Disparity exists between perceived and documented emergency department pain management practices for children. Quality improvement initiatives should focus on improving pain assessment in infants, treating moderate to severe pain in children of all age groups, and education of health care providers in pain management strategies. Resources should target health care processes effective in decreasing pediatric pain.

Objectives-To examine emergency medical services (EMS) usage by children in one state. Methods-Dispatch of an EMS vehicle in response to a call in the US is referred to as a "run". Runs for Utah for 1991-92 were linked to corresponding hospital records. Abbreviated injury severity scores (AISs) were assigned using ICDMAP-90 software. Results-For the two year period there were at least 15 EMS runs per 100 children per year, with incomplete reporting from rural areas. EMS response and scene times were similar for all age groups, but interventions were less frequent for children under 5 years of age. When the principal AIS region of injury was the head, neck, or face, cervical immobilization was less frequent for children less than 5 years of age (54%) than for older children (76%) and immobilization was associated with improved outcome, using the crude measure of lower hospital charges. There was a similar association between splinting of upper extremity fractures and reduced hospital charges. Both associations did not appear to be due to diVerences in injury severity. Conclusions-The majority of EMS use by children is for trauma. Children less than 5 years of age are less likely to have an EMS intervention than older children. Whether the lower frequency of interventions is due to the lack of properly sized equipment on the vehicle, or to other factors, is undetermined. (Injury Prevention 1999;5:294-297) Keywords: emergency medical services; splints; infusions, intravenousThere is little population based information concerning use of pre-hospital emergency medical services (EMS) by children. The limited data available suggest that children, especially the youngest children, may be underserved by EMS. For example, a Kentucky study found that advanced life support interventions were performed for 25% of adolescents but only for 2% of those less than 1 year old. 1Children use ambulances less frequently than adults 2 and account for approximately 10% of all EMS usage. The present study combined pre-hospital and hospital data for children using the EMS system in order to provide additional information concerning usage, interventions, and outcomes and to address a research need identified in the US Institute of Medicine report Emergency Medical Services for Children.5 This question was whether data from several diVerent components of the EMS system, such as pre-hospital care and hospital care, could be linked. If they could, this would allow additional research concerning pre-hospital care, such as analysis of intervention for specific anatomic sites of injury. Methods DATA FILESWhen an ambulance is dispatched in response to a call for assistance in the US, this is commonly referred to as an "EMS run". EMS run reports for Utah for 1991-92 were obtained from the Bureau of EMS, Utah Department of Health. All EMS records were complete except for those from several rural counties, comprising 8% of the population. Reports for canceled runs were excluded. Hospital records were obtained and included demographic inf...

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Best ED practice management of pediatric DKA includes establishing a specific guideline/protocol and ensuring access to a pediatric endocrinologist. Both were identified as improvement areas in this project. Illinois EMSC has developed an educational module and provided direct feedback to all participating EDs, to improve their management of pediatric patients with DKA.