specific resources are highly limited. Dedicated, well-intentioned prehospital emergency medical services (EMS) and ED providers make do without the resources that most would expect to be available for the care of children. For example:

  • Only about 6 percent of hospitals have available all the pediatric supplies deemed essential by the American Academy of Pediatrics and American College of Emergency Physicians for managing pediatric emergencies, although about half of hospitals have at least 85 percent of those supplies (Middleton and Burt, 2006).

  • Of hospitals that do not have a separate pediatric inpatient ward, only about half have written transfer agreements with other hospitals (Middleton and Burt, 2006), which are necessary in case a critically ill or injured child arrives at a hospital that lacks pediatric expertise.

  • Although research shows that pediatric skills deteriorate after a short time without practice (Su et al., 2000; Wolfram et al., 2003), pediatric continuing education is not required or is extremely limited for many prehospital providers (Glaeser et al., 2000).

  • Many medications prescribed and administered to children in the ED are “off label,” meaning they have not been adequately tested in pediatric populations and therefore are not approved for use in children by the U.S. Food and Drug Administration (FDA).

  • Disaster preparedness plans largely overlook the needs of children, even though children’s needs in the event of a disaster often differ from those of adults (Dick et al., 2004; NASEMSD, 2004).

The lack of preparedness carries a cost: many children with an emergency medical condition do not receive appropriate care under the current system. This conclusion is clear from a recent mock drill conducted in 35 of North Carolina’s EDs, including 5 trauma centers. Nearly all of the EDs in the study failed to stabilize seriously injured children properly during trauma simulations. Almost all failed to administer dextrose properly to a child in hypoglycemic shock (a life-threatening drop in blood sugar), correctly warm a hypothermic child, or order proper administration of intravenous (IV) fluids (Hunt et al., 2006). Ongoing research suggests that these problems are not unique to North Carolina EDs. While data on pediatric emergency care outcomes are largely unavailable, data on practice patterns indicate shortcomings in the treatment and care of pediatric patients. Examples include high rates of pediatric medication errors (Selbst et al., 1999; Hubble and Paschal, 2000; Kozer et al., 2002; Fairbanks, 2004; Marcin et al., 2005), low rates of pain management for pediatric patients (Brown et al., 2003), and many missed cases of child abuse (Petrack and Christopher, 1997;

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