A decade of decline in death due to motor vehicle crashes in children aged 1 to 19 years has now reversed.1 Mortality is again increasing, and injury remains the primary cause of death for children older than 1 year in the United States.1 Trauma is a ubiquitous problem, affecting children across age, geographic, and socioeconomic boundaries, but disproportionally impacts vulnerable children.2,3 The development of pediatric trauma systems as an essential component of the public health infrastructure and pediatric health systems is a relatively new concept. Although trauma system development has long been promulgated as worthy of state, regional, and national attention by the American College of Surgeons (ACS) and states, the inclusion of children and their interests in the planning and development phases has often been ignored. This is not pervasive in all states, but penetration across the country has been uneven and often dependent on the workforce, geography, and other children's resources. This treatise is a proposal for addressing the current deficiencies based on a recently published report on the status of state pediatric trauma systems. The goal is to ensure equitable, high-quality care for all injured children.

Trauma systems are currently managed at the state level, and every state except Vermont has a statute establishing a trauma system.4 However, children's interests have often been omitted from state trauma statutes, which meant children were ignored when developing the regulations, designating members of the trauma advisory council, and designating trauma centers. The legislative process to pass laws and write the associated regulations is often lengthy. Legislation is critical to the inclusivity of children, and the ensuing plan will describe the current inequities and how to resolve them.

The Pediatric Trauma System Assessment Score (PTSAS) was recently developed to address these gaps, providing a single metric for assessing state trauma system quality.5 In developing this score, a panel of 15 experts was convened with expertise spanning the trauma care continuum, academic and nonacademic, including state and national representatives, researchers, emergency medicine providers, nurses, trauma surgeons (pediatric and adult), and a rehabilitation expert. Delphi Survey Methodology was used to identify critical components for state trauma systems. After five survey rounds, six domains were selected, each with three to five parameters (Fig. 1). Each domain was scored from 0 to 10 and averaged across panel members. Weighted averages were used to create a total PTSAS summary score from 0 to 100. Following state assessment, huge variation was found in PTSAS across the United States, with state scores ranging from 48 to 100. The score was validated using the US Centers for Disease Control and Prevention Wide-Ranging ONline Data for Epidemiologic Research (CDC WONDER) database. Following linear regression, it was found that, for every 1-point increase in PTSAS, there was a statistically significant decrease in pediatric trauma–related inpatient, outpatient, and overall mortality.5

Figure 1:

Pediatric Trauma State Assessment Score domains.

Given these findings and as an inception point, states can begin to understand and work to improve their PTSAS summary scores. This plan guides initial steps to strengthen state scores in each domain. Each section highlights common gaps across states, describing the discrete action to be taken and expected outcomes to provide stakeholders with a roadmap for advocacy and trauma system improvement. Table 1 provides a summary of all recommendations.

TABLE 1 - Key Steps for PTSAS Improvement at the State and National Level Domain Gap Recommendation Legislation and Funding Inconsistency in legislation around pediatric components of trauma system Inclusion of pediatric interests in state trauma plan Variation in state funding for trauma and creation of budgets to ensure consistent trauma system maintenance Allocation of funds at the state level to ensure consistent funding of trauma systems, including pediatric interests Variation in pediatric representation in State Trauma Advisory Councils/Boards State level regulation to ensure inclusion of pediatric trauma representatives on trauma advisory councils/boards Inconsistent national funding for trauma programs and systems Marshall respective advocacy groups to support the passage of national trauma funding with special appropriations for pediatric trauma Access to Care Lack of pediatric trauma bypass protocols in EMS Implement pediatric-focused destination bypass to ensure triage to pediatric resourced centers when possible Lack of acute care beds for pediatric burn patients Catalogue existing state resources for burn care including pediatric beds and available specialists to assess current and future gaps
Implementation of best-practice guidelines for burn care across states with clear processes for early consultation of burn specialists Inconsistent availability of inpatient rehabilitation beds for children Identify those centers that have pediatric rehabilitation resources and/or accreditation
Catalogue existing state resources for pediatric rehabilitation services (inpatient and outpatient)
Ensure fair pay for those specialists who care for children Injury Prevention and Recognition Inconsistent legislation to ensure review of high-risk pediatric fatalities, including abuse and coroners' cases Mandate the establishment of Child Death Review at the local and state level
Creation of consistent inclusion criteria for the types of child fatalities that must be reviewed by Child Death Review committees Lack of requirements mandating trauma centers provide education around the recognition of child abuse Creation of statewide protocols for the consistent identification of child abuse at all levels of trauma centers
Creation of state-level parent education understanding the risks and consequences of non-accidental trauma Disaster Lack of inclusion of children in disaster plans Require pediatric inclusion in state emergency management and hospital preparedness plans Lack of planning for pediatric transfer during disaster events Inclusion of pediatric consideration in EMS hospital bypass protocols and preplanning for transfer processes during mass casualty disaster events Need to ensure sufficient resources to manage mass casualty events and pediatric surge at hospitals Establish partnerships with HPPs and state emergency management entities Quality Improvement and Trauma Registry Failure of states to evaluate pediatric data separately for children's trauma PI in both the trauma and EMS systems Require annual evaluation of pediatric data for EMS and pediatric injury
Creation of clear recommendations from findings to share with hospitals and EMS systems Lack of consistent public reporting of summary data for injured children Public sharing of annual summary reports on statewide pediatric trauma epidemiology and outcomes
Annual review of pediatric trauma epidemiology and outcomes at State Trauma Advisory Councils/Boards and utilization for PI Pediatric Readiness Inconsistent ED pediatric readiness in hospitals across states Statewide recommendation that all hospitals participate in NPRP surveys and provide plans for ED pediatric readiness improvement
Provision of state grants for critical access hospitals to incorporate pediatric care coordinators into all EDs to improve their pediatric systems
Institute minimum burn readiness guidelines for all trauma hospitals Need for standardized transfer protocols for hospitals to ensure safe transfer of children Require all hospitals to provide protocols for the safe triage, transfer, and receipt of children Need for universal adoption of ALARA guidelines and statewide dissemination of pediatric trauma imaging protocols Facilitate statewide education on ALARA guidelines for pediatric imaging
Encourage statewide dissemination of imaging protocols, coordinated by PTCs, to support the appropriate workup of injured children

ALARA, As Low As Reasonably Achievable; NPRP, National Pediatric Readiness Program.

DEVELOPING PEDIATRIC TRAUMA INFRASTRUCTURE Legislation and Funding

There is no current established and funded national trauma system. The formal establishment, structure, and funding of trauma systems are left to states. Across the United States, there is a variable infrastructure and resources available for managing injured children. Three major pediatric gaps were determined within this domain. First, only 60% of states have laws that ensure the consideration of pediatric needs in the trauma system. Second, despite significant evidence suggesting improved outcomes for injured children served by pediatric trauma centers (PTCs), one third of states lack legislation to designate such centers.6,7 Third, 27% of states do not mandate the inclusion of pediatric representatives on their State Trauma Advisory Councils/Boards.

A similar patchwork exists in the funding of trauma systems (Fig. 2). Eleven states lack a formal trauma system budget, and only 19 states specifically appropriate funds for pediatric needs. In addition, 30% of the US population lives in an area without funding for state trauma systems, and 61% of children live without state funding for pediatric trauma-related needs, representing 100 million Americans and 44.9 million children, respectively.5 It is difficult, although not impossible, for state trauma systems to support their population without appropriated funding. This lack of investment represents a critical gap in nationwide public health infrastructure. Advocating at national and state levels for funding to support trauma systems that are all-age inclusive is necessary, and integration into all-hazards disaster planning would be advantageous.

Figure 2:

State level budgets for trauma systems and programming.

Many examples of successful legislation exist for establishing trauma systems, and some include consideration of pediatric needs within existing infrastructure.8 Those advocates living in states with pediatric gaps can use these examples as a guide. Figure 3 is one example of steps that must be followed or might be encountered to pass such legislation. At each stage of legislative consideration, it is possible for the process to stall because of disinterest by leadership, ongoing debate, or introduction of controversial amendments. This is why advocacy is critical to passing or reforming statutes. Ideally, laws should specifically address the inclusion of children in planning, simulation, and modeling for major mass casualty events and the establishment of PTCs. Such legislation must mandate the appointment of a pediatric representative on the State Trauma Advisory Councils/Boards and uniform adoption of trauma center standards that include children's interests. Coincidentally, appropriation bills must be passed in conjunction with trauma system legislation to codify a consistent funding stream. Creative methods for allocating funds to trauma exist across the United States, including taxes on cigarettes and cannabis, and criminal offense fines.9 The passage of legislation and appropriations for pediatric trauma at the state level represents a critical step to addressing the burden of pediatric trauma care. Both will strengthen the existing infrastructure for trauma and support improved quality of care for all injured children.

Figure 3:

Legislative process and areas of possible bill deferral or rejection.

These efforts will only be fully supported when consideration of pediatric-specific trauma needs is elevated to the national level. Currently, there is little in the US code about pediatric trauma care beyond the recommendation to use ACS and American Academy of Pediatrics guidelines.10 There are minimal appropriations for trauma, and the last time any state grants were created was in 2015.10 Recent efforts have been taken by congress members to pass funding allocation for trauma programs through 2027. However, these proposals fail to move past the Senate Committees.11 Advocacy through national groups that support children's interests and the management of injured children is essential to push forward the national conversation on pediatric trauma and ensure necessary funding for trauma systems.

Access to Care

Well-described disparities exist in the accessibility of PTCs to injured children, especially those in rural areas, who comprise 21% of the US pediatric population.12 Many have discussed increasing adult trauma center emergency department (ED) pediatric readiness as a potential solution to these challenges.13 These interventions only partially address other non–ED-based gaps: efficient triage/transfer of severely ill children to high-resource hospitals, improved access to specialty care for children with complex injuries, and the need for increased access to pediatric burn and rehabilitative services. Some gaps can be addressed through increased use of best practice processes for pediatric emergencies, as less than 50% of states currently use emergency medical services (EMS) destination determination protocols.5 As new guidelines were proposed for the field triage of injured patients that include pediatric considerations,14 we strongly support the broad implementation of these guidelines at the state level. Given the concentration of resources at PTCs, state implementation of telehealth networks and the creation of telemedicine programs can allow for increased diffusion of pediatric expertise to low-resource hospitals.15 Centering these systems at the state level is critical to ensuring the longevity of such programs and collaboration across hospitals and health systems. This must include teleradiology program implementation to facilitate improved consultation and decrease imaging repetition after transfer, such as repeated computed tomography (CT).

Burn care represents a significant area of need, as approximately 20% of states lack burn beds for children. Burn training is decreasing in the United States, as burn rotations are no longer required for general surgery trainees, a minority of plastic surgery graduates pursue burn fellowships, and only one third of pediatric surgical trainees gain burn experience during their fellowship.16,17 While resource creation and workforce expansion may take years, states can maintain pediatric resources by cataloging the existing “every day” resources for pediatric burn care and designating a minimum number of burn beds maintained for children. Increased use of protocols for the initial management of burned children, like those available through the University of Utah, can help ensure appropriate resuscitation and minimize delays in care.

Well-described disparities exist in pediatric access to rehabilitative services, primarily affecting Black and Hispanic children, those on public insurance, and victims of violent mechanisms.18–20 These disparities are exacerbated by the patchwork of existing rehabilitative services, with some states lacking any inpatient pediatric rehabilitation unit and others lacking access to or awareness of pediatric-specific outpatient resources. Key next steps for addressing these disparities include partnering with organizations such as the Commission on Accreditation of Rehabilitation Facilities and pediatric physiatrists. This includes advocating for fair compensation for pediatric services, which are often reimbursed at lower rates than adults. At the state level, these efforts can be supported by gathering further information on the volume of pediatric rehabilitation needs and mandating the maintenance of a minimum number of pediatric rehabilitation beds.

Injury Prevention and Recognition

Implementation of injury prevention interventions is critical to the reduction of trauma-related morbidity and mortality for children. The effectiveness of such efforts depends on understanding the mechanisms and circumstances that lead to child fatalities. One mechanism for elucidating these factors is the Child Death Review, which offers a multidisciplinary approach to understanding the factors that lead to a child's demise.21 This group generally includes representatives from the Coroner's or Medical Examiner's office, public safety, mental health, department of health and others.21 However, 14% of states lack legislation codifying statewide Child Death Review, and 20% of states do not require the review of all abuse cases or unanticipated deaths.5,22 Variability is also noted in the state requirements for trauma center utilization of child abuse identification protocols. Given the high rate of child mortality associated with unrecognized nonaccidental trauma, implementing these evidence-based programs across states is critical to the health and safety of our children.

Many have raised the alarm around the increasing gun violence rates among children, especially as firearm-related deaths are now the leading cause of pediatric mortality in the United States.1,23–25 However, violence prevention programs are variably used and funded, and pediatric enrollment in these programs is low.26 In addition, rules and regulations around firearm licensure and safety requirements vary greatly from state to state.27 Because less strict legislation is associated with increased pediatric firearm-related death, continued support is needed for state and national regulation of high-risk firearms, such as assault-style weapons and high-capacity magazines, and limits to child firearm access through safety measures.28 States should, at a minimum, track the incidence of pediatric firearm-related injury and death and allocate funds for violence prevention programs in high-incidence areas to increase pediatric gun-violence victim enrollment.

Disaster

Despite prior calls to action for improved pediatric disaster readiness, major gaps exist in children's inclusion in state level disaster preparedness plans.29,30 Across the United States, PTSAS demonstrated that approximately 30% of states need to include children in disaster plans, and 40% do not perform drills to practice how children will be moved through their state during mass casualty events.5 Such efforts require understanding how children are affected by all hazards, defining a process for identifying injured children who need higher levels of care, and creating a system to catalogue and verify the pediatric-specific resources at hospitals across the state. The silos between state level emergency management systems, hospital preparedness programs (HPPs), and PTCs create significant barriers to improving these processes. Increased partnership between these groups could significantly improve disaster management processes for all patients, including children. State-mandated expectations for including children in disaster plans and mass casualty drills can improve preparedness, disaster response, and time to reunification of children with families. This includes integrating existing pediatric resources in EMS hospital bypass protocols and preplanning pediatric transfer processes. A predefined list of all hazards with anticipated pediatric-specific considerations will ensure the adaptability of plans to pediatric needs. Because the pediatric voice is often missing at the state level and in HPPs, the involvement of individual pediatric providers in these groups will raise the bar for all children.

At the national level, recent advocacy around the importance of disaster readiness for children may provide avenues for improved funding and resources. Previously, the 2013–2018 National Advisory Committee on Children and Disasters provided recommendations around directing funds to HPPs to ensure the incorporation of pediatric considerations in these programs and mandatory inclusion of pediatric metrics.31 The PTSAS findings suggest that this committee's goals set out in 2018 still need to be met. The 2020–2022 reconvened National Advisory Committee on Children and Disasters will continue to advocate for increased accountability. This may create new funding streams for states to support the development of pediatric-specific disaster plans. While these recommendations focus on improving the processes for managing and transferring children during disaster events, attention to these programs will enhance the efficiency of disaster response for all ages.

SELECTING MEASURES FOR IMPROVEMENT Quality Improvement and Trauma Registry

A major area of needed investment at the state level is the utilization and sharing of state trauma registry data to understand critical areas of pediatric trauma performance improvement (PI). Currently, only 35% of states have any system for publicly reporting state level pediatric injury statistics, and >40% do not account for pediatric considerations in creating PI plans.5 In an ideal system, each state would create an annual public-facing and publicly accessible report that provides data on the epidemiology and outcomes for pediatric trauma patients. To ensure the utilization for PI, states should also mandate annual discussions of this data at State Trauma Advisory Councils/Boards to guide state-driven trauma prevention and quality improvement programming. This could also be a requirement for verified trauma hospitals to ensure annual assessment of pediatric trauma registry data in their quality improvement processes, even if they care for only adolescents.32 Because of the inconsistent enrollment of US hospitals in trauma systems, a challenge with improving outcomes statewide is the lack of participation of many rural hospitals in registries.33 Pursuing improved statewide utilization of trauma data for quality improvement efforts will require that the statewide distribution of designated trauma hospitals matches the population distribution.

Variable utilization of EMS data for PI within EMS organizations and systems presents a similar problem, with >30% of states failing to consider pediatric patients in PI.5,34 This is despite organizations like the National Association of State EMS Officials undertaking significant efforts to encourage PI within EMS. Because only 7% to 10% of EMS transports are children, each state must evaluate EMS runs stratified by age, and trauma and nontrauma transports. Ideally, if designated, such reviews of pediatric transport would occur in the EMS pediatrics subcommittee, including separate reports of trauma transports to be presented to the State Trauma Advisory Councils/Boards. Cross-representation between trauma and EMS committees is needed to facilitate and coordinate such PI efforts. The frequency of this system coordination and cross-fertilization varies greatly. It is primarily tied to grant funding from organizations like Emergency Medical Services for Children. Implementation will help ensure the accountability of EMS organizations in their care and processes for managing critically ill and injured children.

A barrier to PI program implementation for pediatric and adult EMS data is the variation in prehospital guidelines across states. Even when states are provided best practice guidelines for optimal EMS patient care, the uptake and dissemination of such guidelines vary.35 Previously identified barriers include a lack of authority at the state level for protocol implementation and a need for systems to track the implementation of such guidelines.35 In addition to state regulation to ensure that EMS organizations implement best practice guidelines, recruitment of pediatric emergency care coordinators has been suggested as a method for improving EMS pediatric care. Recent estimates indicate that only 25% of EMS agencies have a PECC on staff.36 However, state-national collaboration through state grants and partnerships with organizations like Emergency Medical Services for Children Innovation and Improvement Center can significantly bolster pediatric resources.36 Once these PECC roles are created, the individuals in these roles must be given authority within their organizations. Emergency medical services agencies have little incentive to support these roles without a state or national mandate.36 To ensure change and continued pediatric EMS care improvement, state level regulation is needed to guarantee pediatric readiness within state EMS agencies. Such regulation should be coupled with the continued allocation of funds for EMS system improvement through national or state grants.

Pediatric Readiness

The National Pediatric Readiness Project empowers EDs to improve their capability to provide high-quality care for children, also known as being “pediatric ready.”37 The Emergency Medical Services for Children Program leads the project in partnership with the American Academy of Pediatrics, the American College of Emergency Physicians, the Emergency Nurses Association, and, the newest partner, the ACS.38 At the state level, this is a priority for pediatric trauma not only in relation to ED pediatric readiness but also with procedures/protocols around the movement of children between hospitals and improved hospital infrastructure. As an example, As Low As Reasonably Achievable Guidelines help reduce children's exposure to unnecessary radiation during workup and examinations, especially with CT. This is critical because radiation from CT scans in childhood is known to increase cancer risk.39 However, prior evidence suggests significant variation across the United States in implementing the guidelines and the radiation dose administered.40,41 Statewide regulation of As Low As Reasonably Achievable guideline implementation can help reduce unnecessary radiation exposure for children. Even more critical is the partnership of states with PTCs to create and disseminate best-practice pediatric imaging guidelines. Implementing such guidelines could be coupled with protocols for transfer processes and pediatric trauma consultation to limit unnecessary studies at hospitals destined to transfer children elsewhere. These interventions together would allow for more efficient movement of severely injured children through the trauma system and reduce unnecessary radiation exposure.

Despite recent evidence demonstrating decreased short-term and long-term pediatric trauma–related mortality with increased ED pediatric readiness, 30% of states do not consistently assess ED pediatric readiness.5,42–44 While increased uptake of ED pediatric readiness assessment is anticipated with the inclusion in ACS trauma center standards, not all states use ACS Committee on Trauma guidelines when designating trauma centers. In addition, the proportion of rural community hospitals and critical access hospitals participating in state trauma systems varies widely. Level IV centers are not verified through the ACS Committee on Trauma process and may not be held to the same standards.33 As a result, even with increased support for ED pediatric readiness at trauma centers, variations may remain in the readiness of local hospitals that children present to for care. Given the additional associations found with readiness and improved outcomes for all seriously ill children,45 it behooves states to mandate standard readiness assessments and participation in the National Pediatric Readiness Program for all hospitals, trauma and nontrauma. As with EMS systems, the key to improving readiness for pediatrics is PECC role creation to ensure systems maintenance for managing pediatric patients. Many rural and low-resource hospitals struggle with funds to maintain their current operations, and such requirements must be coupled with the allocation of funds and grants to offset the costs of creating such positions.

UNDERSTANDING NATIONAL RESOURCES AND CREATING PARTNERSHIPS

The aforementioned recommendations support the inclusion of pediatric considerations in state legislation and allocating state or national funds for improving trauma systems and pediatric-focused interventions. Beyond pediatrics, trauma is the leading cause of death for all individuals younger than 45 years in the United States. Improvement in pediatric outcomes will center on governmental investment in trauma systems, with the intentional continued integration of pediatric factors. Multiple national initiatives and funding streams exist that may be of service to states in improving trauma services for children. These organizations, the resources provided, and their collaborations are highlighted briefly below and described in Table 2. The general hierarchy of national organizations funded by the US administration that support pediatric EMS and trauma is outlined in Figure 4. Supplemental Digital Content (Supplementary Data 1, https://links.lww.com/TA/D395) describes these programs and funding.

TABLE 2 - National Organizations and Resources for Children's Emergency Care National Organization Organization Description/Mission Available Resources Processes for Organizing Advocacy Efforts and Collaborating With Other Organizations on Pediatric Trauma Government-funded organizations  National Association of State EMS Officials Provides national leadership to support and advocate for state, territorial, and tribal EMS officials' efforts to improve systems of care Provides clinical guidelines for EMS, including pediatrics
Committee focus on safe transport of children
Works with other EMS organizations to support and advocate for EMS legislation
Created EMS Toolkit for Pediatrics that includes state recommendations
Centralized page with links to other resources for emergency care of children Pediatric Emergency Care Council provides recommendations on policy for EMS. Council has liaisons with:
AAP Committee on Pediatric Emergency Medicine, PEPP Steering Committee, EMSC/IIC Knowledge Management Domain, National Association of EMS Physicians—Pediatric Committee, NHTSA Heatstroke Partnership Working Group, NPRP Steering Committee, NPRP Quality Improvement Registry, PPRP Steering Committee and National Pediatric Disaster Coalition Executive Committee  ASPR-HPP Provides funding through cooperative agreements to states, territories, and eligible metropolitan areas to improve the ability for recipients to plan for large-scale emergencies and disasters
Helps to support the development of health care coalitions Supports regional disaster preparedness and response
Provides funding opportunities to support regional pediatric trauma resource and readiness development Supports the creation of coalitions for improving pediatric emergency management
Partners with ASPR TRACIE to provide technical resources for the care of children  NCTSN Seeks to improve access to services for traumatized children, families, and communities in the United States Provides information about child trauma to federal and state representatives to advocate for increased resources
Helps to develop policies and programs on child traumatic stress Partners with the AAP, Academy on Violence and Abuse, American Professional Society on the Abuse of Children, American Psychological Association, AUSA, and others Professional organizations  AAP National organization that represents approximately 67,000 pediatricians in the United States
Organization provides resources to support clinical care and supports advocacy/programming around the improvement of physical, mental, and social child health Gun Violence Advocacy Toolkit
Patient care resources for trauma, treatment, and resilience
Policy Statement on Pediatric Trauma Management
For members: publications on the management of pediatric trauma No formal committee, section, or council on pediatric trauma
Most trauma-related activities liaison through the Committee on Pediatric Emergency Medicine and Section on Surgery. Other committees, sections, and councils that overlap with needs of traumatically injured children include the following:
Council on Child Abuse and Neglect; Council on Children and Disasters; Council on Injury, Violence, and Poison Prevention; Section on Child Death Review and Prevention; Section on Emergency Medicine; Section on Critical Care; Section on Hospital Medicine; Section on Neurosurgery; Section on Orthopedics, Section on Otolaryngology; Section on Urology; Section on Neonatal-Perinatal Medicine; and Section on Transport Medicine  ACS-COT Committee within the ACS that seeks to develop and implement programs to support injury prevention and improve patient outcomes through advocacy, education, trauma center and trauma system resources, best practice creation, outcome assessment, and quality improvement Trauma Center Standards and Verification Program
Trauma Quality Improvement Program Resources, includes standards on imaging use for pediatric patients
Advocacy resources for state and national agendas relating to trauma
State Legislation Tracker Supports the Pediatric TQIP
Verification Review Committee provides standards for all ACS trauma–verified centers, which includes requirements for pediatric trauma. There is a pediatric subcommittee consisting of pediatric COT members, vice chairs and chairs of the state chapters, and liaisons to pediatric organizations.  ACEP Represents 38,000 emergency physicians and advocates for emergency medicine physicians and their patients
Develops evidence-based clinical policies and supports emergency care and disaster preparedness Offers courses of trauma management, which include pediatric trauma
Provides standards on pediatric ED readiness
Provides resources for pediatric emergency management and trauma management, including directions on performance measures Section on Pediatric Emergency Medicine and Section on Trauma and Injury Prevention
Two committees also address pediatric trauma needs: Pediatric Emergency Medicine committee and Committee on Public Health and Injury Prevention. Other sections and committees that overlap with pediatric and trauma needs include the following: Section on Disaster Medicine, Section on EMS-Prehospital Care, Committee on Disaster Preparedness and Response, and Committee on EMS  ERMA Represents residents in emergency medicine in association with ACEP Provides reference cards and links to educational materials regarding the management of pediatric emergencies and trauma
Includes committee on health policy that provides guidance on how to advocate No formal committee specific to trauma
Related committees include Health Policy Committee, Pediatric Emergency Medicine Committee, and Prehospital and Disaster Committee  AAFP Represents family medicine physicians and advocates for family medicine practices. Provides clinical evidence-based guidelines Resources on recommendations for injury prevention
For members: CME on Emergency Management and policies on gun violence No formal committee or process  NAEMT Represents all EMS practitioners and provides access to educational resources Online Legislative Service with resources for legislative advocacy
Emergency Pediatric Care Committee and Courses No formal committee specific to trauma care
Related committees include Education Committee and EMS Disaster Preparedness Committee  NAEMSE Seeks to empower EMS Medical education through collaboration, education, and innovation Centralized links for EMS management
Supports medical education for EMS No formal committee
Related committees include Education Committee  NAEMSP Represents over 2,000 physicians, paramedics, nurses, administrators, educators, researchers, and EMS personnel
Organization participates in advocacy; provides direct education and training in QI, evidence generation, and dissemination; and promotes meetings, publications, and products to connect and educate members Position statement on physician oversight of pediatric care in EMS Committee on Pediatrics
Related committees include the following: Committee on Emergency Preparedness, Committee on Public Health, and Committee on Quality and Safety
No formal committee on trauma  NEMSMA Professional association of EMS leaders dedicated to the development of excellence in EMS systems Supports policies and funding for pediatric EMS
Supports the publication of research through the Prehospital Emergency Care journal No formal committee or process  SPA/ASA Seeks to advance the safety and quality of anesthesia care, perioperative care, and pain management in children No specific resources for pediatric trauma, however, pediatric anesthesiology is often involved in the care of injured children No formal committee
Related committees include Disaster Preparedness Interest Group  ENA Aims to advance excellence in emergency care and ensure the inclusion of nursing considerations in addressing challenges in emergency care delivery Provides best practice and educational resources for the management of and transfer of pediatric trauma patients. No formal committee or process but is involved with the creation of guidelines for pediatric trauma and pediatric ED readiness  STN Seeks to improve trauma care through supporting trauma nursing efforts related to prevention, education, and collaboration Clinical resources for management of pediatric trauma
Ongoing advocacy around critical issues including injury prevention and improvement of trauma systems No formal committee on pediatrics but does have special interest groups for pediatric trauma and injury prevention  ABA Multidisciplinary organization that is dedicated to supporting burn-related research, education, care, rehabilitation, and prevention
Represents 2,000 members Pediatric burn center standards included in ABA burn center verification
Provides specific designations for pediatric burn centers separate from adult centers
Maintains the National Burn Repository database, which includes specific data fields pertaining to pediatrics
Supports presentation of data on pediatric burns at the annual scientific meeting Committee on Pediatrics
Collaboration with ASPR, Shriners Burn Hospitals for Children and the National Institute on Disability, Independent Living, and Rehabilitation Research to support creation of systems for burn care
Partners with organizations such as the Phoenix Society, which supports burn survivors, in advocating for burn victims
Liaison with the National Academy of Sciences, Engineer, and Medicine to support burn care in discussions about pediatric trauma  PTS Seeks to improve outcomes for injured children through development of guidelines in education, research, and advocacy Provides tools for the transfer and initial resuscitation of pediatric trauma patients
Provides best practice guidelines for the management of pediatric trauma patients Entire organization is dedicated to pediatric trauma
Liaisons with other groups but no formal published list of existing collaborations Advocacy organizations  Childress Institute for Pediatric Trauma Nonprofit organization that partners with Wake Forest Baptist Health to support, share, and facilitate the prevention and treatment of severe injuries in children Provides grants for pediatric trauma research and technology
Creates training and educations resources for EMS, athletic trainers, researchers, and physicians
Supports advocacy efforts through the Congressional Pediatric Trauma Caucus Provides funding for research, education, and advocacy to improve the care and treatment of injured children  TCAA Nonprofit organization that seeks to secure the economic viability of trauma centers and systems across the United States
Supports ongoing advocacy, operations, and financing of trauma centers/systems Advocates for legislation to support the creation of a national system of trauma care No formal committee or process  ATS Nonprofit organization that advocates for trauma systems, trauma prevention programs, and resources for survivors of trauma Provides training and education for professionals involved in the care of injured patients No formal committee or process  Injury Free Coalition for Kids National program consisted of hospital-based, community-oriented programs that focuses on injury prevention Conducts advocacy, research, and education on injury prevention with more than 42 sites
Provides resources on funding for injury prevention and health policy advocacy
Holds an annual conference on injury prevention for children The entire organization is devoted to the prevention of injury to children  SafeKids Nonprofit organization that seeks to prevent pediatric injury—focuses on traffic injuries, drownings, falls, burns, and poisonings Advocates for legislation to improve and protect children from the morbidity and mortality cause by injury
Supports injury prevention efforts such as appropriate use of car seats The entire organization is devoted to injury prevention for children of all ages

AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ABA, American Burn Association; ACEP, American College of Emergency Physicians; ASA, American Society of Anesthesiology; ASPR, Administration for Strategic Preparedness and Response; ATS, American Trauma Society; AUSA, Association of the United States Army; COT, Committee on Trauma; EMSC, Emergency Medical Services for Children; ENA, Emergency Nurses Association; ERMA, Emergency Medicine Residents Association; NAEMSE, National Association of EMS Educators; NAEMSP, National Association of EMS Physicians; NAEMT, National Association of Emergency Medical Technicians; NCTSN, The National Child Traumatic Stress Network; NEMSMA, National EMS Management Association; NHTSA, National Highway Traffic Safety Administration; NPRP, National Pediatric Readiness Project; PEPP, Pediatric Education for Prehospital Providers; PRPP, Prehospital Pediatric Readiness Project; PTS, Pediatric Trauma Society; SPA, Society for Pediatric Anesthesia; STN, Society of Trauma Nurses; TCAA, Trauma Center Association of America; TQIP, Trauma Quality Improvement Program; TRACIE, Technical Resources, Assistant Center, and Information Exchange.

Figure 4:

US administrative programs that support development and preparedness for pediatric emergency management.

National Organizations With Resources for Children's Emergency Care and Trauma

Several national organizations support physicians, clinicians, nurses, and emergency medical technicians in caring for critically ill and in