Remick Katherine, Gross Toni, Adelgais Kathleen, Shah Manish I, Leonard Julie C, Gausche-Hill Marianne
Prehosp Emerg Care. 2017 May-Jun;21(3):399-407. doi: 10.1080/10903127.2016.1258097. Epub 2017 Jan 6.
Citing numerous pediatric-specific deficiencies within Emergency Medical Services (EMS) systems, the Institute of Medicine (IOM) recommended that EMS systems appoint a pediatric emergency care coordinator (PECC) to provide oversight of EMS activities related to care of children, to promote the integration of pediatric elements into day-to-day services as well as local and/or regional disaster planning, and to promote pediatric education across all levels of EMS providers.
A systematic review of the literature was undertaken to describe the evidence for pediatric coordination across the emergency care continuum. The search strategy was developed by the investigators in consultation with a medical librarian and conducted in OVID, Medline, PubMed, Embase, Web of Science, and CINAHL databases from January 1, 1983 to January 1, 2016. All research articles that measured a patient-related or system-related outcome associated with pediatric coordination in the setting of emergency care, trauma, or disaster were included. Opinion articles, commentaries, and letters to the editors were excluded. Three investigators independently screened citations in a hierarchical manner and abstracted data.
Of 149 identified titles, nine were included in the systematic review. The nine articles included one interventional study, five surveys, and three consensus documents. All articles favored the presence of pediatric coordination. The interventional study demonstrated improved documentation, clinical management, and staff awareness of high priority pediatric areas.
The current literature supports the identification of pediatric coordination to facilitate the optimal care of children within EMS systems. In order for EMS systems to provide high quality care to children, pediatric components must be integrated into all aspects of care including day-to-day operations, policies, protocols, available equipment and medications, quality improvement efforts, and disaster planning. This systematic review and resource document serves as the basis for the National Association of EMS Physicians position statement entitled "Physician Oversight of Pediatric Care in Emergency Medical Systems."
医学研究所（IOM）指出紧急医疗服务（EMS）系统存在众多针对儿科的缺陷，建议EMS系统任命一名儿科急诊护理协调员（PECC），以监督与儿童护理相关的EMS活动，促进将儿科要素融入日常服务以及地方和/或区域灾难规划，并推动对各级EMS提供者进行儿科教育。
对文献进行系统回顾，以描述急诊护理连续过程中儿科协调的证据。搜索策略由研究人员与医学图书馆员协商制定，并在1983年1月1日至2016年1月1日期间在OVID、Medline、PubMed、Embase、科学网和CINAHL数据库中进行。纳入所有在急诊护理、创伤或灾难背景下测量与儿科协调相关的患者相关或系统相关结果的研究文章。排除观点文章、评论和给编辑的信件。三名研究人员以分层方式独立筛选文献并提取数据。
在149篇已识别的标题中，9篇被纳入系统回顾。这9篇文章包括1项干预性研究、5项调查和3份共识文件。所有文章都支持儿科协调的存在。干预性研究表明，在记录、临床管理以及工作人员对高优先级儿科领域的认识方面有所改善。
当前文献支持确定儿科协调，以促进EMS系统内对儿童的最佳护理。为了使EMS系统为儿童提供高质量护理，儿科要素必须融入护理的各个方面，包括日常运营、政策、规程、可用设备和药物、质量改进工作以及灾难规划。本系统回顾和资源文件是美国急诊医师协会题为《紧急医疗系统中儿科护理的医师监督》立场声明的基础。
