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 Though children make up almost one quarter of the U.S. population –
or roughly 73 million kids – they account for just 13 percent of EMS
transports and only one percent of rides requiring advanced life
support, researchers report in the Journal of Pediatrics.
Asked what factors may be most responsible for errors, EMS workers
cited inexperience with airway management for tiny bodies,
heightened anxiety working with children, and limited proficiency in
pediatric skills requiring pint-sized equipment as the top culprits,
the survey found.
The need for intense, complex care in these situations, and EMS
workers’ limited experience with them, “make the medical management
of children’s emergencies particularly challenging,” said lead
author Dr. Jeanne-Marie Guise, an emergency medicine researcher at
Oregon Health and Science University in Portland.
To understand what first responders perceive as the biggest
challenges in treating young patients, Guise and colleagues surveyed
753 emergency physicians and EMS providers in 44 U.S. states.
Most of the survey participants were emergency medical technicians (EMTs)
and had been working for 17 years on average, with equal numbers
from rural, suburban and urban communities.
When asked what factors were most likely to result in serious
injuries or death, mistakes, or near misses, about 73 percent cited
lack of experience with pediatric breathing tubes, and heightened
anxiety working with children.
Lack of proficiency in pediatric skills was the number three
concern, with 67 percent of participants saying this was very likely
to contribute to problems, followed by inexperience with pediatric
equipment, cited by 58 percent of participants.
What was surprising, however, is that the participants didn’t cite
two problems often linked to medical errors in hospitals – poor
communication and medication mix-ups – Guise said.
Instead, the top concerns in the study appeared connected to anxiety
that comes with treating the smallest and youngest patients.
“When combined with the anatomic and physiologic differences in
children, compared to adults, a potentially challenging and
stressful situation is likely to result,” Guise said by email.
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One shortcoming of the study is that not all participants completed
all three stages of the survey, the authors acknowledge. The survey
also received fewer responses from California and the Southeast.
More research is needed to understand how anxiety develops during
pediatric cases and what may be done to address it, Guise added.
“Between a relatively lower level of experience caring for sick
children and their own emotional responses – what human does not
feel for that hurt child – caring for children can be difficult,”
Dr. Manish Shah, an emergency medicine researcher at the University
of Wisconsin School of Medicine and Public Health, said by email.
EMS workers might become more familiar with pediatric equipment by
practicing with simulation and mannequins, said Shah, who wasn’t
involved in the study. In addition, it’s important to gather data on
EMS care provided to children to help identify what works and what
needs improvement, he said.
“It is most critical to note this study doesn’t say that EMS
provides bad care to children,” Shah added. “We all have many cases
where EMS was able to provide essential care to benefit children.”
SOURCE: http://bit.ly/1PkJH8H Journal of Pediatrics, online August
18, 2015.
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