Establishing Quality Measures for the Prehospital Pediatric Readiness Project

Caleb E. Ward, Department of Pediatrics, Division of Emergency Medicine, Children's National Hospital & The George Washington University School of Medicine & Health Sciences Washington DC, US.
Kathleen Adelgais, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
Rachael Alter, National Association of State Emergency Medical Services Officials.
Robert Chaplin, University of Nebraska Medical Center, Omaha, NE.
Tabitha Cheng, Department of Emergency Medicine, Harbor-UCLA Medical Center & David Geffen School of Medicine at UCLA.
Mark Cicero, Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven CT.
Ann Dietrich, Clemson University School of Health Research & University of South Carolina School of Medicine Greenville, SC.
Patricia Frost, National Pediatric Disaster Coalition, Pediatric Prehospital Readiness Preparedness Steering Committee.
Andrea L. Genovesi, EMSC Data Center, Utah Data Coordinating Center, University of Utah, Salt Lake City, UT.
Matthew Hansen, Department of Emergency Medicine, Oregon Health & Science University.
Hilary A. Hewes, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
Lindsay R. Jaeger, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
Kathryn Kothari, Department of Pediatrics, Baylor College of Medicine, Houston, TX.
Christian Martin-Gill, Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, PA.
Sheree Murphy, National EMS Quality Alliance.
Katherine E. Remick, Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin TX.
Theresa Walls, Department of Pediatrics, University of Pennsylvania School of Medicine.
Kathleen M. Brown, Department of Pediatrics, Division of Emergency Medicine, Children's National Hospital & The George Washington University School of Medicine & Health Sciences Washington DC, US.

Document Type

Journal Article

Publication Date

1-21-2026

Journal

Prehospital emergency care

DOI

10.1080/10903127.2026.2617921

Keywords

emergency medical services; pediatric emergency medicine; quality improvement

Abstract

OBJECTIVES: Pediatric patients represent a high-risk, low frequency population in emergency medical services (EMS) systems. Quality improvement (QI) is the backbone of high-quality care delivered in EMS and engagement in pediatric-specific QI work is a core domain of the National Prehospital Pediatric Readiness Project (PPRP). There is no widely accepted set of quality measures that focus on the full scope of pediatric prehospital care. Our objective was to establish core PPRP Quality Measures for a National EMS Information System (NEMSIS)-derived pediatric prehospital dashboard to support pediatric QI initiatives. METHODS: We convened a 16-member technical expert panel (TEP) from national professional societies and federal entities. The TEP included physicians, nurses, EMS clinicians, federal partners, state EMS officials, and NEMSIS staff. Candidate measures were identified through a review of national resources and a survey of TEP members. The TEP employed a modified Delphi process to establish consensus priorities and scored measures based on the National Quality Forum Measure Evaluation Criteria. Candidate measures were prioritized based on scientific acceptability, importance to patient outcomes, utility in driving improvements, and feasibility of collection. Candidate measures were scored on a scale of 1 (lowest priority) to 5 (highest priority). Consensus was defined as 75% of the TEP rating a measure ≥ 4. RESULTS: The TEP identified 65 candidate measures. After three rounds of voting, consensus was achieved on 24 measures addressing a range of common pediatric prehospital conditions, including airway management (5 measures), trauma (4), pain control (3), respiratory emergencies (3), cardiac arrest (2), anaphylaxis (1), shock (1), seizures (1), hypoglycemia (1), newborn emergencies (1), non-transport (1), and safe transport (1). Thirteen (54%) of these measures apply to basic life support (BLS) teams. Common reasons for excluding measures included: limited scientific evidence, measure complexity, and redundancy. CONCLUSIONS: A TEP identified 24 quality measures in pediatric EMS that emphasize foundational practice and relevance across a range of volumes and service models. Future validation of these measures with NEMSIS data are needed to establish benchmarks of care across variably resourced EMS agencies and develop effective strategies to support adherence to high-quality pediatric prehospital emergency care.

Department

Pediatrics

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