A needs assessment of advanced life support and emergency medical services in the pediatric patient: state of the art.

The outcome from cardiopulmonary arrest in children in the prehospital and hospital setting is generally poor. The event that compromises the cardiac status is often respiratory embarrassment, and the presenting rhythms are often bradyarrhythmias and asystole. Emergency medical services (EMS) systems have primarily an adult focus and may not be organized to manage optimally the critically ill and injured child. Data from a survey of training programs demonstrate that paramedic and EMT education in pediatric emergencies may be inadequate. Forty-one percent of the programs surveyed had less than 10 hr of pediatric training. Data suggest that EMS providers may not be equipped to manage children effectively. The Los Angeles EMS System for children is described. There are two levels of receiving facilities: Emergency Departments Approved for Pediatrics and Pediatric Critical Care Centers. The system is voluntary and has 85% of the hospitals in compliance with the guidelines. Early recognition of the prearrest state, improved training, and equipping of prehospital care personnel, development of EMS services for children, dissemination of an advanced pediatric life support course, as well as research in pediatric CPR may improve the outcome of resuscitation in the pediatric population.