National Prehospital Pediatric Readiness Project (PPRP) Assessment
This section is intended to support EMSC Program Managers and Project Directors in understanding the purpose, administration, and use of the National Prehospital Pediatric Readiness Project (PPRP) Assessment and related data activities and responsibilities. To read more about the National Prehospital Pediatric Readiness Project, please visit the pediatric readiness website.
What is it?
The National Prehospital Pediatric Readiness Project (PPRP) Assessment is a national pediatric readiness assessment designed to help EMS and fire-rescue agencies evaluate how prepared they are to care for children during emergencies. The assessment supports pediatric readiness measurement, quality improvement, performance monitoring, benchmarking, and national readiness initiatives.
The assessment is based on the nationally recognized recommendations outlined in the 2020 joint policy statement (Pediatric Readiness in Emergency Medical Services Systems), Technical Report, and evaluates readiness across eight key domains:
- Education and Competencies for Providers
- Equipment and Supplies
- Interactions with Systems of Care
- Coordination of Pediatric Emergency Care
- Patient and Family-Centered Care in EMS
- Patient and Medication Safety
- Policies, Procedures, and Protocols
- Quality Improvement/Performance Improvement
Together, these domains provide a comprehensive view of pediatric readiness and help agencies identify strengths, prioritize improvement efforts, and monitor progress over time.
The inaugural national PPRP Assessment was completed in 2024 and established the first national baseline measure of pediatric readiness among EMS and fire-rescue agencies nationwide.
Assessment findings are used to support local quality improvement activities, EMSC performance measures, state and territorial readiness initiatives, research, and national efforts to improve emergency care for children.
The PPRP includes two complementary assessment opportunities.
The National Assessment is conducted approximately every five years and supports national measurement of pediatric readiness, benchmarking, performance measurement, and readiness monitoring.
Between national assessment periods, EMS and fire-rescue agencies may participate in the Open Assessment. The Open Assessment allows agencies to evaluate readiness, receive updated gap reports, identify opportunities for improvement, monitor progress over time, and support ongoing quality improvement efforts.
National Assessment vs. Open Assessment
Why Pediatric Readiness Matters
Children represent a relatively small percentage of emergency responses, yet their care often requires specialized equipment, training, medications, protocols, and coordination. Pediatric readiness helps ensure that EMS and fire-rescue agencies are prepared when pediatric emergencies occur.
Research has demonstrated that stronger pediatric readiness is associated with improved outcomes for children receiving emergency care. By identifying gaps and supporting improvement efforts, readiness initiatives help organizations strengthen systems of care and improve emergency care for children.
Frequently Asked Questions
The sections below address common questions related to assessment administration, participation, performance measures, readiness measurement, and the role of EMSC Program Managers in supporting pediatric readiness improvement.
1. Which prehospital agencies should be surveyed for this data?
According to the definition in the 2023 EMSC Performance Measure Implementation Manual, The PPRP Assessment is intended for EMS and fire-rescue agencies that respond to public 911 emergency calls and provide medical care to patients. This includes both transporting and non-transporting agencies when they meet the EMSC Program’s definition of a prehospital agency.
The assessment should be completed by an individual with operational knowledge of the agency, such as an agency director, administrator, Pediatric Emergency Care Coordinator (PECC), quality improvement lead, or another individual familiar with pediatric readiness practices within the organization.
A list of these agencies for each state/territory with designated contact is in the EDC’s secure online Contact List Management System (CLMS). EMSC Program Managers have 24/7 access to the CLMS for updating, verifying, and managing their list of agencies as well as the contact information.
Accurate agency and contact information are critical to successful assessment administration. CLMS serves as the foundation for assessment deployment, communications, reporting, dashboard access, and ongoing readiness activities. Maintaining current information helps ensure that invitations, reminders, reports, and pediatric readiness resources reach the appropriate individuals.
Prior to assessment periods, the EDC works closely with EMSC Program Managers to identify and address contact data quality issues that could affect participation, reporting, or communication activities. Links to the secure CLMS and Tableau systems for Program Managers can be found on our EDC & TA section under the Program Manager Secure Links & Resources at the bottom of the page.
2. Is there a minimum required response rate?
The goal is to achieve the highest participation rate possible. Strong participation increases confidence that assessment findings accurately represent pediatric readiness across a state or territory.
Higher participation rates increase confidence that assessment findings accurately represent pediatric readiness across a state or territory. Strong participation also improves the usefulness of readiness data for quality improvement, planning, performance measurement, and decision-making.
The EDC supports response-rate efforts through communication planning, data quality review, technical assistance, engagement strategies, performance monitoring, and evidence-based assessment administration practices.
The number of EMS and fire-rescue agencies that meet the EMSC Program’s definition of a prehospital agency varies considerably across states and territories. As a result, the effort required to achieve strong participation rates also varies. Historical EMSC prehospital performance measure data collection efforts conducted between 2020 and 2022 provide useful context regarding the number of eligible agencies and participation patterns observed across states and territories.
Historical data collection efforts also demonstrated that achieving high response rates generally becomes more challenging as the number of eligible agencies increases. These findings highlight the importance of accurate contact information, communication planning, outreach, and follow-up activities during assessment administration.
3. What is the data collection cycle and schedule for this assessment?
The inaugural National Prehospital Pediatric Readiness Project (PPRP) Assessment was completed in 2024 and established the first national baseline measure of pediatric readiness among EMS and fire-rescue agencies. National PPRP Assessments are conducted on a five-year cycle to support performance measurement, benchmarking, and long-term tracking of pediatric readiness trends. According to this plan, the 2nd national deployment of the PPRP would be 2029.
The data collection life cycle for the 2024 PPRP assessment will be similar to the one followed by the National Pediatric Readiness Project (NPRP) Assessment with hospital emergency departments (EDs).
Before the PPRP assessment opens, it is preceded by Program Managers updating and verifying the prehospital agency contact information listed in CLMS. EDC staff assisted Managers with this part of the process by creating state/territory-specific data quality reports of this information which will show the data quality issues. Data quality issues can include missing contact information and/or information being in all capital letters or all lower-case letters. Promotion of the assessment will also be an important part of the prep work. Managers can find marketing materials for this assessment on our website under the Survey and Assessment Promotional Materials section.
During national assessment periods, agencies are provided a defined 3-month participation window to complete the assessment and receive readiness results. Upon completion, respondents receive immediate feedback through a gap report that can be used to support planning, education, policy development, and improvement activities.
The assessment lifecycle extends beyond data collection and includes communication planning, contact management, assessment administration, data quality review, analysis, reporting, dashboard development, benchmarking, and quality improvement support.
The assessment generally closes the last day of the month of the data collection. The weeks following the close, EDC staff export the 6,000+ responses. EDC staff then spend 1 to 2 months cleaning the data and preparing the final dataset for analysis. Cleaning and preparation include removing duplicates or incomplete responses as well as ensuring addresses are formatted in proper form for geographic analysis (urbanicity). Preliminary analysis is conducted while the data is geo-coded (latitude, longitude, census information, and urbanicity). The initial task of the EDC is to report national and state/territory performance measure results, hopefully within 2 months of the assessment close. Further and more in-depth analysis and programming for various secure Tableau dashboards for all responses and QI purposes starts approximately 3-5 months after the assessment has closed.
The months following the release of Tableau dashboards are used by Managers to share their results and educate prehospital agencies to effect improvement in the 8 domains listed above. Managers can find resources for these activities on our website under the Survey and Assessment Promotional Materials section.
4. Who sends the assessment invitation and reminders?
The PPRP and assessment is a collaboration of national organizations in which EMSC is a partner. The assessment is a national quality improvement effort requiring centralized national deployment for improved data quality, integrity, and comparability.
Successful national assessments depend on more than the assessment instrument itself. Communication strategy plays a critical role in participation, data quality, engagement, and representativeness.
Assessment communications are developed using evidence-based survey methods, communication best practices, assessment analytics, and lessons learned from previous national data collection efforts. Communication schedules, message timing, branding, audience segmentation, and reminder strategies are intentionally designed to support participation and data quality.
For EDC-led assessment activities, communications are distributed using a professional communication platform that supports large-scale delivery, message tracking, open-rate monitoring, click-through analysis, engagement measurement, and continuous improvement.
Many elements of the communication strategy are informed by established survey methods research, including Dillman’s Tailored Design Method, which emphasizes multiple planned contacts, respondent-centered communication, and evidence-based approaches to improving participation while reducing burden.
During National PPRP Assessment periods, State Partnership grant recipients may choose from two approaches for sending assessment invitations and reminder emails:
- State-led Process in close collaboration with the EDC
- EDC-led Process in close collaboration with SP grant recipients.
State-led Process
Under the State-Led Process, the EMSC State Partnership Program is responsible for sending the assessment invitation email and reminder emails to eligible agencies in close collaboration with the EDC. The EDC provides approved email templates, distribution schedules, implementation guidance, and technical assistance designed to support standardized assessment administration and evidence-based survey methods.
Accurate agency contact information maintained in CLMS is essential for successful assessment administration. State Partnership Programs are responsible for reviewing and updating agency contact information prior to assessment deployment. Assessment invitation emails, reminder emails, outreach activities, and reporting all depend on the quality of information maintained within CLMS. Incomplete or outdated contact information may result in email delivery failures, reduced participation, and additional follow-up efforts during the assessment period.
Prior to each National PPRP Assessment cycle, the EDC provides State Partnership grant recipients with access to an online State-Led Process Request Form. Programs interested in sending their own assessment invitation email and reminder emails must submit the online request form and demonstrate their ability to meet established criteria related to email distribution, assessment administration, outreach activities, and participation support.
The State-Led Process criteria are aligned with evidence-based survey administration methods and national assessment best practices that help support participation, data quality, consistency, and comparability across states and territories. These criteria are intended to help ensure that assessment administration remains standardized while supporting valid and representative readiness findings.
Submitted requests are reviewed in collaboration with HRSA to determine whether the State Partnership Program can successfully implement the State-Led Process while maintaining alignment with the national assessment strategy and evidence-based survey methods.
Programs approved for the State-Led Process are responsible for sending all required assessment emails according to the approved assessment timeline. These emails include the pre-notification email, assessment invitation email, reminder emails, and other approved outreach emails identified within the national assessment communications strategy.
The EDC provides the PPRP Steering Committee-approved email templates and communication schedule for all required assessment emails. These templates and schedules are designed using evidence-based survey administration methods to support participation, data quality, consistency, and comparability across states and territories. State Partnership Programs may customize approved signature blocks and add appropriate state or territorial endorsement signatures; however, the content of the approved email templates may not be modified. This helps ensure that all participants receive consistent messaging aligned with the national assessment strategy, PPRP Steering Committee-approved communications, and evidence-based survey methods.
EDC-led Process
Under the EDC-Led Process, the EDC is responsible for sending the assessment invitation email and reminder emails on behalf of participating State Partnership Programs using approved email templates, established distribution schedules, and evidence-based survey administration practices.
Accurate agency contact information maintained in CLMS remains a shared responsibility between the EDC and State Partnership Programs. Although the EDC manages assessment invitation and reminder email distribution under this approach, successful delivery still depends on the accuracy of agency contact information contained within CLMS. Reviewing and updating agency records prior to assessment deployment can significantly reduce email delivery failures and improve participation rates.
Unlike the State-Led Process, there are no eligibility criteria that must be met to participate in the EDC-Led Process. State Partnership grant recipients simply notify the EDC that they would like the EDC to manage the assessment invitation and reminder email distribution for their state or territory.
The EDC develops assessment invitation and reminder emails according to the approved assessment timeline while monitoring participation, providing technical assistance, and supporting response-rate improvement efforts throughout the assessment period.
The EDC provides the PPRP Steering Committee-approved email templates and communication schedule for all required assessment emails. These templates and schedules are designed using evidence-based survey administration methods to support participation, data quality, consistency, and comparability across states and territories. Communications distributed through the EDC-Led Process may include EMSC State Partnership Program leadership within signature blocks or endorsement sections in addition to national project leadership.
State Partnership Programs continue to play an important outreach role under the EDC-Led Process.
As part of the national communications strategy, State Partnership Programs remain responsible for sending 2 designated outreach emails identified within the assessment communications plan. These typically include a pre-notification email announcing the upcoming assessment and a follow-up outreach email to nonresponding agencies prior to distribution of the final assessment reminder email.
These outreach emails help reinforce assessment awareness, encourage participation, and support response-rate improvement efforts through trusted state and territorial EMSC program relationships.
Nonrespondent Outreach and Calling Support
Regardless of whether a State Partnership Program selects the State-Led Process or the EDC-Led Process for assessment email distribution, the State Partnership Program remains responsible for outreach to nonresponding agencies during the nonrespondent outreach phase of the data collection.
State Partnership Programs that would like EDC assistance with nonrespondent calling activities may submit a request through an online Nonrespondent Calling Support Request Form. Information about this process, including access to the request form, is provided by the EDC during the assessment period.
For approved requests, the EDC and the State Partnership Program share responsibility for outreach activities. The EDC divides the list of nonresponding agencies into two groups, assigning approximately one-half of the agencies to the State Partnership Program and retaining the remaining agencies for EDC outreach efforts.
To support consistency and alignment with evidence-based survey administration practices, the EDC provides approved calling scripts, outreach guidance, and supporting materials for use during nonrespondent calling activities. State Partnership Programs may choose to involve Family Advisory Network (FAN) representatives or other approved partners in outreach efforts when appropriate. Individuals participating in outreach activities should use the approved calling materials to help ensure consistent messaging and alignment with the national assessment strategy.
Programs with more complete and accurate CLMS contact information are generally better positioned to reach nonresponding agencies and achieve stronger participation rates.
Because nonrespondent outreach resources are limited, EDC calling efforts may be prioritized based on factors such as the number of remaining nonrespondents, the completeness and quality of available contact information, projected impact on participation rates, and other operational considerations designed to maximize assessment participation and data quality.
5. How many and when should I send assessment communications?
Successful assessment administration depends on more than the assessment itself. Communication timing, message frequency, and outreach strategy all play an important role in participation, data quality, and the overall usefulness of assessment findings.
The EDC develops communication schedules using evidence-based survey administration methods, national assessment best practices, and findings from previous national prehospital data collection efforts. Communication schedules are designed to balance participation goals with respondent burden while maintaining consistency across states and territories.
For National PPRP Assessments, the EDC provides a comprehensive communications strategy that includes the timing of assessment invitation emails, reminder emails, outreach activities, and nonrespondent follow-up efforts. Communication schedules are reviewed and approved through the PPRP governance process and are designed to support participation, data quality, and representative assessment findings.
Historical EMSC prehospital data collection efforts have also provided valuable information regarding when agencies are most likely to engage with assessment communications. These findings help inform communication schedules and outreach strategies used during national assessments.
Historical analyses found that agency participation was generally highest on Tuesdays and Wednesdays and lowest on weekends. Mondays and Fridays produced fewer workweek responses than mid-week communications. These findings suggest that the timing of assessment emails and outreach activities can influence participation and support more effective use of communication efforts. As a result, National PPRP communication schedules are intentionally designed to prioritize higher-engagement days whenever possible.
Historical analyses of response timing also found that participation was generally highest during morning business hours, particularly between 8:00 a.m. and 10:59 a.m. local time. Participation tended to decline later in the day and approaching weekends. The data also show that late afternoon communications are less effective, with participation decreasing after the lunch hour.
Together, these findings indicate that communication timing matters. Agencies are generally most responsive to assessment communications sent on Tuesdays and Wednesdays during morning business hours, particularly between 8:00 a.m. and 10:59 a.m. local time. In contrast, communications distributed on Monday mornings, Friday afternoons, evenings, or weekends may receive less immediate attention and often require additional follow-up efforts to achieve similar participation rates. This pattern is consistent with evidence-based survey administration methods, which recognize that respondents are often managing competing priorities at the beginning and end of the workweek. Following the approved National PPRP communication schedule helps maximize participation, reduce outreach burden, and support high-quality readiness data.
While communication schedules are informed by these findings, they are only one component of a successful assessment strategy. Accurate CLMS contact information, coordinated outreach efforts, reminder emails, state engagement, and nonrespondent follow-up activities all contribute to achieving strong participation rates.
6. How or where can I customize the assessment for EMSC data collection?
To ensure consistency, comparability, and data integrity, assessment questions are standardized nationally and are not modified at the state level. Standardized questions allow results to be compared fairly across agencies, states, territories, and future assessment cycles.
The assessment underwent extensive development, expert review, pilot testing, field testing, cognitive interviewing, and stakeholder review before implementation.
Pilot testing helps identify opportunities to improve question wording, instructions, assessment functionality, and the overall respondent experience. Field testing allows the assessment to be administered under conditions that more closely resemble a national deployment, helping evaluate how the assessment performs in real-world settings prior to implementation.
As part of the review and approval process, the PPRP Steering Committee pilot tested assessment questions with EMS and fire-rescue agencies across the United States and conducted one-on-one cognitive interviews with participating agencies. The assessment development, review, and approval process took more than two years to complete.
This rigorous development process helps ensure that assessment questions are understandable, meaningful, and capable of producing reliable, valid, and actionable data.
Standardization is essential because assessment results are used to support pediatric readiness initiatives, quality improvement efforts, national reporting, benchmarking, and performance measurement activities across the country.
Limited customization is available for select state- and territory-specific terminology. For a small number of questions, the EDC can incorporate state- or territory-specific terms to improve local relevance and support accurate interpretation of response options. Before each assessment cycle, EDC staff review and verify this terminology with each EMSC Program Manager to ensure accuracy and alignment with local usage.
Aside from these approved terminology customizations, assessment questions, response options, and core assessment content may not be modified. This helps preserve data quality, maintain consistent measurement across jurisdictions, and ensure that results remain comparable over time.
While EDC staff create state/territory versions of the survey with their custom terms, you can download a general PDF version (English and Spanish) of the survey instrument from our website.
