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Q&A with a prehospital PECC: ‘It’s worth it’

A Pa. pediatric emergency care coordinator shares her expertise with patients, parents and her colleagues


“We don’t have a lot of pediatric calls,” says PECC Nicole Dambaugh. “It’s not a bad thing that we don’t have the calls. But the volume is not there, so it’s hard to get the experience.”

Emergency Medical Services for Children Innovation and Improvement Center

Nicole Dambaugh is an EMT-P in Cranberry Township, Pennsylvania. We sat down to talk with her about her experience as a pediatric emergency care coordinator (PECC) within her EMS agency. Dambaugh has been a paramedic for more than a decade, serving as a PECC for the last two and a half years. She is a mother of two and currently enrolled in nursing school.

Why did you decide initially to become a PECC or pediatric champion?

Dambaugh: It started about eight to nine years ago, when I had a 5-month-old pediatric arrest. We got ROSC back on him. It was the week before Christmas, and I realized I didn’t ever want to see a parent feel like: “There isn’t a provider here that knows what to do.” Then, after I had my children, I realized this is definitely something I want to do. The icing on the cake was about two months ago. My husband is also a paramedic, and we were on a call together. We helped a midwife deliver a baby and then she goes “He’s not breathing – here!” The cord was still attached and everything. But we were able to resuscitate him. I got to hold him a couple weeks ago, and he’s totally healthy, no deficits or anything.

What support or guidance did you receive when taking on this role?

My previous boss, Ted, has been phenomenal. He asked: “Do you want to do different trainings? What can we do to help expand everybody’s knowledge and get a basic general understanding of pediatrics? How can we help them get over this fear?” Because pediatrics, especially in this area, is not a common call. Last year, we did a little over 200 pediatric calls. So a lot of people have that fear of walking into this and feeling like, “Oh no, here’s this tiny human – what do I do?” They don’t understand the whole transition of: it’s just smaller equipment. It’s the same stuff, it’s just smaller. Your medications are the same, they’re just little lower doses. Monday was Ted’s last day, so we’re in the process of changing of the guard. But our new interim boss, Matt, is a good friend and also has two little kids, so he gets the importance of the pediatric role and supports a lot of my ideas.

What do you think has been the most helpful in terms of helping people get over that fear?

Honestly, muscle memory. If they’ve had it in their hands, if they’ve looked at it, if they’ve touched it, then they’re going to be more familiar with it. They’re going to be more apt to think “Oh, I can use this,” or “Hey, Nicole, made me play with this little wheel thing the other day, I can use that.” Just holding the equipment and tools, touching them, and being familiar with them – it helps build that muscle memory. As a PECC, they’ve given me permission to do monthly trainings. We just had a class on Friday. We brought in a pediatric training guru on Friday and he taught a class. We went over Broselow tape, the Pedi-Wheel, lawsuits that can potentially go on with calls, and so on.

What resource would you say has been the most helpful in your development as a PECC?

The biggest resource would be the Children’s Hospital. We are very lucky to have UPMC Children Hospital literally 20 minutes away – maybe 13 or 14 minutes – depends on how fast you’re driving in the situation. Children’s Hospital has been phenomenal. UPMC prehospital coordinators are always asking if we need supplies replaced, helping with trainings, and really anything we may need.


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What would you say has been the biggest challenge in promoting pediatric readiness?

We don’t have a lot of pediatric calls, and it seems that when we do have pediatric calls, I’m the medic on scene. I’m familiar with the equipment, but I try to show my partners as we’re going through the call. It’s not a bad thing that we don’t have the calls. But the volume is not there, so it’s hard to get the experience.

Can you think of an example of a time when your work as a PECC directly improved patient care?

I was called to an 8-month-old that was choking. We walked in, and mom was really upset, so we talked her down, looked at the baby, and I explained “Hey, you know this is what you need to look for or this is how he’s presenting.” Just having the knowledge that I had, and the fact that I could bring it down to her terms, helped her a lot. My partner actually told her: “She’s our pediatric person – if you have a pediatric question, she’s the person to go to.” So we ended up talking for 45 minutes, and at the end she said, “I know it’s COVID, but I need to hug you.” So she gave me a hug and thanked me and said, “You’re just this wealth of knowledge.” To me, it’s just every day, this is what I do. But to somebody like her, it made a world of difference. So it’s worth it.

What would you say to someone who is interested in pediatrics, but is not sure about becoming a PECC?

I would say to them: why not? What do you have to lose? Why not continue to make yourself a better provider and better serve your community?

Special thanks to Hoi See Tsao, MD, a pediatric emergency physician at Brown University, for her assistance with this interview.

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Recognizing the paucity of adequate pediatric emergency care nationwide, the 1984 Congress authorized the federal Emergency Medical Services for Children (EMSC) Program. Housed under the U.S. Department of Health and Human Services (HHS) within the Health Resources and Services Administration (HRSA) and Maternal and Child Health Bureau (MCHB), the EMSC Program has strived for over 30 years to reduce pediatric mortality and morbidity across the nation.

The EMSC EIIC Pre-Hospital Care domain focuses on pediatric care from education and prevention to incident recognition, treatment at an emergency scene and transport to an emergency department. The major emphasis of this domain is the establishment and support of Prehospital Pediatric Emergency Care Coordinators (PECC).

We use improvement science as the basis for our collaborative efforts to improve outcomes for children in emergency situations. Our collaboratives are networks designed for shared learning, driven by an evidence base and known gaps to facilitate rapid translation of research into clinical practice. We support these collaboratives through varied learning systems, coaching, project management, information technology infrastructure, data management, and analytics.