Emergency medical services responders’ perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study

Abstract

ObjectivePrehospital emergency medical services (EMS) providers report anxiety as the second most common contributor to paediatric patient safety events. The objective of this study was to understand how EMS providers perceive the effect of stress and anxiety on paediatric out-of-hospital patient safety.SettingThis was a nationwide study of EMS providers from 44 of 50 (88%) US states.ParticipantsA total of 753 eligible EMS professionals, including emergency medical technicians, emergency department physicians and nurses (general and paediatric), and respiratory therapists who participate in out-of-hospital transports.Primary and secondary outcome measuresOutcomes included responses to: (1) clinical situations where heightened stress or anxiety was likely to contribute to safety events, (2) aspects of these clinical situations that cause stress or anxiety and (3) how stress or anxiety may lead to paediatric safety events.ResultsEMS providers reported that the clinical situations where stress and anxiety were more likely to contribute to paediatric patient safety events were trauma, respiratory distress and cardiac issues. Key themes were: (1) provider sympathy or identification with children, (2) difficulty seeing an innocent child hurt and the inherent value of children and (3) insufficient exposure to paediatric emergencies.ConclusionsCaring for paediatric emergencies creates unique stresses on providers that may affect patient safety. Many of the factors reported to cause provider stress and anxiety are inherent attributes of children and therefore not modifiable. Tools that support care during stressful conditions such as cognitive aids may help to mitigate anxiety in the prehospital care of children. Further research is needed to identify opportunities for and attributes of interventions.

Understanding mind–body disciplines: A pilot study of paced breathing and dynamic muscle contraction on autonomic nervous system reactivity

“…These findings may be highly relevant for workers who need to make quick and accurate decisions in high stress environments. Real‐time management of stress could lead improved performance under pressure as suggested by a large‐scale study of emergency medical responders, where increased perceived anxiety was correlated with patient safety events and compromised decision making (Guise et al, ).…”

The most common causes of stress and psychosomatic manifestation among nurses at the Department of Neonatal Intensive Care

“…Ovi rezultati su u saglasnosti sa procenom drugih istraživača koji su potvrdili da su anksioznost i stres najčešće prisutni u toku zbrinjavanja povređene dece, kao i novorođenčadi sa respiratornim distres sindromom i kardiovaskularnim problemima. 21 Takođe, prisutne psihosomatske manifestacije koje su prijavili naši ispitanici u saglasnosti su sa kliničkim manifestacijama (psihosocijalnim, neurološkim, endokrinološkim i imunološkim) koje su opisane u literaturi kao posledice hroničnog stresa. 22,23 U dostupnoj literaturi, dokazana je pozitivna korelacija između visokog nivoa izgaranja kod sestara (i lekara) zaposlenih u urgentnoj službi i kvantitativnim, kognitivnim i emocionalnim zahtevima posla.…”

Establishing the Key Outcomes for Pediatric Emergency Medical Services Research

“…Despite the unique nature of the EMS environment and the distinct challenges of caring for children in the prehospital environment, there is little context‐specific research to guide the development of prehospital protocols. Recently, pediatric EMS clinical research has seen significant growth in both the number of publications and investigators; however, the majority of these studies are observational in nature . To date, to our knowledge, there have only been two randomized trials conducted specifically for children in the EMS setting, one that addressed airway management and one related to treatment for active seizures .…”

“…To date, to our knowledge, there have only been two randomized trials conducted specifically for children in the EMS setting, one that addressed airway management and one related to treatment for active seizures . Recently, pediatric EMS clinical research has seen significant growth in both the number of publications and the number of investigators; however, the majority of these studies are observational in nature . There is also a concerted effort among national organizations and researchers to focus on defining and implementing “best practices” in pediatric EMS care derived from the currently available evidence base even though this knowledge base is generally recognized to be limited …”