Nobody Likes Kids

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At least not when it comes to EMS responses. I don’t know of any more stress inducing call than one for a really sick child. There is a lot of hysteria, some of by people who should know better.

Kids who are young enough can not tell you what is wrong, their parents usually aren’t very helpful, either. Medication doses are different depending mostly on size of the patient. Did I mention that IVs can be difficult? Thank goodess for Broslow Tapes and Intraosseous Infusions.

This article points out some of the problems and has some good information. The headline is click bait, though.

Lack of experience with kids may lead to EMS errors

(Reuters Health) – 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, a U.S. survey of first responders suggests.

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

That’s the one good thing about pediatric EMS calls. There aren’t that many of them. A disproportionate (compared to adults) number of calls are trauma related . That’s fortunate too as while there are differences between adult and pediatric trauma, they are not insurmountable and mostly amount to patterns of injury and kid’s ability to compensate for blood loss for a deceptively long time. Treatment priorities are similar as well. The problem of course is that no one wants to see a child injured.

When asked what factors were most likely to result in serious injuries or death, mistakes, or near misses, about 73 percent cited lack of experience with pediatric breathing tubes, and heightened anxiety working with children.

Lack of proficiency in pediatric skills was the number three concern, with 67 percent of participants saying this was very likely to contribute to problems, followed by inexperience with pediatric equipment, cited by 58 percent of participants.

What was surprising, however, is that the participants didn’t cite two problems often linked to medical errors in hospitals – poor communication and medication mix-ups – Guise said.

The last is not surprising to me. First, we have a much smaller tool box of medications to give. Second, there are fewer of us on an EMS call than there are in the Emergency Department.

The other problems can be addressed by training, bu training is expensive and many EMS systems don’t like to spend money on it. Of course the odds are pretty good that there won’t be that many pediatric medical responses in a year. I used to average one pediatric (under 12) cardiac arrest every 3 years.

I had one very bad year for pediatric cardiac arrests. Three within about a 45 day period. One was a child of about 8 who died from bad medical advice from a Dial a Nurse service run by her medical insurance provider. One was an infant who was born with medical problems that guaranteed a very short life. The third was a two year old child who was shot.

I’ve had a few serious emergencies involving kids, and those were mostly related to kids with serious existing medical conditions. The “good” thing about those patients was that they had parents who were very involved in their care, knew all about the rare diseases their children had, and could even direct me to the best route for medical care. In more than one case, the parents (usually the mother) even knew the doses and carried the specialized medications their child needed.

I suppose it could be ego shaking to take medical direction from “Dr. Mom” as I called those ladies, but it wasn’t. It made the calls easy, truth be told.

More research is needed to understand how anxiety develops during pediatric cases and what may be done to address it, Guise added.

They can just write me a check and I’ll save them the work. The anxiety develops because medics, at least those with a clue, are scared shitless that the patient might die and the medic can do nothing about it.

EMS workers might become more familiar with pediatric equipment by practicing with simulation and mannequins, said Shah, who wasn’t involved in the study. In addition, it’s important to gather data on EMS care provided to children to help identify what works and what needs improvement, he said.

Here is my suggestion, for what it might be worth. Simulations are good, but only good if the people who are running them know the capabilities of paramedics and EMTs. The education should be two way. The medics learn more about patient care, the doctors and others learn what our capabilities are. The doctors also need to understand that EMS systems can’t stock a lot of very expensive equipment that will reach it’s expiration date before it is needed. Hospitals might be able to help with that as well.

“It is most critical to note this study doesn’t say that EMS provides bad care to children,” Shah added. “We all have many cases where EMS was able to provide essential care to benefit children.”

The study doesn’t say that at all, but the reader won’t know that from the headline. Which, as I said, is click bait.

Pediatric EMS care improved during my career, but the core issues still persist. They are not insurmountable, they just need educators and administrators to pay attention to them and work on solutions.

 

 

1 COMMENT

  1. Yep, my daughter the paramedic gets a lot of those since she’s one of the go to’s for peds transport and NICU calls… She hates them…

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