skills is a challenge because many providers have infrequent contact with critically ill and injured children; only rarely do they perform ALS interventions on children. Surveys indicate that prehospital providers find the age group birth to 3 years most concerning and support increased continuing education in pediatric emergency care (Glaeser et al., 2000). Additionally, the majority of pediatric visits occur at general EDs (Gausche et al., 1995), which are less likely than specialized facilities to have providers specifically trained in pediatric emergency medicine. Anecdotal accounts of physicians expressing doubt about their skills to care for a critically ill or injured child are not uncommon (Frush and Hohenhaus, 2004). The abilities of emergency care providers to address the needs of children are discussed further in Chapter 4.

Essential Tools

The IOM committee that developed the 1993 report was concerned by reports that emergency providers lacked the equipment necessary to care properly for children and recommended that pediatric equipment and supplies be made more widely available. Since the release of the 1993 report, professional organizations have continued to update guidelines on essential and recommended equipment and supplies, and many states have used funding from the EMS-C program to purchase pediatric equipment. While some progress has been made, however, deficiencies in pediatric equipment and supplies remain a problem for some providers. The average ED has about 80 percent of the recommended pediatric supplies, and only 6 percent of the nation’s EDs are fully equipped to care for children (Middleton and Burt, 2006). Some data indicate that there was no increase in the availability of pediatric equipment in EDs between 1998 and 2002 (Middleton, 2005).

Research on the availability of the pediatric supplies and equipment recommended for prehospital providers has been limited primarily to studies of regions or states, and no recent data are available. A 1993 study of EMS ambulance agencies in Oklahoma found that deficiencies in equipment needed for pediatric emergencies were common (Graham et al., 1993). A 1998 study of compliance with the guidelines of the Committee on Ambulance Pediatric Equipment and Supplies in Kansas revealed that only 5 percent of ambulance services reported having essential equipment on all vehicles; 92 percent of agencies failed to achieve compliance with the guidelines on any vehicle. The most frequently lacking pediatric basic life support (BLS) items were stethoscopes (58 percent), traction splints (53 percent), and non-rebreather masks (45 percent). The most frequently lacking pediatric ALS items were nasogastric tubes (75 percent), monitor electrodes (50 percent), and Magill forceps (41.7 percent) (Moreland et al., 1998). Again, there is

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