By Michelle Murphy, MBA, EMT-P
On EMS for Children (EMSC) Day, May 18, 2022, the EMSC Innovation and Improvement Center (EIIC) hosted a webinar for prehospital care providers on caring for the pediatric behavioral and mental health patients, and highlighted resources available for EMS professionals who experience the on-scene death of a child.
The webinar, “COPE-ing with the Challenges of Pediatric Behavioral and Mental Health Emergencies,” presenters included Kenshata Watkins, MD; and Nicolaus Glomb, MD; from UCSF Benioff Children’s Hospital, in Oakland, California; and Mary Fallat, MD; from the University of Louisville and Norton Children’s Hospital, in Louisville, Kentucky.
About the speakers:
- Kenshata Watkins, MD, BS Ed. Dr. Watkins is a third-year post-graduate fellow in pediatric emergency medicine at UCSF Benioff Children’s Hospital in Oakland, California. Dr. Watkins is also a fellow for the Advocacy Domain within the EMSC Innovation and Improvement Center, and participates in research into best practices specific to pediatric mental health.
- Nicolaus Glomb, MD, MPH. Dr. Glomb is an associate professor of pediatrics and global health at the University of California San Francisco and works as a pediatric emergency medicine physician at UCSF Benioff Children’s Hospital in Oakland, California. Dr. Glomb also serves as the scientific advisor and EMS researcher with the SPARC node of the Pediatric Emergency Care Applied Research Network.
- Mary E. Fallat, MD. Dr. Fallat is professor of surgery at the University of Louisville and Director of Surgical Quality at Norton Children’s Hospital where she has practiced pediatric surgery for 35 years. She is PI for the HRSA Kentucky EMS for Children project, helped define a way for prehospital professionals to approach death in the field, and is completing a report on national pediatric trauma system development. She is the sub-PI leading the Trauma and Burn hub for the 2021 awarded HRSA Pediatric Pandemic Network Grant. She represented the Trauma Surgeon sector on the National EMS Advisory Council from 2015-2021.
New research performed by Dr. Glomb and colleagues in Alameda County, California, has shown that through proper assessment in the field, EMS providers can determine which children with a behavioral or mental health emergency can safely be diverted to a psychiatric care facility and away from an emergency department.
Top quotes on mental and behavioral for the pediatric care
The presenters provided valuable tips on treating children and families with compassionate care. The basic tenets of equity, diversity and inclusion ideals were reviewed in the context of caring for a youth in a mental health crisis. The presenters also included the care of a family that has suffered the devastating loss of a loved one, with clear and concrete actions that EMS professionals can take to provide supportive and sensitive care to a family in mourning, as well as how to take care of themselves after the event.
Following are top quotes from the presenters on mental and behavioral for the pediatric patient and EMS professional:
- “Because EMS personnel are the first point of contact for some kids experiencing a mental health crisis, any interactions you have impact subsequent interactions in the emergency department on the inpatient side. You’re the bridge between other providers – both health and non-health – and you can be positioned to be an advocate.” — Kenshata Watkins, MD
- “The United States has experienced an increase in pediatric behavioral health emergencies and it’s outpacing the rate of growth of adult visits for behavioral health emergencies by 30%. On top of this, we know that children with behavioral health emergencies are spending days, sometimes weeks in the emergency department not getting the care that they need.” — Nicolaus Glomb, MD
- On communicating with caregivers on the death of a child: “I always remind people that, regardless of how you feel about it at the time, they will remember what you said and how you deliver this message, and if you deliver it compassionately, they will remember it in a kind way, but they will remember it first thing in the morning and the last thing at night for months, because this is something that was tragic to them” — Mary Fallat, MD
Top takeaways on mental and behavioral health in the prehospital setting
Following are 4 takeaways on mental and behavioral care for children in the prehospital setting.
1. EMS professionals play a powerful and critical role in the care of the pediatric behavioral health patient
As the first point of contact, EMS professionals play an important role in setting the tone of the interaction between a patient and the rest of the emergency medical continuum. Understanding equity, diversity and inclusion (EDI) in a prehospital context is vital in building patient trust.
To support EDI concepts, prehospital practitioners can practice the following ABCDE acronym:
- Ask how the patient identifies
- Be an ally
- Check your biases
- Document appropriately
- Engage in equitable care
2. Implementation of pediatric behavioral health emergency field-screening protocols by EMS can reduce hospital involuntary holds and allow for timely mental health evaluations
A retrospective review on pediatric mental and behavioral health encounters in Alameda County, California, demonstrated that implementation of EMS field-screening protocols to safely identify and medically clear pediatric patients with low-risk behavioral health emergencies (BHE) can ensure appropriate transportation directly to a pediatric psychiatric emergency services facility and minimize hospital involuntary hold encounters.
Over the course of five years, over 7,500 children less than 18 years of age were screened, of which approximately 40% were taken to a pediatric psychiatric emergency facility with <1% requiring transfer to a hospital for care within 24 hours.
3. A new resource is available for prehospital providers when responding to one of the most challenging patient encounters: the on-scene death of a pediatric patient
With Health Resources and Services Administration EMSC Program Targeted Issue grant funding, Dr. Mary Fallat developed the Compassionate Options for Pediatric EMS or “COPE” program. This program developed a series of educational videos and now has a new pocket card available to prehospital practitioners to serve as a quick reference guide when responding to a call involving the death of a child. The pocket card walks providers through the steps of communicating with family and caregivers and provides healthy guidance for the provider to cope following these difficult encounters with a link to a more comprehensive website.
4. Stress and provider burden is significant for EMS providers, but there is help and resources available
Suicide among EMS providers is five times greater than that of the average population. The Code Green Campaign calls a Code Aler’ on the mental health of prehospital providers and is breaking the silence about mental illness in EMS and public safety by sharing the stories of those who have been there.
Watch the full recording of the EMS for Children Day webinar “COPE-ing with the Challenges of Pediatric Behavioral and Mental Health Emergencies” here.
Additional resources for caring for pediatric patients
Learn more about caring for pediatric patients’ mental health needs and death notification with these resources:
- EMSC For Children Innovation & Improvement Center. The mission of the EMSC For Children Innovation & Improvement Center is to optimize outcomes for children across the emergency care continuum by leveraging quality improvement science and multidisciplinary, multisystem collaboration.
- How to assess pediatric mental health emergencies. As the numbers of pediatric patients with diagnosed mental health conditions climb, EMS providers will be increasingly asked to treat these kids
- Dealing with death. Designating specific roles and other tips to make the hardest part of the job a bit easier
- Article Bites: Measuring the impact of death notification training on burnout. Is death notification training associated with decreased burnout among EMS professionals?
About the author
Michelle Murphy, MBA, EMT-P, is a project manager for the EMS for Children Innovation and Improvement Center (EIIC) at the University of Texas. Her prior work experience is in emergency medical services at Stony Brook Medicine as a hospital-based paramedic where she coordinated patient transfers, transported high acuity patients, and responded to 911 calls. Michelle obtained a Master of Business Administration in Health Care Management from St. Joseph’s College.
