Baylor College of Medicine and Texas Children’s Hospital. Pediatric Evidence-Based Guidelines Assessment of EMS System Utilization in States (Principal Investigator: Manish Shah, MD). Prehospital care is usually standardized within an EMS system through the use of guidelines or protocols, also known as offline medical direction. However, offline medical protocols vary from one EMS agency to another, making standardization of care across EMS agencies challenging. The goal of this project is to improve the evidence-base for pediatric prehospital care utilizing the National Prehospital Evidence-Based Guideline (EBG) Model Process. To date, the multidisciplinary project team has developed four pediatric-relevant EBGs – airway management, allergic reactions, shock, and spinal care – after a thorough review of the medical literature, including an evaluation using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.