Pediatric Readiness in Emergency Medical Services Systems

Owusu‐Ansah, Sylvia; Moore, Brian R.; Shah, Manish I.; Gross, Toni; Brown, Kathleen M.; Gausche‐Hill, Marianne; Remick, Katherine; Adelgais, Kathleen; Rappaport, Lara; Snow, Sally K.; Wright-Johnson, Cynthia; Leonard, Julie C.; Lyng, John; Fallat, Mary E.

doi:10.1542/peds.2019-3308

Cited by 43 publications

(34 citation statements)

References 76 publications

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“…That clinical intuition can be refined in formal education and incorporated in future EBGs. As a part of this education, EMS clinicians should be introduced to the Emergency Information Form (EIF), a simple and easy to utilize document for CSHCN endorsed by the American Academy of Pediatrics and the American College of Emergency Physicians [3,30]. If the population of children who need a pediatric capable destination is successfully identifiable by EMS clinicians and direct transport is possible, this could relieve a significant burden on local non-specialty facilities as well as patients and their families.…”

Section: Discussionmentioning

confidence: 99%

“…Emergency medical services (EMS) clinicians (Basic and Advanced Emergency Medical Technicians and Paramedics) are tasked with assessing, treating, and transporting patients in the prehospital environment [1][2][3]. For pediatrics, the transport destination determined by the EMS clinician is a particularly important aspect of the child's overall emergency care.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency Medical Services Clinicians’ Pediatric Destination Decision-Making: A Qualitative Study

Fratta¹,

Fishe²,

Schenk³

et al. 2021

Cureus

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Objective This study sought to identify factors that influence emergency medical services (EMS) clinicians’ destination decision-making for pediatric patients. We also sought EMS clinicians’ opinions on potential systems improvements, such as protocol changes and the use of evidence-based transport guidelines. Methods Thirty-six in-depth phone interviews were conducted using a semi-structured format. We utilized a modified Grounded Theory approach to understand the complicated decision-making processes of EMS personnel. Memo writing was used throughout the data collection and analysis processes in order to identify emerging themes. The research team utilized hierarchical coding of interview transcripts to organize data into sub-categories for final analysis. Results EMS clinicians cited the perceived need for specialty care, the presence of a medical home, a desire for improved continuity of care, and the availability of aeromedical transport as factors that promoted transport to a pediatric specialty center. They voiced that children with emergent stabilization needs should be transported to the closest facility, however, they did not identify any specific medical conditions suitable for transport to non-specialty centers. EMS clinicians recommended improvements in pediatric-specific education, improved clarity of hospitals’ pediatric capabilities, and the creation of a pediatric-specific destination decision-making tool. Conclusion This study describes specific factors that influence EMS clinicians’ transport destination decision-making for pediatric patients. It also describes potential systems and educational improvements that may increase pediatric transport directly to definitive care. EMS clinicians are in support of specific designations for hospitals’ pediatric capabilities and were in favor of the creation of a formal destination decision-making tool.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergency Medical Services Clinicians’ Pediatric Destination Decision-Making: A Qualitative Study

Fratta¹,

Fishe²,

Schenk³

et al. 2021

Cureus

View full text Add to dashboard Cite

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“…4 Research is often focused on paediatric readiness in emergency departments 5 (EDs) and emergency medical services (EMS). 6 Little guidance exists within the paediatric anaesthesia literature. For example a PubMed search on July 26, 2021 using 'pediatric anesthesia mass casualty' yielded only one result.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Paediatric patients in mass casualty incidents: a comprehensive review and call to action

Desmond¹,

Schwengel²,

Chilson³

et al. 2022

British Journal of Anaesthesia

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The paediatric population is disproportionately affected during mass casualty incidents (MCIs). Several unique characteristics of children merit special attention during natural and man-made disasters because of their age, physiology, and vulnerability. Paediatric anaesthesiologists play a critical part of MCI care for this population, yet there is a deficit of publications within the anaesthesia literature addressing paediatric-specific MCI concerns. This narrative review article analyses paediatric MCI considerations and compares differing aspects between care provision in Australia, the UK, and the USA. We integrate some of the potential roles for anaesthesiologists with paediatric experience, which include preparation, command consultation, in-field care, pre-hospital transport duties, and emergency department, operating theatre, and ICU opportunities. Finally, we propose several methods by which anaesthesiologists can improve their contribution to paediatric MCI care through personal education, training, and institutional involvement.

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“…Discomfort and anxiety seem to translate into true patient safety hazards, as significant medication errors [10,11], non-systematic evaluation [12,13], and other challenges [14,15] in the emergency care of small children have been reported. Education, protocol development, mental aids, and encouragement for systematic evaluation have been proposed to address the challenges in pediatric emergency care [1,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study

Oulasvirta

Harve‐Rytsälä

Lääperi

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background The challenges encountered in emergency medical services (EMS) contacts with children are likely most pronounced in infants, but little is known about their out-of-hospital care. Our primary aim was to describe the characteristics of EMS contacts with infants. The secondary aims were to examine the symptom-based dispatch system for nonverbal infants, and to observe the association of unfavorable patient outcomes with patient and EMS mission characteristics. Methods In a population-based 5-year retrospective cohort of all 1712 EMS responses for infants (age < 1 year) in Helsinki, Finland (population 643,000, < 1-year old population 6548), we studied 1) the characteristics of EMS missions with infants; 2) mortality within 12 months; 3) pediatric intensive care unit (PICU) admissions; 4) medical state of the infant upon presentation to the emergency department (ED); 5) any medication or respiratory support given at the ED; 6) hospitalization; and 7) surgical procedures during the same hospital visit. Results 1712 infants with a median age of 6.7 months were encountered, comprising 0.4% of all EMS missions. The most common complaints were dyspnea, low-energy falls, and choking. Two infants died on-scene. The EMS transported 683 (39.9%) infants. One (0.1%) infant died during the 12-month follow-up period. Ninety-one infants had abnormal clinical examination upon arrival at the ED. PICU admissions (n = 28) were associated with young age (P < 0.01), a history of prematurity or problems in the neonatal period (P = 0.01), and previous EMS contacts within 72 h (P = 0.04). The adult-derived dispatch codes did not associate with the final diagnoses of the infants. Conclusions Infants form a small but distinct group in pediatric EMS care, with specific characteristics differing from the overall pediatric population. Many EMS contacts with infants were nonurgent or medically unjustified, possibly reflecting an unmet need for other family services. The use of adult-derived symptom codes for dispatching is not optimal for infants. Unfavorable patient outcomes were rare. Risk factors for such outcomes include quickly renewed contacts, young age and health problems in the neonatal period.

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Pediatric Readiness in Emergency Medical Services Systems

Cited by 43 publications

References 76 publications

Emergency Medical Services Clinicians’ Pediatric Destination Decision-Making: A Qualitative Study

Emergency Medical Services Clinicians’ Pediatric Destination Decision-Making: A Qualitative Study

Paediatric patients in mass casualty incidents: a comprehensive review and call to action

Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study

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