Prehospital Variability of Pediatric Emergency Acuity Assessment Criteria in Japan: A Nationwide Analysis of Fire Department Protocols

Abstract

Introduction

In pediatric emergency care, acuity assessment is required based on age-specific physiological characteristics. However, in Japan, prehospital pediatric acuity d protocols vary regionally in the assessment tools and vital sign criteria used. This study aimed to clarify the differences in assessment tools and vital sign criteria currently used for pediatric acuity determination in Japan.

Methods

This study used data from a nationwide survey conducted in August 2024 by the Pediatric Emergency Committee, Japanese Society for Emergency Medicine, which targeted emergency medical services supervisors at all 720 fire departments across Japan regarding the presence and content of pediatric acuity determination protocols. Collected protocols were compared and analyzed for differences in assessment tools, vital sign thresholds, and age categorizations.

Results

Responses were obtained from 561 departments (77.9%). After consolidation of duplicate prefecture-level protocols, 32 unique pediatric acuity determination protocols were included in the final analysis. Only one protocol fully adhered to the Fire and Disaster Management Agency (FDMA) framework, whereas most protocols were based on the Foundation for Ambulance Service Development (FASD) criteria. The upper and lower limits of vital signs varied, with apparent differences in younger age groups. Age categorizations ranged from three broad divisions to detailed subdivisions.

Conclusion

Japan's prehospital pediatric acuity determination shows substantial regional variability, reflected in the identification of multiple distinct protocols and limited real-world adherence to FDMA-based criteria. Nationwide standardization and implementation of FDMA-based criteria should be prioritized before developing new systems, followed by validation in real-world practice to ensure feasibility, equity, and clinical effectiveness.