offered guidance to EMS systems considering the addition of RSI protocols that include emphasis on initial and ongoing training Key messaging for EMS systems is that basic airway management, including positioning and effective BVM ventilation, is an imperative skill for EMTs of all levels to learn and maintain Due to the lack of evidence supporting the use of ETI in pediatric patients and the recognition that educational efforts to maintain proficiency have severe limitations, some systems have discontinued the practice In general, however, protocols for pediatric prehospital airway management have been determined by conventional wisdom over published evidence and impacted by local/regional transport scenarios EMS systems should perform rigorous self-evaluation and continuous quality assurance when creating airway support protocols Methods supported in protocols should be based on the skill level of the providers, equipment and medications available, ongoing training and experience of providers, average transport times, and most importantly, medical oversight CHILDREN WITH SPECIAL HEALTHCARE NEEDS Special healthcare needs in children are defined as long term (lasting longer than months) and are more significant than that of the general population The prevalence of this group in the United States is 15.1% and has been described as the most rapidly growing group of the pediatric population who require emergency medical care Special considerations for EMS systems include the identification of these patients in the community, additional education for providers on unique care and transport needs, and the importance of preparedness for disasters Educational programs available to the prehospital provider are listed in Table 134.5 Spaite et al also note the importance of adherence to existing EMS protocols to optimize treatment for this population of patients It is important to recognize that these patients may be transported on a more frequent basis than their counterparts, therefore specific needs, learning, and feedback from each interaction can be used to anticipate and prepare for the next encounter EM and PEM providers are an important part of that feedback loop The AAP and ACEP have recommended that families with CWSHCN use an emergency information form (EIF) to assist in providing accurate and complete information that will aid the prehospital provider in assessment and transport decisions Medical jewelry has also been noted as a useful adjunct to help provide immediate access to critical information Use of healthcare directives is important, but can be especially challenging for the EMS provider in an acute situation Clear protocols should address this issue for each service, and medical control providers should be literate with this issue Identification of the medical home can help families and providers plan and partner for optimal interactions Contact information for providers who can help with care and process can be invaluable