Traffic Safety Administration National Registry http://www.nremt.org of Emergency Medical Technicians Pediatric http://www.heart.org/HEARTORG/CPRAndECC/HealthcareProviders/Pediatrics/PediatricAdvanced Life Advanced-Life-Support-PALS_UCM_303705_Article.jsp Support (PALS) Pediatric Trauma http://www.pediatrictraumasociety.org Society The reports stated that the federal government should support the development of national standards for emergency care performance measurement, the categorization of all emergency care facilities, and protocols for the treatment, triage, and transport of prehospital patients, with emphasis on using evidence-based practices NHTSA has supported the development of evidence-based guidelines (EBGs) for prehospital care, discussed further in a later section of this chapter A gap analysis of EMS-related research was completed after the recommendation of the IOM reports The EMSC program supported pediatric regionalization by providing grants to six states to fund regionalization demonstration programs in 2012 To address standardization in EMT competency, the report recommended that all states adopt a common scope of practice for EMS personnel The EMS Scope of Practice Model and Education Standards maintained by the DOT were discussed in detail earlier in this chapter Medical direction standardization has been addressed by the recognition of an EMS physician subspecialty Specifically addressing pediatric emergency care, the report stated “If there is one word to describe pediatric emergency care in 2006, it is uneven ” More details of the recommendations specific to pediatrics are listed here: The emergency care workforce should receive pediatric knowledge and skills training Pediatric competencies should be defined; EMS providers should be required to maintain those competencies Each EMS provider organization should have a pediatric emergency care coordinator Pediatric priorities in emergency preparedness should be enhanced The evidence base for pediatric emergency care should be supported Family-centered care should be fostered An evidence-based approach should be used to improve pediatric patient safety While many of the 2006 IOM recommendations have not been realized, significant strides have been made The EMS Agenda 2050, developed in 2018, and available at http://emsagenda2050.org , continues to strive toward the vision of a people-centered EMS system that is equitable, efficient, and evidence based EMS RESEARCH It is challenging to perform quality clinical research in the EMS system There are few large-scale, randomized clinical studies that have been undertaken in the pediatric EMS population The uncontrolled environment and the urgency of injury and illness treatment often make quality data collection and informed consent more complicated than in the ED setting Additional barriers include monitoring adherence to study protocols, providing ethical research training to EMS personnel, randomizing patients to treatment groups, and measuring patient outcome data that occur once patient care has been transitioned to a hospital In addition, a significant amount of funding, which has been lacking, is required to overcome these barriers Even with well-designed research, it may be difficult to generalize the findings outside the study population and locale due to the high level of variability within EMS systems across the United States No two systems are designed to operate in exactly the same way with regard to staffing, protocols, oversight, demographics, or training This further emphasizes the large amount of funding required to complete multicentered research that will be required to obtain sufficient sample sizes and make results generalizable