Pediatric patient documentation: Add 'memory jogger' details
EMS providers need to understand the unique legal considerations that apply to pediatric patients and add additional details about the incident
“Kids are not mini-adults!”
I will never forget Scott Davies, one of my paramedic school instructors, driving that point home at every opportunity, and he was right. Pediatric patients are different from adult patients in too many ways to list and EMS providers must take special care not to overlook those differences.
Aside from the obvious physiological, anatomical, biological and pharmacological differences, there are different legal considerations for pediatric patients as well. Chief among those differences is the way statutes of limitations work.
Application of statute of limitations to children
A statute of limitations governs the period of time in which someone can bring a lawsuit for damages. Depending on the severity of the claim and other specifics, statutes of limitation can be as short as a few months and as long as a few years. In some criminal cases, murder for example, there is no statute of limitations, so one can be charged with a murder committed decades earlier.
Generally, a statute of limitations begins to run when the act causing damage occurs or when the damage is first recognized. There are also circumstances when a statute of limitations may “toll” or pause only to begin running again when the tolling circumstance changes.
In an EMS context, damages caused to children and lawsuits arising therefrom, the statute of limitations (in many cases) does not begin to run until the minor reaches the age of majority – 18 years old. That is to say, theoretically and in certain circumstances, a child who suffers damages at the age of one year, could conceivably sue as many as 20 years later. Granted, that scenario is lottery ticket rare, but possible nevertheless and it is something to consider when documenting pediatric calls.
Documentation is just as important as assessment and treatment
Remember that, in EMS, a provider may be named in an action, but it is far more likely that a provider will be called as a witness; in either scenario, your testimony can make or break a case. However, experience has shown me that there are many providers who seem to be overwhelmed by all the responsibilities associated with EMS and thorough, complete, accurate documentation seems to be the corner most easily cut.
Don’t be fooled! Documentation is every bit as important as the assessment and treatment leading up to it.
I have written before about the importance of documentation with respect to continuity of care and I have written plenty about the importance of properly documenting the non-transport calls; surprisingly to some considerable resistance.
Documentation, in general, should illustrate a provider’s appreciation of the circumstances underlying the call, the assessment findings, the awareness of associated protocols, and the procedures implemented to manage the findings. While the same is true for pediatric patients, it will be worthwhile taking a few extra moments to cross T’s and dot I’s to show – on paper at least – that your care was above reproach.
Add 'memory joggers' to the PCR
Once you have crafted a stellar PCR, go one step further and supplement your documentation with 'memory joggers.' These are just a few suggestions:
1. Specific details that will assist with memory years later
There are no rules for this and no particular place to put them; narrative, supplemental report, even a log of some sort would be fine. Remember that whatever you write, wherever you write it, could be discoverable – meaning it could end up projected on a giant screen in court.
The idea here is to document things such as height, hair color, clothing, location, and other things that may help jog your memory after you have long since forgotten the call.
2. Document details of conversations with parents/witnesses
Remember that you are more likely to be called to testify as a witness than as a named party. In that capacity, your testimony may be considered of expert value and jurors may put added stock in what you have to say. Therefore, you may want to take a few extra minutes to document interactions with parents or guardians or other witnesses on the scene; what you said, what they said, and perhaps details about their demeanor if you suspect something is not quite right.
3. Imagery that paints a picture
For the same reasons mentioned above, paint yourself a picture – with words – that can bring you back to the call; describe the scene or location or the vehicle; describe the people – clothing, posture, unique vocal characteristics, and demeanor; your general impressions. Use anything that may help you remember more about the incident years later.
While this advice would be appropriate for all patients, it is the pediatric patient who has the longest potential statute of limitations or shelf life; that is, a pediatric call can haunt you well into retirement, so it is the pediatric call that is most worth this added investment of time and energy.
The object here is not to increase workload to the point of impractical. The idea here is to recognize that pediatric calls have unique characteristics and to spend a few extra minutes jotting a few extra things down. You will probably never see them again. But, if you do, you will be grateful to yourself that you did.