Emergency Department Resource Hub

Pediatric Triage Policies 
Essential Requirements: Your ED must have a triage policy that utilizes a standard, valid and reliable system to identify patients at high risk, which is based on severity of illness and injury, physiologic state and the risk or suspicion of critical illness and injury. This policy must include pediatric complaints that would be considered high risk (e.g., neonatal fever, immunocompromised with fever, open fracture, suicidal or homicidal ideations) and account for normal Vital Sign parameters in children that may differ from adults.

• Resources
  • Sample Pediatric Triage Guidelines
  • Illness and Injury Triage Policy Template
  • Sample Patient Care Policy and Procedures

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Pediatric Assessment and Reassessment 
Essential Requirements: Your ED must have a triage policy that utilizes a standard, valid and reliable system to identify patients at high risk, which is based on severity of illness and injury, physiologic state and the risk or suspicion of critical illness and injury. This policy must include pediatric complaints that would be considered high risk (e.g., neonatal fever, immunocompromised with fever, open fracture, suicidal or homicidal ideations) and account for normal Vital Sign parameters in children that may differ from adults.

• Resources
  • Validity of Different Pediatric Early Warning Scores in the Emergency Department
  • Pediatric Vital Signs Ranges
  • Sample Pediatric Assessment-Reassessment Guidelines
  • Sample Vital Signs Policy

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Immunizations 
Essential Requirements: Your ED must have policy, procedures and plans to obtain and update the immunization status on all pediatric patients. This policy must include universal screening for vaccine deficiencies and clear documentation of vaccine status that are easily accessible by the medical provider. Tetanus vaccination status should always be considered for injured children, with consideration to the type of injury, wound contamination and most recent tetanus vaccination.

• Resources
  • American Academy of Pediatrics – Recommended Child and Adolescent Immunization Schedule – January 2026
  • American Academy of Pediatrics – Shared Decision Making Guidelines
  • Immunizations and Responsibility of the Emergency Nurse
  • Vaccine Information Sheets
  • Flowchart to Assess Pediatric Vaccination Status – American College of Emergency Physicians
  • American Academy of Pediatrics Policy Statement – Increasing Immunization Coverage

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Children Maltreatment 
Essential Requirements: Your department must have a written policy that addresses how child maltreatment cases are identified and managed in your department. A sample policy is provided in the resource section below.

• Resources
  • Sample Policy – Child Maltreatment
  • Evaluation of Suspected Child Physical Abuse
  • Murray LK, Nguyen A, Cohen JA. Child sexual abuse. Child Adolesc Psychiatr Clin N Am. 2014 Apr;23(2):321-37.
  • Screening for Physical Abuse in Children 
  • Abuse – Pathway to Promote Collaboration and Create a Safety Net for Children with Injuries (EDTC)

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Death of a Child 
Essential Requirements: Your ED must have a policy or guideline for the ED team following a death of a child.

• Resources
  • Guidelines for Supporting the Family After the Death of a Child
  • End of Life in the ED – Policy Template
  • Helping Children Cope with Death
  • Communicating News, Administrative Duties, Care Initiatives
  • End of Life Issues for Pediatric Patients in the ED
  • Care of a Dying Patient and Disposition of a Body
  • Sample Patient Death Policy

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Radiation Dosing 
Essential Requirements: Your ED must have a policy or guideline establishing age- or weight-appropriate dose reductions for children consistent with “as low as reasonably achievable” principles.

• Resources
  • Sample Policy – Imaging and Radiology
  • Radiation Risk to Children from Computed Tomography
  • Optimal Emergency Department Management of Children with Minor Blunt Head Trauma
  • State of Wisconsin Pediatric Imaging Guidelines for Blunt Trauma
  • Sample Radiation Protection Policy

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Behavioral Health 
Essential Requirements: Your ED must have a policy or procedure that specifically addresses assessment, evaluation, management disposition and appropriate transfer of children with behavioral health complaints.

• Resources
  • Pediatric Suicide Risk Screening & Assessment
  • Care of the Agitated Patient
  • Deescalation Tips for the Agitated Pediatric Patient
  • Pediatric Mental Health Care in the Emergency Department Toolkit
  • Elements of the National Alliance on Mental Illness’s Compassionate Care in the Emergency Room
  • Substance Abuse and Mental Health Services Administration (SAMHSA) Guidance for a Trauma-Informed Care Approach to Caring for Children with Mental Disorders
  • Substance Abuse and Mental Health Services Administration (SAMHSA) Practitioner Training and Virtual Learning Labs for Mental Health
  • Guidance for Emergency Department Preparedness for Children Seeking Mental Health Care
  • American Psychological Association Guidance on Setting up Telepsychology Services
  • American Academy of Pediatrics and American College of Emergency Physicians Policy Statement – Pediatric Mental Health Emergencies in the Emergency Medical Services System
  • Technical Report – Pediatric and Adolescent Mental Health Emergencies in the Emergency Medical Services System
  • Executive Summary: Evaluation and Management of Children with Acute Mental Health or Behavioral Problems – Recognition of Clinically Challenging Mental Health Related Conditions Presenting with Medical or Uncertain Symptoms

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Social Services for All Ages 
Essential Requirements: Availability of 24/7 social services in your ED are an important resource that can assist with broad and specific needs of children and families.

• Resources
  • Relationship between Emergency Medical Services Use and Social Service Needs in a Pediatric Emergency Department Population
  • Example of Interpreter Contact Card

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Family-Centered Care 
Essential Requirements: You must first have a written policy that addresses family-center care in your ED and have the following essential elements of patient- and family-centered care included in that policy. These elements are 1) involving families in care decisions and medication safety processes, 2) the presence of family during all aspects of care and 3) family education and bereavement counseling. A sample policy is provided in the resource section below.

• Resources
  • Sample Policy – Family Presence during Invasive Procedure and Resuscitation
  • Sample Family-Centered Care Guidelines 
  • Sample Family Presence Program in the ED

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Disaster Planning 
Essential Requirements: Your hospital or ED disaster plan must address the following issues:

• • • • Availability of medications, vaccines, equipment, supplies and appropriately trained providers for children in disasters.
      • Decontamination, isolation, quarantine of families and children of all ages along with minimization of parent-child separation and methods for reunification.
      • All disaster drills include pediatric patients and have a plan for pediatric surge capacity for both injured and non-injured children.
      • Access to behavioral health resources for children in the event of a disaster is another critical element.
      • The care of children with special health care needs, including children with developmental disabilities.
•  Resources
  • Sample Checklist – Essential Pediatric Domains and Consideration
  • Checklist for Pediatric Considerations for a Disaster – EMSC
  • Pediatric Tabletop Disaster Exercises Resource Kit – AAP
  • Emergency Nurses Association Topic Brief – Disaster Planning: Preparing for Pediatric Surges
  • Homeland Security Exercise and Evaluation Program (HSEEP)
  • Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resource, Assistance       Center, and Information Exchange
  • CDC Public Health Emergency Exercise Toolkit
  • FEMA Independent Study Courses
    • An Introduction to Exercises (IS-0120.c)
    • Exercise Design and Development (IS-0129.a)
  •  Pediatric Disaster Simulation Resources
    • Simulated airway drills as a tool to measure and guide improvements in endotracheal intubation preparation in the pediatric emergency department
    • Pediatric Emergency Medicine Disaster Simulation Curriculum: The 5-Minute Trauma Assessment for Pediatric Residents (TRAP-5)– See Appendices at the end of the article
  • American Academy of Pediatrics and American College of Emergency Physicians Policy Statement – Emergency Information Forms and Emergency Preparedness for Children with Special Health Care Needs
  • English to Chinese Pediatric Translator
  • ED Disaster Checklist
  • Sample Pediatric Safe Area Registration Sheet for Unaccompanied Minors

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Interfacility Transfer Guidelines 
Essential Requirements: Your hospital must have an interfacility transfer guideline. Your interfacility transfer guideline should include:

• • • • Process for initiation of transfer.
      • Description of the roles and responsibilities of the referring facility and referral center.
      • Process for selecting the appropriate care facility.
      • Process for selecting the appropriately staffed transport service to match the patient’s acuity level (e.g., level of care required by patient or equipment needed in transport).
      • Process for patient transfer (including obtaining informed consent).
      • Plan for transfer of copy of patient medical record.
      • Plan for transfer of a copy of the signed transport consent.
      • Plan for transfer of personal belongings of the patient.
      • Plan for provision of directions and referral institution information to family.
•  Resources
  • SAMPLE – Interfacility Transfer Agreement Template
  • Steps to Create a Transfer Agreement – EIIC
  • Pediatric Interfacility Transfer Guideline, EMSC Innovation and Improvement Center
  • Sample ED Transfer Checklist 

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Interfacility Transfer Agreement 
Essential Requirements: Your hospital must have an interfacility transfer agreement with tertiary pediatric facility.

• Resources
  • Interfacility Transfer Toolkit, EMSC Innovation and Improvement Center