Challenges faced by prehospital emergency physicians providing emergency care to pediatric patients : Defining entrustable professional activities by identifying self-perceived competency strengths and deficits in prehospital emergency medicine.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · 2026-05-30 · Observational study
Abstract
BACKGROUND: Pediatric emergencies constitute a small proportion of prehospital cases yet pose unique diagnostic and therapeutic challenges for emergency physicians due to age-specific physiological differences, limited exposure, and infrequent opportunities for skill acquisition. Competency-based medical education frameworks and entrustable professional activities (EPAs) may offer suitable concepts to structure pediatric emergency training. METHODS: This mixed-methods study combined a retrospective analysis of 9,409 prehospital emergency physician protocols (2012-2021) with a survey assessing self-perceived competence and training needs among emergency physicians. Pediatric emergency characteristics, clinical management, and utilized interventions were analyzed. Survey data captured demographic characteristics, perceived competency across defined scenarios, sources of knowledge acquisition, and perceived gaps in pediatric emergency preparedness. RESULTS: Among all prehospital missions, 606 pediatric emergencies (6.45%) were identified, predominantly involving adolescents with any condition, and any age with trauma and neurological conditions. Invasive interventions such as intubation, cardiopulmonary resuscitation, or intraosseous access were rarely needed. Survey responses (n = 437) revealed heterogeneous self-perceived competencies: seizures, anaphylaxis, and hypoglycemia were associated with high confidence, whereas neonatal care, pediatric polytrauma, and cardiopulmonary resuscitation demonstrated markedly lower confidence levels. Knowledge was primarily acquired during the initial emergency physician qualification training period, as well as through subsequent clinical exposure in routine practice, with limited engagement in ongoing pediatric-specific training. More than 70% of participants advocated for structured, mandatory, and simulation-based pediatric training. CONCLUSION: Pediatric emergencies in the prehospital setting are uncommon yet challenging, revealing gaps between training expectations, clinical exposure, and perceived competencies. Strengthened pediatric emergency training-particularly simulation-based practice and EPA-based curricular elements-may enhance preparedness, standardize entrustment decisions, and improve patient safety. Future work should operationalize nested pediatric EPAs and evaluate competency outcomes prospectively. TRIAL NUMBER: IRB-2023-06.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Children · Clinician perspective · Prehospital physicians
Related articles
- Pediatric emergency medical care in Yerevan, Armenia: a knowledge and attitudes survey of out-of-hospital emergency physicians. (Int J Emerg Med, 2014)
- Assessment of general emergency medicine physicians' medical education regarding management of pediatric emergencies in western Normandy, France. (Arch Pediatr, 2020)
- Critical interventions, diagnosis, and mortality in children treated by a physician-manned mobile emergency care unit. (Scand J Trauma Resusc Emerg Med, 2025)
- Prehospital paediatric emergencies in Belgium: an epidemiologic study. (Eur J Emerg Med, 2015)
- Factors Affecting Paramedic Personnel in the Assessment and Management of Emergency Pediatric Patients within the Prehospital Settings in the United Kingdom. (Int J MCH AIDS, 2023)
- Vital signs assessment, documentation, and influencing factors in pediatric prehospital care: A qualitative descriptive study of advanced-level paramedics' experiences. (Int Emerg Nurs, 2026)