Policy & Position Statement
The gold standard for expertise in pediatric emergencies is fellowship training and board certification in Pediatric Emergency Medicine (PEM). PEM subspecialists, through fellowship training, have both advanced training and education in pediatric emergency care, as well as extensive experience from managing large volumes of very sick children and dealing with both typical as well as atypical presentations of serious pediatric disease. Paradoxically, 89% of emergency department visits by children in the United States are to community hospital emergency departments. More than 75% of those emergency departments have no PEM-trained subspecialists and are staffed exclusively by Emergency Medicine –trained physicians. As noted in the 2006 Institute of Medicine report “Emergency Care for Children: Growing Pains”, published by the National Academy of Sciences, wide variation of treatment patterns among these community ED providers exists. and many of these physicians express less comfort and more stress with pediatric patient encounters as compared with adults. In light of this current situation, movement toward closer collaboration and working alliances between the two specialties of EM and PEM will be key to improving the state of pediatric emergency care delivery in the United States.
The PEPNETWORK aims to extend the reach of PEM subspecialists beyond the tertiary pediatric ED setting into the community, and partner Pediatric Emergency Medicine physicians with their Emergency Medicine colleagues who share the brunt of responsibility for emergency pediatric care delivery in the United States and worldwide. This will be accomplished through development and dissemination of simplified protocols for those pediatric emergencies most commonly encountered in the community hospital emergency department setting. These protocols will be BOTH evidence-based AND also incorporate and utilize the PEM subspecialist knowledge gleaned from experience with large volumes of sick children to reliably fill in gaps where solid evidence is still not yet available. These practice guidelines will help make decision making more concrete and clear-cut for many of those community-based ED physicians who may less commonly encounter these pediatric presentations.
Sharing leadership in the development of these practice guidelines with colleagues who are leaders in the field of Emergency Medicine who themselves see children as part of their practice, and having them take charge of the dissemination process, is key to the success of the PEPNETWORK initiative for several reasons: