Policy & Position Statement

Strengthening The Pediatric Work Force

PEM, EM, and the Pediatric Workforce

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.

Extending the Reach of PEM Subspecialists

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.

Joining Forces to Improve Pediatric Emergency Care

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:

• A healthy feedback loop will be established: As an Emergency Medicine driven project, EM physicians in the pediatric workforce will be able to provide input from their practice in the community ED setting (which may differ significantly from the tertiary pediatric ED, in terms of available resources, etc.) to evaluate whether these protocols are realistic and accepted for use by them; and if not, to provide suggestions on how to improve them.
• The Network may become readily accepted as a liaison between PEM physicians practicing in specialized pediatric emergency departments and EM physicians in community ED practice, and foster collaboration and understanding between the two specialties.
• The Network may effectively promote incorporation of these jointly developed guidelines for pediatric emergencies into Emergency Medicine residency education.
• The Network may facilitate both specialties (EM and PEM) to move toward more uniform and mutually agreed upon practice, if not a standard of care, for pediatric practice by emergency providers in both community (non-pediatric) and tertiary pediatric ED’s.