Gaps identified in pediatric emergency readiness among US EMS agencies

A recent study published in Annals of Emergency Medicine as part of the National Prehospital Pediatric Readiness Project has highlighted important gaps in training, quality improvement, and care coordination for young patients in many US emergency medical services (EMS) agencies.¹

According to Kathleen Adelgais, MD, MPH, professor at the University of Colorado Anschutz and lead study author, readiness was significantly greater among agencies with a pediatric emergency care coordinator (PECC). This highlights increasing the number of agencies with a PECC as a key target to improve care, as only 38% of agencies reported having one.

“There has never been a survey as comprehensive as this and that’s why we feel it is so impactful,” said Adelgais.

Current readiness performance

The study included 911-response EMS agencies across all 50 US states and several US territories, with nearly 7000 agencies responding. These agencies responded to a survey containing 207 questions.² Then, they were given a Pediatric Readiness Score between 0 and 100 based on 8 regions of pediatric readiness, including:¹

• Staff education and training
• Equipment and supplies
• Patient and medication safety
• Family-centered care
• Policies and protocols
• Quality improvement efforts
• Coordination with hospitals and public health systems
• Designated pediatric leadership

Across agencies, a median Pediatric Readiness Score of 65.5 out of 100 was reported. According to investigators, this indicates moderate readiness overall. The best scores were reported for established safety policies, clear procedures and protocols, and having the right pediatric equipment and supplies.

Measurable impact of dedicated leadership

In comparison, the worst scores were reported for family-centered care, coordination with broader health systems, and quality improvement and performance tracking. Seventy-five percent of agencies had less than 8 pediatric patients per months. According to investigators, this made it more difficult to maintain skills and systems centered on children.

Significant improvements in scores across all domains were reported for agencies with a PECC, but only 38% of agencies had an individual in this position. Improvements in agencies with a PECC included a 5-fold increase in the odds of having top scores in quality improvement and an over 5-fold increase in the odds of excelling in coordination with health systems.

Significant improvements in family-centered care were also reported among agencies with a PECC. According to investigators, this indicates having a dedicated leader in an EMS agency can make a significant difference.

Recommendations for improving outcomes

Investigators highlighted the significance of these findings, noting that children have different medical needs than adults, often requiring specialized equipment, medication dosing, communication approaches, and coordination with families and hospitals. This highlights the need to improve pediatric readiness in out-of-hospital settings.

The study also indicated potential for safer care, fewer medication errors, and better disaster preparedness by increasing pediatric readiness. Based on these findings, investigators recommended the PECC role be expanded and improvements be given to pediatric quality measurement and performance tracking.

Additionally, family-centered policies need to be increased, and disaster preparedness should be improved for pediatric patients. Finally, more research is needed about how readiness scores relate to patient outcomes.

“When emergencies happen, readiness makes all the difference,” said Adelgais.

References

1. First national report finds strengths, gaps in emergency care for children before they reach the hospital. February 26, 2026. Accessed March 4, 2026. https://www.eurekalert.org/news-releases/1117946
2. Adelgais KM, Remick KE, Hewes HA, et al. The national pediatric prehospital readiness project: First comprehensive assessment of United States emergency medical services agencies. Annals of Emergency Medicine. 2026. doi:10.1016/j.annemergmed.2026.01.013