It’s a warm summer afternoon and no different from any other day in your community. A 911 call comes into the communications center for a one-year-old female not breathing.
Professionals at the call center dispatch the appropriate resources while they support the babysitter in starting CPR. EMS arrives on the scene, rapidly assesses the patient and successfully resuscitates the child before transporting to the hospital. A few days later the child is discharged with no neurological deficits.
EMS answers the call to a wide range of emergencies every day, but perhaps the most challenging, professionally and emotionally, is the pediatric patient. Tina Hilmas, RN, BSN, Project Manager at Center for Patient Safety and former NICU nurse acknowledges, “Taking care of the pediatric patient can be the most rewarding patient encounter but also extremely challenging.”
This is not a patient population that is attended to on a daily basis. It is also a population which varies greatly depending upon the age and size of the child. This lack of experience, coupled with the age specific dosing requirement of treatments, can greatly increase the stress level of the EMS provider. Add to this a panicked family and these factors can challenge even the most experienced provider.
“Children can get critically ill extremely fast and many times it is the knowledge and skill level of the provider team that prevents the child from reaching a critical point,” Hilmas said. “Attention to detail, involving the family so the provider is aware of subtle deviances from normal behavior, and having a team to provide support and knowledge is vital to providing safe, professional and effective care of the pediatric patient.”
Pediatric patient adverse events
While CPS only has fragmented data regarding events involving pediatrics, CPS is adding pediatrics to this report to raise awareness about the risk associated with this patient population. This is a diverse patient population comprised of newborns to adolescents; each with their own special needs.
What is the best strategy to manage a pediatric patient? CPS recommends developing a system-based approach that supports each and every patient regardless of age or size.
In addition, a team strategy devised to assign providers to manage the patient as well as somebody who can support the family would help alleviate the stress associated with this patient population. Having a systematic and well-orchestrated approach with built in safety checks to account for human factors is a first step in providing safer care and improved outcomes.
Finally, greater reporting of adverse events, near misses and unsafe conditions is strongly encouraged since many errors may be overlooked, unknown or omitted as the event is not identified. These are areas of risk and concern:
- Lack of training and education specific to pediatrics as well as infrequent hands-on experience.
- Severely injured/critically ill children are high-stress events which could lead to a provider wanting to scoop and run rather than stay and treat.
- System design, especially in regards to medication administration, can lead to errors as this patient population has specific requirements that are different than adults.
- Inappropriate equipment to safely secure and transport a child in an ambulance.
