Spring 2026

A new national EMS pediatric readiness assessment establishes the first U.S. benchmark for how prepared 911 responding EMS and fire rescue agencies are to care for children.

For academic emergency medicine leaders, the findings move pediatric readiness from a conceptual goal to something that can now be measured and tracked. The findings were recently published in the Annals of Emergency Medicine.

Across nearly 7,000 EMS agencies nationwide, the median Prehospital Pediatric Readiness Score was 65.5 out of 100. Readiness was strongest in equipment, safety, and policies, and weakest in family-centered care, quality improvement, and system integration. Agencies with a pediatric emergency care coordinator had significantly higher readiness scores across all domains. The study was conducted through the National Prehospital Pediatric Readiness Project (PPRP).

While nationally coordinated, pediatric readiness is implemented locally within regional systems of care that connect EMS agencies, referral hospitals, trauma centers, and academic emergency departments.

“Hospitals and EMS agencies in each region should collaborate to discuss their agency-specific gaps identified in the assessment. They can implement solutions using regional pediatric expertise and the comprehensive, curated resources available in the Prehospital Pediatric Readiness Project toolkit,” said Dr. Manish Shah, professor of emergency medicine at Stanford and senior author on the publication.

What the National EMS Pediatric Readiness Score Reveals

The assessment used a 207-question survey aligned with national recommendations for out-of-hospital pediatric care and scored agencies across eight domains

• Education and competencies

• Equipment and supplies

• Patient and medication safety

• Patient- and family-centered care

• Coordination of care

• Interactions with systems of care

• Policies, procedures, and protocols

• Quality and performance improvement

The findings underscore significant room for improvement, with substantial variation across agencies. Equipment and policies scored near the top of their ranges, while quality improvement and systems integration were among the lowest.

The gaps highlight areas where EMS agencies have opportunities to better integrate key principles into frontline practice, including:

• Patient- and family-centered care: strengthening family engagement during transport and resuscitation and expanding access to language services
  
  
• Quality and performance improvement: monitoring pediatric outcomes through linked EMS and hospital data
  
  
• Interactions with systems of care: improving regional coordination to ensure children are transported to facilities equipped to manage trauma, critical illness, mental health emergencies, and mass casualty incidents

Noting that the availability of equipment and protocols scored substantially higher than quality improvement and systems of care domains, Shah commented, “Many EMS systems have the basic tools they need to provide pediatric care, but opportunities exist to improve and integrate pediatric care into the broader emergency care infrastructure.”

For emergency medicine leaders, this distinction is critical. Many EMS agencies appear to have the necessary pediatric equipment and written guidance. The larger challenge is building continuous quality improvement infrastructure, strengthening cross-system coordination, and integrating pediatric care into broader EMS frameworks.

The Pediatric Emergency Care Coordinator (PECC) as a Systems Lever

Only 38 percent of responding agencies reported having a pediatric emergency care coordinator. However, the presence of this role was strongly associated with higher EMS pediatric readiness scores across domains, including agencies achieving top performance.

Pediatric emergency care coordination can offer a practical way to improve systems of care, particularly in regions anchored by academic emergency medicine departments.

The role can ensure integration of pediatric needs into policies and protocols, the promotion of pediatric-specific continuing education and quality improvement initiatives, and collaboration with other agencies and hospitals to integrate pediatric needs across the emergency care continuum.

From Readiness Measurement to Pediatric Outcomes

The assessment measures readiness rather than patient-level outcomes. It establishes a national baseline but does not determine whether higher EMS pediatric readiness translates into improved clinical outcomes for children.

“To determine whether higher pediatric readiness translates into better outcomes, we would need to link readiness data with patient-level outcome data,” Shah said.

For academic emergency medicine leaders, the implications are clear. The field now has a standardized EMS pediatric readiness score and clearly identified areas for improvement. Opportunities for improvement will vary from one EMS agency to another; EMS agencies are encouraged to analyze their gap report after completing the 2024 assessment. Those who have not yet done so are encouraged to download and complete the assessment.

Emergency departments play a vital role in their regional systems of care, so partnering with EMS agencies to address these regional gaps in prehospital pediatric readiness has potential for measurable gains in safety, timeliness, and improved patient outcomes.

This national assessment, launched in 2024 through the federally funded Emergency Medical Services for Children Program within the Health Resources and Services Administration and supported by more than 30 national organizations, now provides both a benchmark and a framework for coordinated systems improvement across the prehospital and hospital interface.