Berlin, VT – A trip to the local Emergency Department (ED) with a child can be a high stress situation for any parent. And while the ED care team at University of Vermont Health Network – Central Vermont Medical Center can’t erase parents’ anxiety completely, the group’s recent participation in a statewide initiative focused on improving pediatric readiness earned them accolades for the care and clinical management they provide to the hospital’s youngest patients.
“Central Vermont Medical Center has achieved the highest level of pediatric emergency readiness in Vermont through its participation in our statewide initiative,” said David Nelson, MD, a pediatric emergency physician at University of Vermont Medical Center who leads Vermont’s program to improve pediatric emergency services for children..
The Always Ready for Children program is a collaboration of Vermont Department of Health, Emergency Medical Services for Children (EMSC) and Vermont Child Health Improvement Program (VCHIP). Participating hospitals undergo a 100-point readiness assessment that evaluates their ability to care for pediatric emergencies based on personnel qualifications, equipment availability and established protocols. The ED at Central Vermont Medical Center achieved the program’s “Innovator” level recognition – the highest standard of pediatric readiness.
“Kids are inherently scared when they’re sick, and coming into an environment with masks and other things they don’t often experience can be scary on top of that,” said Karolyn Jarodsky, RN, a clinical nurse coordinator in the ED at Central Vermont Medical Center, and the nursing team lead on the ED’s pediatric readiness initiative. “We really focus a lot on providing trainings and education to our staff, because we don’t specialize [in pediatric care].”
While Central Vermont Medical Center does not have a dedicated inpatient unit for pediatric patients, the need to ensure best practices and clinical skills related to pediatric care is among the ED’s highest priorities. The department’s team of clinicians – all board certified ED physicians – also have specific training and certifications related to pediatric care. The physicians also work with members of UVM Health Network’s pediatric emergency medicine group to ensure their facilities, processes and clinical skills remain current.
That’s important because the hospital’s ED sees more pediatric patients than you might realize, said Matthew Greenberg, MD, an ED physician at Central Vermont Medical Center and clinician lead on the hospital’s pediatric readiness initiative. About 15% of visits to the hospital’s ED involve patients under the age of 18, he said. In fiscal year 2024, there were more than 28,000 visits to the hospital’s ED, according to annual data published by UVM Health Network.
Most of those patients don’t require critical care, Dr. Greenberg said, and those that do are transferred to pediatric care units like those at University of Vermont Children’s Hospital. But the focus at Central Vermont Medical Center is ensuring that every aspect of the hospital’s emergency care operations keeps pediatric patients in mind.
“Kids are not small adults, they have differences in physiology and in the way they respond to medication,” said Dr. Greenberg. “It’s important to think of them as a unique population with unique needs. The great majority of children who come into the ED are not incredibly sick. It’s being aware and finding those cases that’s really important.”
Improving Emergency Medical Services for Kids throughout Our Region
In 2024, Always Ready for Children saw participation from all of Vermont’s 14 hospitals. After their initial assessment, each hospital receives targeted improvement recommendations and support for implementing any changes.
Recent national research published in 2024 demonstrates the critical importance of initiatives focused on pediatric readiness in emergency departments. Researchers found that hospitals scoring 88 or higher on the readiness assessment showed a 76% reduction in mortality risk for pediatric patients. Nationwide, these improved standards are estimated to save the lives of more than 2,100 children each year.
“Many hospitals need particular assistance with policy development,” said Dr. Nelson. ”For example, pediatric medication dosing requires weight in kilograms, so if a hospital only records weights in pounds, potentially dangerous errors can occur.”
The readiness assessment is only the first focus of Dr. Nelson’s program – the second is practical training in pediatric emergency care. Dr. Nelson and a team that includes four pediatric emergency nurses from University of Vermont Medical Center and a child life specialist visit hospitals across Vermont conducting hands-on training sessions.
At Central Vermont Medical Center, the group recently conducted trainings on pediatric airway management, IV skills, medication administration, emergency condition recognition and techniques for keeping young patients calm during treatment.
“At CVMC, they’ve managed some critically-ill pediatric patients, and when we conducted case reviews it was clear their care team executed flawlessly, providing optimal care in every situation,” said Dr. Nelson. “Through their commitment to both formal assessment and practical skill development, Central Vermont Medical Center has demonstrated exceptional dedication to providing the highest standard of care for children facing medical emergencies in central Vermont.”
Dr. Nelson is also planning to bring the program, which is based on programs developed in partnership with the American Academy of Pediatrics, American College of Emergency Physicians and the Emergency Nurses Association, to UVM Health Network hospitals in northern New York.
“This is a really good program to be involved in,” he said. “It’s a stepping stone to more, and Vermont is doing a phenomenal job. It’s very impressive how well our ED care teams can handle anything and everything that walks through their doors.”