The main challenge in providing safe care to children in ambulances may be the limited experience many emergency medical service (EMS) providers have in treating kids, according to a US survey of first responders, reported by Reuters Health.

Though children make up almost one quarter of the US population – or roughly 73 million kids – they account for just 13% of EMS transports and only 1% of rides requiring advanced life support, researchers report in the Journal of Pediatrics.

Asked what factors may be most responsible for errors, EMS workers cited inexperience with airway management for tiny bodies, heightened anxiety working with children, and limited proficiency in pediatric skills requiring pint-sized equipment as the top culprits, the survey found.

The need for intense, complex care in these situations, and EMS workers’ limited experience with them, “make the medical management of children’s emergencies particularly challenging,” said lead author Dr Jeanne-Marie Guise, an emergency medicine researcher at Oregon Health and Science University in Portland.