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.

backgroundPediatric 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.

methodsThis 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.

resultsAmong 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.

conclusionPediatric 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.