance. Thus the EMS environment lacks even the meager redundancies and system protections found in the ED that occur with a team approach to patient care. Additionally, much of the equipment used by EMTs was designed for in-hospital use and has not been well adapted for the EMS environment (Fairbanks, 2004).

Additional Challenges for Pediatric Emergency Care

Most of the above challenges contribute to a potentially unsafe emergency care environment for all patients, not just children. However, other factors complicate care for children more than that for adults. First, some children are preverbal and cannot self-report their symptoms. Many have multiple caregivers, which increases the likelihood that providers will be given an incomplete or inaccurate medical and medication history. Also, children are likely to be accompanied by parents or guardians suffering from great anxiety, which requires staff to attend to them while also staying focused on the patient (Chamberlain et al., 2004). Young children, particularly those who are frightened or in pain, are unable to cooperate with the examiner or understand the process of care, and may actively resist the performance of painful or uncomfortable procedures. As a result, pediatric providers must use a variety of tactics, including use of short-acting sedatives and other hazardous drugs, to complete treatment successfully.

Timeliness represents another important challenge for pediatric patients in the emergency care setting. The emergency care system must be

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