EMS care for sick children starts with leaders
Since we know sick kids are infrequently encountered and cause significant EMS provider apprehension, we have an obligation to improve provider’s preparation
As a leader you always hear about a certain type of call even though it is likely less than 2 percent of your run volume. It starts the same way, “Chief did you hear about that pediatric arrest we ran yesterday?”
Dealing with pediatric patients seems to cause the most apprehension in paramedics. As leaders, we need to be able to find ways we can assist our workforce in developing the confidence needed to address this special population.
Why pediatric patients are scary
I’m sure you’ve heard the saying pediatric patients are just small adults, and they should be taken care of as such. We now know this is a false statement and we have to ensure paramedics have the knowledge, skills, and gain the experience to address this special population.
For a paramedic, it is vital they have comfort and the ability to identify the difference between pediatric anatomy and physiology. These variations can cause confusion in the provider that does not fully understand the difference. Pediatric airway differences include a higher glottic opening, a proportionately larger tongue, and a trachea that is hourglass in shape, with the narrowest portion immediately below the cricoid ring.
When dealing with the cardiovascular system, pediatric patients are unable to drastically increase stroke volume, and they respond to inadequate perfusion by increasing heart rate and dramatically increasing peripheral vascular resistance. This allows them to maintain a normal blood pressure even though they are in shock, but this compensation is brief.
Another challenge is the amount of pediatric calls we actually run. Not using pediatric assessment and treatment skills on a regular basis will cause even the seasoned paramedic some nervousness. For example, pediatric patients are treated with weight-based medications; having an understanding of how much medication to deliver is a constant test of memory or willingness to understand and use job aids.
Thinking back to your initial paramedic training, we spent countless hours studying in the areas of cardiology, respiratory, and medical management and treatments, yet it seemed pediatric education lasted only 20 minutes. Why was this topic glossed over and not given more attention?
Students learn from the beginning this topic is not as important as the multi-hour subjects. To be comparable to other topics, pediatric initial training should be 30-40 hours, and should cover anatomy and physiology, pathophysiology, management and treatment of medical patients, trauma patients and pediatric and neonatal resuscitation.
Dealing with fear
I enjoy asking paramedics, “How long do you like to stay on-scene when working a pediatric arrest?”
Unlike an adult cardiac arrest, where they work the code in place, they usually scoop up kids and run. Many times they are met at the ambulance by firefighters carrying the infant to the ambulance.
Using this question as a gauge will outline how comfortable the medic is with dealing with a pediatric arrest on-scene. Studies have shown spending time at the scene, managing the airway, delivering compressions and getting meds circulated will aid in the return of spontaneous circulation. Apprehension of not feeling comfortable with the arrest causes paramedics to retreat to the ambulance and begin transport.
Knowing this, as leaders we have to take responsibility for assisting our medics to deliver the highest patient care possible with confidence and skill mastery. You already know initial training was sparse, call volume does not allow for regular and enough pediatric patient contact, and without asking the medics their comfort level before a patient contact you will not understand their readiness.
When a mother hands your paramedic a 3-month-old infant in cardiac arrest, is not the time to figure out a medic is not comfortable managing that arrest.
Develop skills and confidence
Our egos, from field providers to leaders, may keep us from asking the questions and acknowledging our apprehension. Knowing that this mentality occurs, leaders need to plan to increase paramedics’ core knowledge and develop skills confidence.
There are many great courses and products on the market to help personnel learn and prepare. Choose a pediatric course such as the NAEMT Emergency Pediatric Course (EPC) that addresses both management and treatment methodologies. Add Pediatric Advanced Life Support (PALS) to the mix as it is a great compliment to a paramedic’s knowledge.
Use your CQI program to determine protocol compliance. Check drug dosage calculations, joule settings and intubation tube sizes to assess treatment knowledge. Because of the low volume and frequency, ensure a higher number of pediatric calls are being audited. Set a benchmark that triggers additional training.
Another great tool is to listen to the paramedic’s radio report to the hospital. Hear their voice and determine how frazzled they seem at the time of care. In all fairness, this is a very emotionally charged situation so take that into account when making your subjective assessment.
Develop opportunities to get your medics to shadow pediatricians or urgent care clinician, and attend hospital rounds in the pediatric ICU. Rounding with these medical partners will assist in developing knowledge, understanding and confidence.
Being comfortable with delivering care during a pediatric respiratory or cardiac arrest takes time and effort. As leaders do everything possible to give the paramedic’s the best chance for running a successful call.