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To determine which factors of training and education influence emergency medical technicians' (EMTs) feelings toward pediatric emergencies in a rural state.A 12-question survey was adapted from a previously studied, nationally administered questionnaire and distributed to all registered EMTs in the state of Maine. Data collected included level of EMT, number of pediatric calls per month, and hours of pediatric continuing education (CE) received. Questions were based upon a 5-point Likert scale and explored level of comfort with various areas of training and education, types of emergencies encountered, and ages of patients.Eighty-seven percent of all respondents experienced 3 or less (0-3) calls for pediatric emergencies per month, and 73% of all respondents reported receiving 8 or fewer hours of CE in pediatric topics over the previous 2 years. Advanced level of training (EMT-P or EMT-I vs. EMT-B) was associated with increased comfort levels in all areas except Resources (P < 0.05). Additional hours of CE (4+ vs. 0-3) was associated with increased comfort levels in all areas queried (P < 0.05). Increased call volume (4+ vs. 0-3) was associated with increased comfort levels for: children <4 years old, most skills and chief complaints (except Pediatric Assessment by Age, Child Abuse, and Newborn Deliveries), and most aspects of training (except Confidence and Resources) (P < 0.05).Level of EMT and hours of CE influence the level of comfort felt by EMTs when confronting a pediatric emergency. Specific CE requirements for topics in pediatric emergency medicine should be considered for all EMTs.