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POLICY STATEMENT Organizational Principles to Guide and Define the Child Health
Care System and/or Improve the Health of all Children
Access to Optimal Emergency Care
for Children
Kathleen M. Brown, MD, FAAP, FACEP,a Alice D. Ackerman, MD, MBA, FAAP,b Timothy K. Ruttan, MD, FACEP, FAAP,c
Sally K. Snow, RN, BSN, CPEN, FAEN,d COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE; AMERICAN COLLEGE OF EMERGENCY
PHYSICIANS, PEDIATRIC EMERGENCY MEDICINE COMMITTEE; EMERGENCY NURSES ASSOCIATION, PEDIATRIC COMMITTEE, 2018–2019
Every year, millions of pediatric patients seek emergency care. Significant abstract
barriers limit access to optimal emergency services for large numbers of
children. The American Academy of Pediatrics, American College of Emergency
Departments of aPediatrics and Emergency Medicine and Children’s
Physicians, and Emergency Nurses Association have a strong commitment to National Medical Center, School of Medicine of Health Sciences, George
identifying these barriers, working to overcome them, and encouraging, Washington University, Washington, DC; bDepartment of Pediatrics,
Virginia Tech Carilion School of Medicine, Roanoke, Virginia;
through education and system changes, improved access to emergency care c
Department of Pediatrics, University of Texas at Austin Dell Medical
for all children. School, Department of Pediatrics, Dell Children’s Medical Center of
Central Texas, Pediatric Emergency Medicine, Austin, Texas; and
d
Emergency Nurses Association, Schaumburg, Illinois
Policy statements from the American Academy of Pediatrics benefit
from expertise and resources of liaisons and internal (AAP) and
All children deserve access to optimal (safe and high-quality) emergency external reviewers. However, policy statements from the American
care. Given the inherent vulnerabilities of children and potential lifelong Academy of Pediatrics may not reflect the views of the liaisons or the
organizations or government agencies that they represent.
consequences of poorly treated health conditions, access to optimal
emergency health care is particularly important. In the United States, The guidance in this statement does not indicate an exclusive course
of treatment or serve as a standard of medical care. Variations, taking
emergency departments (EDs) serve as the national safety net for into account individual circumstances, may be appropriate.
individuals unable to find care elsewhere as well as a resource during
All policy statements from the American Academy of Pediatrics
public health emergencies and disasters through the provision of automatically expire 5 years after publication unless reaffirmed,
comprehensive acute care 24 hours a day and 7 days a week. Vulnerable revised, or retired at or before that time.
populations who rely more heavily on the ED for services are Published simultaneously in Annals of Emergency Medicine.
disproportionally affected when this safety net is weakened or fails, and This document is copyrighted and is property of the American
this needs to be addressed to ensure optimal care for all Americans. A Academy of Pediatrics and its Board of Directors. All authors have filed
conflict of interest statements with the American Academy of
significant portion of annual ED visits are by children younger than 18 Pediatrics. Any conflicts have been resolved through a process
years. Recent national data reveal that children account for approximately approved by the Board of Directors. The American Academy of
Pediatrics has neither solicited nor accepted any commercial
20% of all ED visits, which represents more than 27 million total ED visits involvement in the development of the content of this publication.
in the United States.1 The vast majority of these visits take place outside of
DOI: https://doi.org/10.1542/peds.2021-050787
pediatric medical centers and children’s hospitals.2
The American Academy of Pediatrics (AAP), American College of
To cite: Brown KM, Ackerman AD, Ruttan TK, et al. AAP
Emergency Physicians (ACEP), and Emergency Nurses Association (ENA) COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE; AMERICAN
have previously endorsed policy statements advocating for improved COLLEGE OF EMERGENCY PHYSICIANS, PEDIATRIC EMERGENCY
access to emergency care.3–5 Despite these statements and calls for action MEDICINE COMMITTEE; EMERGENCY NURSES ASSOCIATION,
by other groups,6 access to optimal emergency care remains limited for PEDIATRIC COMMITTEE, 2018–2019. Access to Optimal
Emergency Care for Children. Pediatrics. 2021;147(5):
many children in the United States. The 2014 ACEP “Report Card on
e2021050787
Emergency Medicine” examined access to emergency care for patients of
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PEDIATRICS Volume 147, number 5, May 2021:e2021050787 FROM THE AMERICAN ACADEMY OF PEDIATRICSall ages on a state-by-state basis, and clinic appointments or urgent care others have outlined some of the
it found that few states have adequate centers; and deficiencies in pediatric prehospital
policies and resources to deliver an • poor access to timely primary care care, including:
acceptable level of emergency care appointments among vulnerable • variability in pediatric readiness
access. The overall nationwide grade patients, especially children who between urban, suburban, and
of D2 was unchanged since the last have public insurance, have rural prehospital care systems as
report card was issued in 2009, language barriers, are members of well as discrepancies in readiness
reflecting a lack of improvement in racial and ethnic minorities, and/or between high-volume pediatric
emergency care access, despite recent live in underserved areas.9,10 facilities and their low-volume
efforts at health care reform.7 (fewer than 10 pediatric patients
2. Entry Into the Emergency Care per day) counterparts;
System
PROBLEMS THAT RESTRICT ACCESS TO • lack of comprehensive pediatric
CARE Many factors may limit a family’s training, experience, competency
ability to access the emergency care assessment, and ongoing quality
Children and their families face
system for their child. These include: improvement for prehospital EMS
barriers to optimal emergency care at
many key points of access. These • lack of universal access to and interfacility transport
include the following. enhanced or basic 911 services and professionals;
wireless 911 service for cellular • limited scientific evidence on which
1. Public and Professional phones, with continued reliance in
Awareness of Available Resources to base protocols or procedures for
some areas on local 10-digit prehospital care of children;
and Systems of Care
emergency telephone numbers;11
Deficits remain in the awareness and • limited high-quality and specific
• language barriers that can impede evidence-based guidelines for care
perceptions of the public and health the use of 911 services in many
care professionals regarding the efficacy and safety within all levels
locales; of EMS for children; and
emergency care system and how best
to access emergency care when • limited transportation resources to • lack of validated quality metrics
needed. These include: access emergency care outside of and paucity of quality improvement
the 911 system; efforts in pediatric prehospital care.
• lack of a consensus on what should
• long transportation times,
drive entry into the emergency care
especially in rural environments;12 4. Availability of Optimal Emergency
system and appropriate points of Care for Children
access for patients; • concern for financial consequences
of activating the 911 system and Underserved areas and
• underuse of emergency medical
incurring bills that may not be populations.
services (EMS) in emergencies
adequately covered by all insurance o Impact of closing hospital EDs:
because of a misconception by
types; The closure of EDs and
some caregivers that they can reach
EDs faster on their own; • concerns on the part of families of hospitals that
ill or injured children regarding disproportionately serve
• limited access to a medical home
immigration issues, social service disadvantaged populations has
for patients and poor coordination
agency intervention, and other impacted both rural areas and
of 2-way communication between
legal or financial concerns that underserved urban areas, with
emergency physicians, nurse
might arise once care has been differential impacts in each type
practitioners or physician
accessed; and of region.13
assistants, and the primary care
provider;8 • excessive demand on the o Critical access hospitals: The
emergency care system because of federal government has
• misconception that urgent care
inappropriate use of 911 systems historically supported rural
centers provide comprehensive
by patients who do require them. hospitals. In 1997, the Centers
emergency services;
This limits the availability of such for Medicare and Medicaid
• lack of knowledge of the services and can potentially delay Services created the Critical
inconsistent readiness of EDs to a more urgent transport. Access Hospital Program,
care for children of all ages;2 through which Congress,
• language and health literacy 3. Availability of Optimal Pediatric through the Balanced Budget
barriers to understanding the Prehospital Care Act of 1997, designated several
appropriate use of less emergent The Institute of Medicine (now the small rural hospitals as critical
sources of care, such as urgent National Academy of Medicine)6 and access facilities, recognizing that
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2 FROM THE AMERICAN ACADEMY OF PEDIATRICStheir small size limited their and effectiveness of emergency Access to pediatric medical
scope of service.14 Such care in children.19–24 subspecialists, pediatric surgical
hospitals received extra federal Readiness of EDs for pediatric specialists, and mental health
funding to focus on critical patients: Data from the 2013 professionals: Significant
medical services. Often, these National Pediatric Readiness geographic variation exists in
facilities have low volumes in Project (NPRP) noted that access to pediatric subspecialty
general and in particular have pediatric preparedness had care, with children in rural areas
low pediatric volumes, which improved since 2003, with the disproportionately affected by
limits experience in pediatric national median assessment score poor access to subspecialists and
care and creates a challenge for increasing from 55 to 69 of 100 longer transport times to centers
skill retention. Moreover, points.2 Despite this improvement, that provide specialty care,
changes in health care many gaps in pediatric readiness including care for behavioral and
reimbursement models have led remain, particularly in EDs with mental health emergencies.28,29
to struggles for rural hospitals, a low volume of pediatric patients. This lack of access limits the
leading to many closures and In the 2013 assessment, at least ability to provide emergency and
decreased services in some 15% of EDs lacked at least 1 ongoing care for children closer to
instances. From 2010 to 2016, specific piece of recommended their homes and places a larger
75 rural hospitals in the United equipment, 81% reported barriers burden on families requiring
States closed or ceased to implementing guidelines for specialty care in addressing
operations, prompting new pediatric emergency care, only complications from ongoing
47% included pediatric-specific disease processes and
concerns about access to
components to their disaster treatments.30–32 Moreover,
essential services in rural
plans, and fewer than one-half regardless of their insurance,
communities.15,16
included children in disaster patients may experience
o Development of expanded drills.2 Further study of 1 state challenges with accessing
medical services: Accelerated (California) determined that the specialty care and navigating
trends toward retail medical presence of a pediatric emergency networks of care.33 Telemedicine
clinics, urgent care clinics, and care coordinator and the inclusion has been proposed as a potential
freestanding EDs, in addition to of pediatric-specific elements in solution to this problem and has
expansion of existing facilities, the ED quality improvement plan received significant attention
disproportionately benefit areas were associated with improved because of coronavirus disease
with a higher socioeconomic scores on the NPRP. However, in 2019, with improvement in access
status, which has the potential the same state, only about one-half and a reduction in previously
to create further disparities in of the hospitals had a person described implementation
access to care in underserved designated as a pediatric barriers.34
areas.17 emergency care coordinator, and
ED crowding: Long ED wait times fewer than one-half had
5. Financial Considerations
for pediatric patients can a quality improvement plan that
included at least 1 pediatric- Limited and often inadequate
discourage families from seeking
specific metric.25 payment for primary care for many
timely care for emergency
children decreases both the
situations. In addition, crowded Quality of care (evidence-based
availability of primary care and the
EDs create a challenging and practice and quality
ability to provide unscheduled visits
rushed environment that is less improvement): Despite significant
in the primary care office setting.
child friendly and fails to address growth in high-quality pediatric
Children covered by Medicaid or the
the specific needs of each pediatric emergency care research, Children’s Health Insurance Program
patient.18 Long wait times and a relative paucity of data to visit the ED more frequently than
crowding in EDs is particularly support evidence-based care for both those with private insurance and
difficult for children with special childhood emergencies remains. In those who are uninsured. However,
health care needs, including those addition, a significant delay reasons for the visit differed among
with physical and intellectual between the creation of evidence population groups. When asked about
disabilities or mental and and its translation into practice in their child’s last visit to the ED,
behavioral health concerns. the ED further challenges respondents for children who had
Crowding has been associated knowledge translation and Medicaid or Children’s Health
with decreased safety, timeliness, dissemination.26,27 Insurance Program were more likely
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PEDIATRICS Volume 147, number 5, May 2021 3than those with private coverage to Improving Access to Emergency Care Despite these recent efforts to
report that their usual medical home for Children improve access to emergency care,
was not open or they did not have The emergency care environment access to optimal emergency care for
another place to obtain care. In remains challenging for pediatric children can and should be improved.
contrast, respondents for certain patients, as outlined in this report, The ACEP, the AAP, and the ENA
categories of privately insured but efforts have been ongoing in believe that every child in need
children were more likely to report recent years to improve access to should have access to quality
they last visited the ED because the optimal pediatric emergency care. pediatric emergency health care in
family’s primary care provider told Professional organizations such as the the appropriate setting. Efforts must
them to go or they perceived that the ACEP, the AAP, and the ENA, along be made at local, state, and federal
condition was too serious to be with government agencies such as the levels to improve prompt and
treated by primary care.35 In a recent Emergency Medical Services for appropriate access to pediatric
study, researchers demonstrated that Children (EMSC) program of the emergency health care, including
office-based primary care Health Resources and Services dental, behavioral, and mental health
pediatricians increased their Administration, have worked to emergencies for all children,
Medicaid participation after the increase the information available to regardless of socioeconomic status,
payment increases, in large part by lay people as well as medical ethnic origin, language, immigration
increasing their Medicaid panel professionals. Enhanced and next- status, type of insurance, geographic
percentage.36 generation 911 systems are steadily location, or health status.
improving the ease and reliability of
Other financial concerns include:
calls for help and enable prehospital
• A failure by payers to use the professionals to respond RECOMMENDATIONS
“prudent-layperson” standard for appropriately and efficiently. An I. Improving Entry Into the
definition of emergency care, which increased focus on prehospital care Emergency Care System
creates financial hardships after and pediatric readiness in the ED
a care episode and can discourage The ACEP, the AAP, and the ENA
setting through EMSC programs, the
future timely emergency visits. recommend the following.
NPRP, and state-based pediatric
• An increased number of insurance readiness recognition programs in A. Pediatricians, emergency
plans with high deductibles may hospitals has increased both physicians, emergency nurses,
discourage families from seeking awareness and the ability to address health care systems and their
emergency care when needed. pediatric emergencies at all stages of professional organizations should
Increasing regulatory and managed care. work with stakeholders within
care initiatives related to their communities to improve
Although inherent challenges remain, public and health care
emergency access for children that
an increased focus on pediatric professional’s awareness of
often require complex and time-
emergency research through available resources and systems of
consuming telephone calls and
networks, such as the Pediatric care by:
documentation to ensure
Emergency Care Applied Research
appropriate payment for care. 1. improving transparency of
Network, has helped to advance the
• Managed care protocols designed evidence base, increase awareness,
pediatric systems of care within
to reduce the use of emergency communities, including
and promote efforts to address the
facilities provide variable levels of educating families and
need for more information.37–39 In
appropriate alternatives for care. caregivers about the urgent and
addition, pediatric emergency
emergency care resources in
• Increasing numbers of “narrow medical education continues to
their community;
networks” (in which, in exchange expand through increasing numbers
for paying lower insurance of fellowships, residency training that 2. developing and disseminating
premiums, the plan restricts the includes dedicated pediatric knowledge and resources to
number and type of physicians, emergency education, and ongoing increase public, health
nurse practitioners, or physician targeted continuing medical professional, and government
assistants whose services are education training. Pediatric nursing awareness about the
covered) can limit access to EDs in residency training programs and magnitude of the problem of
children’s hospitals and to certification in pediatric emergency access to emergency medical
subspecialty services, which delays nursing contribute positively to care for children;
access to timely care and can result patient satisfaction and nurse 3. improving awareness, use, and
in poor health outcomes. retention.40 dissemination of
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4 FROM THE AMERICAN ACADEMY OF PEDIATRICScomprehensive resources Internet protocols, text III. Improving Emergency
available through the EMSC messaging, and video transfer; Department Care for Children and
program; and Adolescents
4. encouraging collaborative 3. improving collaboration and The ACEP, the AAP, and the ENA
efforts by emergency connectivity between schools, recommend the following:
physicians, nurse practitioners child care facilities, mental A. Pediatricians, emergency
and physician assistants, and health professionals, medical physicians, emergency nurses,
primary care providers to homes, and local EMS systems health care systems, and
identify an appropriate medical to facilitate easy access into the
professional organizations should
EMS system.
home for every child; work with stakeholders within
5. increasing access to a medical their communities to ensure
home by expansion of after- II. Improving Pediatric Prehospital availability of optimal emergency
hours and/or improved Care care for children by
coordination with after-hours The ACEP, the AAP, and the ENA 1. promoting improved readiness
or urgent care clinics with the recommend the following: and a minimal standard for
medical home for ambulatory readiness in all EDs, as outlined
A. State and federal governmental
sensitive conditions to improve in the joint policy statement
agencies should work with EMS
timely and appropriate care;8 “Pediatric Readiness in the
systems to ensure optimal
6. encouraging the use of the prehospital care for children by: Emergency Department;”45
emergency information form 2. developing quality metrics and
published by the AAP and 1. funding, supporting, and
promoting the further quality improvement efforts for
ACEP41 (this form is ED care of pediatric patients;
particularly helpful for children development and improvement
of EMS for children at the 3. encouraging the availability of
with medical complexity);42
federal, state, and local levels; and access to existing pediatric
and
2. insuring the inclusion of medical subspecialists,
7. developing electronic versions pediatric surgical specialists,
of the emergency information children’s needs in all funded
efforts to improve prehospital and mental health
form with health information professionals who have special
care (eg, EMS education, EMS
exchange for easy access. skills and expertise that are
quality metrics [National EMS
B. Federal governmental agencies Quality Alliance (NEMSQA)], required for optimal care of
should provide ongoing funding prehospital evidence-based critically ill and injured
support for future resource guideline consortium); and children;
development, education, research, 4. encouraging the expansion of
3. encouraging state EMS systems,
and quality outcomes training programs to ensure
local EMS agencies, and
measurement by the EMSC future availability of adequate
hospitals to incorporate
program, as recommended in the numbers of pediatric surgical
children in disaster planning
2006 Institute of Medicine report. and medical subspecialists
and response.43
C. State and federal governmental necessary to provide
B. EMS physicians and agency
agencies should work with EMS specialized pediatric
leaders should work with
systems and health care emergency care;
pediatricians, emergency
organizations to improve entry 5. supporting the development of
physicians, emergency nurses,
into the emergency care system nurse practitioners and
their professional organizations,
by: physician assistants with
and other stakeholders within
1. improving all 911 systems to particular training and
their communities to ensure
facilitate communication with expertise in pediatric
availability of optimal prehospital
non–English speaking families; emergency care, with the goal
care for children by promoting
to expand access to emergency
2. continuing to broaden improved readiness for
care, with appropriate levels of
enhanced and next-generation pediatric patients, as outlined
supervision based on
911 systems to more locations in the joint policy statement
jurisdictional regulations;
in the United States to allow “Pediatric Readiness in
wireless services via cellular Emergency Medical Services 6. promoting the development,
phones as well as voice-over Systems.”44 dissemination, and
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PEDIATRICS Volume 147, number 5, May 2021 5implementation of evidence- 4. developing funding sources, delivery of care for services
based guidelines and other multidisciplinary support, and that can be delivered via
strategies to improve enhanced research efforts telemedicine;
diagnostic accuracy, directed at all aspects of 5. expanding coverage for the
therapeutic effectiveness, and pediatric emergency care, expanse of language-translation
minimization of unwanted including health equity, to services required to provide
variation in care; provide the evidence for emergency care;
7. continuing to explore new and standards for effective and safe 6. expanding networks of care to
innovative methods of pediatric patient care; and allow patient access to
medical subspecialist care, 5. promoting the inclusion of specialty care and children’s
such as telemedicine, to pediatric expertise into hospitals when indicated for
aid medical professionals in comprehensive psychiatric patients and reducing
settings of limited resources; emergency programs, when barriers to care for patients
and these are available in within networks of care;
a community. and
8. promoting the development of
guidelines and education to the C. State and federal governmental 7. improving transparency of
approach of children with agencies, health care systems, and coverage for emergency care
behavioral and emotional professional organizations should and eliminate the retrospective
difficulties (intellectual work with payers to overcome denial of payments for any
disabilities, autism spectrum financial barriers to the provision reasons, including for chronic
disorder, and mental of optimal emergency care for conditions or out-of-network
health disorders) for both children by: emergency care.
prehospital and emergency 1. encouraging managed care
care.46 organizations to accept the LEAD AUTHORS
B. State and federal governmental prudent-layperson definition Kathleen M. Brown, MD, FAAP, FACEP
agencies, health care systems, and of an emergency and provide Alice D. Ackerman, MD, MBA, FAAP
professional organizations should payment for services Timothy K. Ruttan, MD, FAAP
work with stakeholders within mandated by the Emergency Sally K. Snow, RN, BSN, CPEN, FAEN
their communities to ensure the Medical Treatment and
availability of optimal emergency Active Labor Act (42 USC
AMERICAN ACADEMY OF PEDIATRICS
care for children by x1395dd);
1. promoting maintenance of ED 2. improving payment for
facilities and work to prevent pediatric care, by using a value- COMMITTEE ON PEDIATRIC EMERGENCY
the closing of hospitals that based model that encourages MEDICINE, 2020–2021
provide critical services in the achievement of a pediatric-
Gregory P. Conners, MD, MPH, MBA, FAAP,
underserved communities; relevant cost to benefit ratio, Chairperson
2. encouraging all EDs and especially valuing efforts that James Callahan, MD, FAAP
facilities that provide urgent lead to prevention or better Toni Gross, MD, MPH, FAAP
control of long-standing Madeline Joseph, MD, FAAP
care for children to establish Lois Lee, MD, MPH, FAAP
transfer agreements and problems, recognizing
Elizabeth Mack, MD, MS, FAAP
protocols with facilities with that the most effective Jennifer Marin, MD, MSc, FAAP
higher levels of pediatric care intervention may not be the Suzan Mazor, MD, FAAP
resources to promote timely one with the lowest cost but Ronald Paul, MD, FAAP
still represents the optimal Nathan Timm, MD, FAAP
access to specialty pediatric
emergency care and choice;
subspecialty tertiary care for 3. providing appropriate payment LIAISONS
critically ill and injured levels at all episodes of care to
Mark Cicero, MD, FAAP – National
children;47 facilitate unscheduled primary Association of EMS Physicians
3. developing state or regional care visits and reduce the Ann Dietrich, MD, FACEP – American College
programs to recognize burden on the emergency care of Emergency Physicians
system; Andrew Eisenberg, MD, MHA – American
facilities that have Academy of Family Physicians
demonstrated pediatric 4. providing payment for Mary Fallat, MD, FAAP – American College of
readiness;48,49 telemedicine to optimize the Surgeons
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6 FROM THE AMERICAN ACADEMY OF PEDIATRICSCynthia Wright Johnson, MSN, RN – National Ilene A. Claudius, MD, FACEP EMERGENCY NURSES ASSOCIATION,
Association of State EMS Officials Joshua Easter, MD PEDIATRIC COMMITTEE, 2018-2019
Sara Kinsman, MD, PhD, FAAP – Maternal Ashley Foster, MD
and Child Health Bureau Sean M. Fox, MD, FACEP
Cynthiana Lightfoot, BFA, NRP – AAP Family Marianne Gausche-Hill, MD, FACEP
2018 PEDIATRIC COMMITTEE MEMBERS
Partnerships Network Michael J. Gerardi, MD, FACEP
Charles Macias, MD, MPH, FAAP – EMSC Jeffrey M. Goodloe, MD, FACEP (Board Cam Brandt, MS, RN, CEN, CPEN, Chairperson
Innovation and Improvement Center Liaison) Krisi M. Kult, BSN, RN, CPEN, CPN
Diane Pilkey, RN, MPH – Maternal and Child Melanie Heniff, MD, JD, FAAP, FACEP Justin J. Milici, MSN, RN, CEN, CPEN, CCRN,
Health Bureau James (Jim) L Homme, MD, FACEP TCRN FAEN
Katherine Remick, MD, FAAP – National Paul T. Ishimine, MD, FACEP Nicholas A. Nelson, MS, RN, CEN, CPEN,
Association of Emergency Medical Technicians Susan D. John, MD CTRN, CCRN, NRP, TCRN
Sam Shahid, MBBS, MPH – American College Madeline M. Joseph, MD, FACEP Michele A. Redlo, MSN, MPA, RN, CPEN
of Emergency Physicians Samuel Hiu-Fung Lam, MD, MPH, RDMS, Maureen R. Curtis Cooper, BSN, RN, CEN,
Elizabeth Stone, RN, PhD, CPEN – Emergency FACEP CPEN, FAEN, Board Liaison
Nurses Association Simone L. Lawson, MD
Moon O. Lee, MD, FACEP
Joyce Li, MD 2019 PEDIATRIC COMMITTEE MEMBERS
FORMER COMMITTEE MEMBERS, Sophia D. Lin, MD Michele Redlo, MSN, MPA, BSN, RN, CPEN,
2018–2020 Dyllon Ivy Martini, MD Chairperson
Joseph Wright, MD, MPH, FAAP, Chairperson Larry Bruce Mellick, MD, FACEP Krisi Kult, BSN, RN, CPEN, CPN
(2016–2020) Donna Mendez, MD Katherine Logee, MSN, RN, NP, CEN, CPEN,
Javier Gonzalez del Rey, MD, MEd, FAAP Emory M. Petrack, MD, FACEP CFRN, CNE, FNP-BC, PNP-BC
Lauren Rice, MD Dixie Elizabeth Bryant, MSN, RN, CEN, CPEN,
Emily A. Rose, MD, FACEP NE-BC
FORMER LIAISONS, 2018–2020 Timothy Ruttan, MD, FACEP Maureen Curtis Cooper, BSN, RN, CEN, CPEN,
Mohsen Saidinejad, MD, MBA, FACEP FAEN
Brian Moore, MD, FAAP – National
Genevieve Santillanes, MD, FACEP Kristen Cline, BSN, RN, CEN, CPEN, CFRN,
Association of EMS Physicians
Joelle N. Simpson, MD, MPH, FACEP CTRN, TCRN, Board Liaison
Mohsen Saidinejad, MD, MBA, FAAP, FACEP –
Shyam M. Sivasankar, MD
American College of Emergency Physicians
Daniel Slubowski, MD
Sally Snow, RN, BSN, CPEN, FAEN – STAFF
Annalise Sorrentino, MD, FACEP
Emergency Nurses Association
Michael J. Stoner, MD, FACEP Catherine Olson, MSN, RN
Carmen D. Sulton, MD, FACEP
STAFF Jonathan H. Valente, MD, FACEP
Samreen Vora, MD, FACEP
Sue Tellez Jessica J. Wall, MD ABBREVIATIONS
Dina Wallin, MD, FACEP
Theresa A. Walls, MD, MPH
AAP: American Academy of
AMERICAN COLLEGE OF EMERGENCY Pediatrics
Muhammad Waseem, MD, MS,
PHYSICIANS, PEDIATRIC EMERGENCY Dale P. Woolridge, MD, PhD, ACEP: American College of
MEDICINE COMMITTEE, 2020–2021 FACEP Emergency Physicians
Ann M. Dietrich, MD, Chairperson ED: emergency department
Kiyetta H. Alade, MD
EMS: emergency medical
Christopher S. Amato, MD,
Zaza Atanelov, MD STAFF services
Marc Auerbach, MD Sam Shahid, MBBS, MPH
EMSC: Emergency Medical
Isabel A. Barata, MD, FACEP Services for Children
Lee S. Benjamin, MD, FACEP ENA: Emergency Nurses
Kathleen T. Berg, MD
Association
Kathleen Brown, MD, FACEP CONSULTANT
Cindy Chang, MD NPRP: National Pediatric
Jessica Chow, MD Marianne Gausche-Hill, MD, FACEP, FAAP, Readiness Project
Corrie E. Chumpitazi, MD, MS, FACEP FAEMS
Address correspondence to Kathleen Brown, MD. Email: Kbrown@cnmc.org
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2021 by the American Academy of Pediatrics and American College of Emergency Physicians
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
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PEDIATRICS Volume 147, number 5, May 2021 7REFERENCES
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PEDIATRICS Volume 147, number 5, May 2021 9Access to Optimal Emergency Care for Children
Kathleen M. Brown, Alice D. Ackerman, Timothy K. Ruttan, Sally K. Snow and
COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE; AMERICAN
COLLEGE OF EMERGENCY PHYSICIANS, PEDIATRIC EMERGENCY
MEDICINE COMMITTEE; EMERGENCY NURSES ASSOCIATION, PEDIATRIC
COMMITTEE, 2018-2019
Pediatrics 2021;147;
DOI: 10.1542/peds.2021-050787 originally published online April 21, 2021;
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/147/5/e2021050787
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Kathleen M. Brown, Alice D. Ackerman, Timothy K. Ruttan, Sally K. Snow and
COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE; AMERICAN
COLLEGE OF EMERGENCY PHYSICIANS, PEDIATRIC EMERGENCY
MEDICINE COMMITTEE; EMERGENCY NURSES ASSOCIATION, PEDIATRIC
COMMITTEE, 2018-2019
Pediatrics 2021;147;
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