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Hauch H, El Mohaui N, Sander M, Rellensmann G, Berthold D, Kriwy P, Zernikow B, Wager J, Schneck E. Implementation and evaluation of a palliative care training unit for EMS providers. Front Pediatr 2023; 11:1272706. [PMID: 37830055 PMCID: PMC10565227 DOI: 10.3389/fped.2023.1272706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
Background The prevalence of children with life-limiting conditions (LLCs) is rising. It is characteristic for these children to require 24/7 care. In emergencies, families must decide to call the emergency medical service (EMS) or a palliative care team (PCT)-if available. For EMS teams, an emergency in a child with an LLC is a rare event. Therefore, EMS providers asked for a training unit (TU) to improve their knowledge and skills in pediatric palliative care. Aim of the study The questions were as follows: whether a TU is feasible, whether its integration into the EMS training program was accepted, and whether an improvement of knowledge can be achieved. Methods We designed and implemented a brief TU based on findings of a previous study that included 1,005 EMS providers. The topics covered were: (1) basics in palliative home care, (2) theoretical aspects, and (3) practical aspects. After participating in the TU, the participants were given a questionnaire to re-evaluate their learning gains and self-confidence in dealing with emergencies in pediatric patients with LLC. Results 782 (77.8%) of 1,005 participants of the previous study responded to the questionnaire. The average age was 34.9 years (±10.7 years SD), and 75.3% were male. The average work experience was 11.4 years (±9.5 years SD), and 15.2% were medical doctors. We found an increase in theoretical knowledge and enhanced self-confidence in dealing with emergencies in patients with LLC (confidence: before training: 3.3 ± 2.0 SD; after training: 5.7 ± 2.1 SD; min.: 1; max.: 10; p < 0.001). The participants changed their approaches to a fictitious case report from more invasive to less invasive treatment. Most participants wanted to communicate directly with PCTs and demanded a standard operating procedure (SOP) for treating patients with LLC. We discussed a proposal for an SOP with the participants. Conclusion EMS providers want to be prepared for emergencies in children with LLCs. A brief TU can improve their knowledge and confidence to handle these situations adequately. This TU is the first step to improve collaboration between PCTs and EMS teams.
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Affiliation(s)
- Holger Hauch
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- Palliative Care Team for Children, University Children’s Hospital, Giessen, Hesse, Germany
| | - Naual El Mohaui
- Palliative Care Team for Children, University Children’s Hospital, Giessen, Hesse, Germany
| | - Michael Sander
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital, Giessen, Hesse, Germany
| | - Georg Rellensmann
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Daniel Berthold
- Department for Medical Oncology and Palliative Care, University Hospital of Giessen and Marburg, Giessen Site, Germany
| | - Peter Kriwy
- Institute for Sociology, Technical University of Chemnitz, Chemnitz, Saxony, Germany
| | - Boris Zernikow
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
| | - Julia Wager
- Department of Children’s Pain Therapy and Pediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital, Giessen, Hesse, Germany
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Hauch H, El Mohaui N, Vaillant V, Sander M, Kriwy P, Rohde M, Wolff J, Berthold D, Schneck E. Prehospital emergency medicine for children receiving palliative home care in Germany-a cross-sectional, exploratory study of EMS providers. Front Pediatr 2023; 11:1104655. [PMID: 36865689 PMCID: PMC9971952 DOI: 10.3389/fped.2023.1104655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The prevalence of children with life-limiting conditions is rising, and since the amendment of the social insurance code in Germany, palliative home care teams have treated an increasing number of children. These teams provide 24/7 readiness, yet some parents still call the general emergency medical service (EMS) for various reasons. EMS is exposed to complex medical problems in rare diseases. Questions arose about the experiences of EMS and whether they felt prepared for emergencies involving children treated by a palliative care team. METHODS This study used a mixed methods approach to focus on the interface between palliative care and EMS. First, open interviews were conducted, and a questionnaire was developed based on the results. The variables included demographic items and individual experiences with patients. Second, a case report of a child with respiratory insufficiency was presented to assess the spontaneous treatment intentions of EMS providers. Finally, the need, relevant topics, and duration of specific training in palliative care for EMS providers were evaluated. RESULTS In total, 1,005 EMS providers responded to the questionnaire. The average age was 34.5 years (±10.94SD), 74.6% were male. The average work experience was 11.8 years (±9.7), 21.4% were medical doctors. Experience with a call of a life-threatening emergency involving a child was reported by 61.5% and severe psychological distress during such a call was reported by 60.4%. The equivalent distress frequency for adult patient calls was 38.3%. (p < 0.001). After review of the case report, the EMS respondents suggested invasive treatment options and rapid transport to the hospital. Most (93.7%) respondents welcomed the consideration of special training in pediatric palliative care. This training should include basic information about palliative care, an analysis of cases involving palliatively treated children, an ethical perspective, practical recommendations, and available (24/7) local contact for further guidance and support. CONCLUSION Emergencies in pediatric palliatively treated patients were more common than expected. EMS providers perceived the situations as stressful, and there is a need for specific training with practical aspects.
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Affiliation(s)
- Holger Hauch
- Palliative Care Team for Children, University Children's Hospital, Giessen, Hesse, Germany.,University Children's Hospital Giessen, Department of Pediatric Oncology, Giessen, Hesse, Germany
| | - Naual El Mohaui
- Palliative Care Team for Children, University Children's Hospital, Giessen, Hesse, Germany
| | - Vera Vaillant
- Palliative Care Team for Children, University Children's Hospital, Giessen, Hesse, Germany
| | - Michael Sander
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital, Giessen, Hesse, Germany
| | - Peter Kriwy
- Institute of Sociology, University of Technology, Chemnitz, Saxony, Germany
| | - Marius Rohde
- University Children's Hospital Giessen, Department of Pediatric Oncology, Giessen, Hesse, Germany
| | - Johannes Wolff
- Department of Oncology, Cleveland Clinic, Pediatric Oncology, Cleveland, OH, United States
| | - Daniel Berthold
- University Hospital Giessen, Palliative Care Team for Adults, Giessen, Hesse, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital, Giessen, Hesse, Germany
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Kou M, Baghdassarian A, Rose JA, Levasseur K, Roskind CG, Vu T, Zuckerbraun NS, Leonard K, Shabanova V, Langhan ML. Milestone achievements in a national sample of pediatric emergency medicine fellows: impact of primary residency training. AEM EDUCATION AND TRAINING 2021; 5:e10575. [PMID: 34124521 PMCID: PMC8171745 DOI: 10.1002/aet2.10575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Pediatric emergency medicine (PEM) fellowships recruit trainees from both pediatric and emergency medicine (EM) residencies. The Accreditation Council for Graduate Medical Education (ACGME) defines separate training pathways for each. The 2015 PEM milestones reflect a combination of subcompetencies from the two residencies. This project aims to compare the milestone achievement of PEM fellows based on their primary residency training. We hypothesize that fellows trained in pediatrics achieve PEM milestones at different rates than EM-trained fellows in the ACGME domains of patient care, medical knowledge, systems-based practice, practice-based learning, professionalism, and interpersonal and communication skills. METHODS This is a multicenter, retrospective cohort study of fellows from a national sample of U.S. PEM fellowship programs. Basic demographic information and deidentified, biannual milestone scores for 23 competencies were collected for fellows training between 2015 and 2018. Subcompetencies are scored on a 5-point milestone scale. Descriptive and multivariable analyses for longitudinal data were performed to compare milestone assessments by primary residency training. RESULTS Complete data were obtained for 600 fellows; 95% (570) and 5% (30) completed pediatric and EM residency, respectively. In both year 1 and year 2 of fellowship, the mean milestone scores of EM-trained fellows were statistically higher than pediatrics-trained fellows across the majority of subcompetencies. By the final year of training, there were no statistically significant differences in milestone scores for any of the subcompetencies. CONCLUSIONS Fellow milestone achievement between groups was not significantly different by graduation. However, fellows entering PEM training from an EM background attained higher scores on the milestones than fellows from a pediatric background in the first year of fellowship.
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Affiliation(s)
- Maybelle Kou
- Emergency MedicineInova Children’s Hospital/VCU SOMFalls ChurchVirginiaUSA
| | - Aline Baghdassarian
- Pediatrics and Emergency MedicineChildren’s Hospital of Richmond at VCU/Virginia Commonwealth University SOMRichmondVirginiaUSA
| | - Jerri A. Rose
- PediatricsRainbow Babies & Children’s Hospital/Case Western Reserve University School of MedicineClevelandOhioUSA
| | - Kelli Levasseur
- Emergency MedicineBeaumont Children’s Hospital/Oakland University William Beaumont School of MedicineRoyal OakMichiganUSA
| | - Cindy G. Roskind
- Emergency Medicine in PediatricsColumbia University Medical CenterNew YorkNew YorkUSA
| | - Tien Vu
- PediatricsChildren’s Hospital Colorado/University of Colorado School of MedicineDenverColoradoUSA
| | | | - Kathryn Leonard
- PediatricsWashington University in St. Louis School of MedicineSt. LouisMissouriUSA
| | | | - Melissa L. Langhan
- Pediatrics and Emergency MedicineYale University School of MedicineNew HavenConnecticutUSA
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Feasibility and integration of an intensive emergency pediatric care curriculum in Armenia. Int J Emerg Med 2021; 14:1. [PMID: 33407068 PMCID: PMC7789778 DOI: 10.1186/s12245-020-00320-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Emergency pediatric care curriculum (EPCC) was developed to address the need for pediatric rapid assessment and resuscitation skills among out-of-hospital emergency providers in Armenia. This study was designed to evaluate the effectiveness of EPCC in increasing physicians’ knowledge when instruction transitioned to local instructors. We hypothesize that (1) EPCC will have a positive impact on post-test knowledge, (2) this effect will be maintained when local trainers teach the course, and (3) curriculum will satisfy participants. Methods This is a quasi-experimental, pre-test/post-test study over a 4-year period from October 2014‑November 2017. Train-the-trainer model was used. Primary outcomes are immediate knowledge acquisition each year and comparison of knowledge acquisition between two cohorts based on North American vs local instructors. Descriptive statistics was used to summarize results. Pre-post change and differences across years were analyzed using repeated measures mixed models. Results Test scores improved from pretest mean of 51% (95% CI 49.6 to 53.0%) to post-test mean of 78% (95% CI 77.0 to 79.6%, p < 0.001). Average increase from pre- to post-test each year was 27% (95% CI 25.3 to 28.7%). Improvement was sustained when local instructors taught the course (p = 0.74). There was no difference in improvement when experience in critical care, EMS, and other specialties were compared (p = 0.23). Participants reported satisfaction and wanted the course repeated. In 2017, EPCC was integrated within the Emergency Medicine residency program in Armenia. Discussion This program was effective at impacting immediate knowledge as well as participant satisfaction and intentions to change practice. This knowledge acquisition and reported satisfaction remained constant even when the instruction was transitioned to the local instructors after 2 years. Through a partnership between the USA and Armenia, we provided OH-EPs in Armenia with an intensive educational experience to attain knowledge and skills necessary to manage acutely ill or injured children in the out-of-hospital setting. Conclusions EPCC resulted in significant improvement in knowledge and was well received by participants. This is a viable and sustainable model to train providers who have otherwise not had formal education in this field.
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A Grounded Theory Qualitative Analysis of Interprofessional Providers' Perceptions on Caring for Critically Ill Infants and Children in Pediatric and General Emergency Departments. Pediatr Emerg Care 2018; 34:578-583. [PMID: 27749805 DOI: 10.1097/pec.0000000000000906] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to explore pediatric emergency department (PED) and general emergency department (GED) providers' perceptions on caring for critically ill infants and children. METHODS This study utilized qualitative methods to examine the perceptions of emergency department providers caring for critically ill infants and children. Teams of providers participated in 4 in situ simulation cases followed by facilitated debriefings. Debriefings were recorded and professionally transcribed. The transcripts were reviewed independently and followed by group coding discussions to identify emerging themes. Consistent with grounded theory, the team iteratively revised the debriefing script as new understanding was gained. A total of 188 simulation debriefings were recorded in 24 departments, with 15 teams participating from 8 PEDs and 32 teams from 16 GEDs. RESULTS Twenty-four debriefings were audiotaped and professionally transcribed verbatim. Thematic saturation was achieved after 20 transcripts. In our iterative qualitative analysis of these transcripts, we observed 4 themes: (1) GED provider comfort with algorithm-based pediatric care and overall comfort with pediatric care in PED, (2) GED provider reliance on cognitive aids versus experience-based recall by PED providers, (3) GED provider discomfort with locating and determining size or dose of pediatric-specific equipment and medications, and (4) PED provider reliance on larger team size and challenges with multitasking during resuscitation. CONCLUSIONS Our qualitative analysis produced several themes that help us to understand providers' perceptions in caring for critically ill children in GEDs and PEDs. These data could guide the development of targeted educational and improvement interventions.
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Bölenius K, Vestin C, Saveman BI, Gyllencreutz L. Validating a questionnaire - prehospital preparedness for pediatric trauma patients. Int Emerg Nurs 2017; 34:2-6. [PMID: 28545931 DOI: 10.1016/j.ienj.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/05/2017] [Indexed: 11/20/2022]
Abstract
In recent decades, prehospital emergency care has undergone extensive development. Today, prehospital emergency nurses (PENs) are well trained and provide advanced care to patients of all ages. Caring for pediatric trauma patients is considered to be particularly demanding. However, in Sweden and internationally, there is a lack of research regarding PENs' preparedness for caring for pediatric trauma patients. OBJECTIVE The development and testing of a questionnaire on self-reported preparedness among PENs caring for pediatric trauma patients in a prehospital emergency setting. METHODS Questionnaire development included face and content validity tests resulting in 38 questions. Eighteen of these questions were analyzed by test-retest. The content of the questionnaire was statistically analyzed. RESULTS Fifteen questions were considered valid after reliability and validity tests. Three questions did not fulfill the stability criteria. The content analyses show a low degree of experience with pediatric trauma patients and half of the participants reported stress symptoms when responding to such alarms. CONCLUSION The questionnaire assessing PENs preparedness caring for pediatric trauma patients in Sweden is considered to be suitable for research and clinical practice to improve the care of pediatric trauma patients and the health of PENs, although further testing of the questionnaire is required.
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Taubenböck S, Lederer W, Kaufmann M, Kroesen G. HEMS in Alpine Rescue for Pediatric Emergencies. Wilderness Environ Med 2016; 27:409-14. [PMID: 27377920 DOI: 10.1016/j.wem.2016.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this study was to describe the pediatric emergencies encountered by the Christophorus-1 helicopter emergency medical service (HEMS) during a period of 2 years. METHODS Emergency treatment of pediatric casualties by HEMS was evaluated at a helicopter base. Children up to 14 years who were treated by HEMS emergency physicians from Christophorus-1 during primary missions in the alpine region were retrospectively enrolled. RESULTS Of the 1314 HEMS operations conducted during a 2-year investigation period, pediatric emergencies accounted for 114 (8.7%). Trauma was the most common emergency indication (91.3%) in alpine areas, and 77.5% of the indications were related to skiing and snowboarding; 11.3% of the prehospital pediatric emergencies were classified as life-threatening. Interventions on site were rendered in 46.3% of cases. Mean and SD intervals for approach were 11.0 ± 3.0 minutes; for treatment, 14.0 ± 6.0 minutes; and for transport, 8.0 ± 4.0 minutes. Intervals on site were significantly longer whenever it was necessary to search for an interim landing place (P < .001) or perform rope extrication (P < .001). Aggravating environmental conditions such as low temperature (78.8%), rocky terrain (18.8%), or precipitation (12.5%) were common. CONCLUSIONS Rapid procedures are preferred to sustained on-scene treatment, particularly when surrounding conditions are hostile. HEMS emergency physicians attempt to keep on-site intervals short and treatment and monitoring to the essential to minimize delay in rescue.
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Affiliation(s)
- Stefan Taubenböck
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Wolfgang Lederer
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
| | - Marc Kaufmann
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Gunnar Kroesen
- Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austria
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Harve H, Salmi H, Rahiala E, Pohjalainen P, Kuisma M. Out-of-hospital paediatric emergencies: a prospective, population-based study. Acta Anaesthesiol Scand 2016; 60:360-9. [PMID: 26489697 DOI: 10.1111/aas.12648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 09/14/2015] [Accepted: 09/19/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND We wanted to study the incidence, distribution and characteristics of paediatric out-of-hospital emergency care on a population level. This knowledge could ameliorate the design and education of emergency medical services and their personnel. METHODS We studied all (n = 1863) emergency medical services responses and the patient records for paediatric patients (age 0-16 years) in Helsinki, Finland (population 603,968, paediatric population 92,742) during a 12-month period (2012). Patient characteristics, diagnoses, time intervals, medical treatments, procedures, vital measurements and outcome of out-of-hospital treatment were available for analysis. RESULTS The incidence of emergency medical services -treated paediatric out-of-hospital emergencies was 3.8/1000 inhabitants and 20/1000 1-16-year-old inhabitants. This formed 4.5% of all emergency calls, while children have a threefold share of the population (15%). Falls, dyspnoea, seizures and poisonings account for half of all emergencies. Few patients suffered from a life-threatening condition or trauma. Cardiac arrest or need for advanced life support measures (e.g. intubation) was rare. After evaluation by the emergency medical services, only half of the patients (56%) needed ambulance transportation to hospital. Only 30 (3.7%) of the non-transported patients made an unpremeditated visit to the emergency department after the original contact with the emergency medical services. All of them were well upon arrival to the emergency department. CONCLUSION Paediatric out-of-hospital emergencies are infrequent and have specific characteristics differing from the adult population. The design and training of emergency medical services and their personnel should focus on evaluation and management of the most frequent situations.
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Affiliation(s)
- H. Harve
- Emergency Medical Services; Department of Emergency Care; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - H. Salmi
- Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
- Anaesthesiology and Intensive Care; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - E. Rahiala
- Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - P. Pohjalainen
- National Institute for Health and Welfare; Helsinki Finland
| | - M. Kuisma
- Emergency Medical Services; Department of Emergency Care; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Baghdassarian AA, Donaldson RI, DePiero AD, Chernett NL, Sule H. Pediatric emergency medical care in Yerevan, Armenia: a knowledge and attitudes survey of out-of-hospital emergency physicians. Int J Emerg Med 2014; 7:11. [PMID: 24506949 PMCID: PMC3932946 DOI: 10.1186/1865-1380-7-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/29/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Out-of-hospital emergency care is at an early stage of development in Armenia, with the current emergency medical services (EMS) system having emergency physicians (EPs) work on ambulances along with nurses. While efforts are underway by the Ministry of Health and other organizations to reform the EMS system, little data exists on the status of pediatric emergency care (PEC) in the country. We designed this study to evaluate the knowledge and attitudes of out-of-hospital emergency physicians in pediatric rapid assessment and resuscitation, and identify areas for PEC improvement. METHODS We distributed an anonymous, self-administered Knowledge and Attitudes survey to a convenience sample of out-of-hospital EPs in the capital, Yerevan, from August to September 2012. RESULTS With a response rate of 80%, the majority (89.7%) of respondents failed a 10-question knowledge test (with a pre-defined passing score of ≥7) with a mean score of 4.17 ± 1.99 SD. Answers regarding the relationship between pediatric cardiac arrest and respiratory issues, compression-to-ventilation ratio in neonates, definition of hypotension, and recognition of shock were most frequently incorrect. None of the participants had attended pediatric-specific continuing medical education (CME) activities within the preceding 5 years. χ2 analysis demonstrated no statistically significant association between physician age, length of EMS experience, type of ambulance (general vs. resuscitation/critical care), or CME attendance and pass/fail status. The majority of participants agreed that PEC education in Armenia needs improvement (98%), that there is a need for pediatric-specific CME (98%), and that national out-of-hospital PEC guidelines would increase PEC safety, efficiency, and effectiveness (96%). CONCLUSIONS Out-of-hospital emergency physicians in Yerevan, Armenia are deficient in pediatric-specific emergency assessment and resuscitation knowledge and training, but express a clear desire for improvement. There is a need to support additional PEC training and CME within the EMS system in Armenia.
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Affiliation(s)
- Aline A Baghdassarian
- Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, Delaware 19803, USA
- Jefferson School of Population Health, Thomas Jefferson University, 901 Walnut Street, 10th Floor, Philadelphia, PA 19107, USA
- Jefferson Medical College, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, USA
- Division of Pediatric Emergency Medicine, Virginia Commonwealth University Medical Center Main Hospital, 2nd Floor, Ste 2-500, 1250 E. Marshall Street, P.O. Box 980401, Richmond, VA 23298-0401, USA
| | - Ross I Donaldson
- Department of Emergency Medicine, Harbor-UCLA Medical Center, 924 Westwood Boulevard, Suite 300, Los Angeles, CA 90095, USA
- UCLA School of Public Health, 640 Charles EYoung Dr S, Los Angeles, CA 90024, USA
| | - Andrew D DePiero
- Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, Delaware 19803, USA
- Jefferson Medical College, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, USA
| | - Nancy L Chernett
- Jefferson School of Population Health, Thomas Jefferson University, 901 Walnut Street, 10th Floor, Philadelphia, PA 19107, USA
| | - Harsh Sule
- Department of Emergency Medicine, Thomas Jefferson University Hospital, 1020 Sansom Street, Philadelphia, PA 19107, USA
- Jefferson Medical College, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107, USA
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Alanazi AF. Emergency medical services in Saudi Arabia: A study on the significance of paramedics and their experiences on barriers as inhibitors of their efficiency. Int J Appl Basic Med Res 2013; 2:34-7. [PMID: 23776806 PMCID: PMC3657988 DOI: 10.4103/2229-516x.96803] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Emergency Medical Services (EMS) provides out-of-hospital acute medical care to different types of serious emergencies. The team of EMS includes paramedics, besides many other staff working in the pre-hospital setting. Although the paramedics are the first responders to the patient in emergency, they face several barriers, which interfere with their efficiency. AIM However, the magnitude of these obstacles is not known, hence; it was found worthwhile to evaluate the depth of these difficulties. MATERIALS AND METHODS A questionnaire that included eight different commonly experienced barriers and four different variables of strength was framed. The questionnaire was served to 140 paramedics in three different regions (Jeddah, Riyadh, and Dammam) of Saudi Arabia. RESULTS The positive response obtained was statistically significant for traffic congestion (P<0.01; P<0.001), nuisance by bystanders and family members (P<0.001), lack of competence of doctors and the administration in the EMS routines (P<0.05; P<0.01; P<0.001), lack of trust and confidence (P<0.001) lack of independence (P<0.001), patient's resistance (P<0.001), Interference of legal issues and litigation proceedings (P<0.05; P<0.001), paramedic's impression on general public and the family of the patients (P<0.001). CONCLUSIONS The authorities in the hospitals and EMS administration should improve the barriers which interfere with the efficiency of a paramedic and cause gross humiliation to the patients, and the Health authorities should impart proper education and training to the paramedics.
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Affiliation(s)
- Abdullah Foraih Alanazi
- Department of Pediatric Emergency, King Saud Bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia
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Abstract
Life-threatening pediatric emergencies are rare events in which precise, correct and fast drug dosing is essential. Intravenous drugs are most commonly dosed based on the child's weight in mg/kg. Numerous tools exist for aiding the physician in the error prone calculation, none of which meet all criteria for the perfect tool. Besides frequent training of practical skills and awareness of the problem of calculating the exact drug dose, it seems indispensable to have a localized tool at hand for these critical events.
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Al-Anazi AF. Pediatric emergency medical services and their drawbacks. J Emerg Trauma Shock 2012; 5:220-7. [PMID: 22988399 PMCID: PMC3440887 DOI: 10.4103/0974-2700.99687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 03/10/2012] [Indexed: 12/04/2022] Open
Abstract
Aim: To survey the literature on Pediatric Emergency Medical Services (PEMS) with an aim to focus its drawbacks and emphasize the means of improvement. Materials and Methods: Published articles selected for inclusion were based on the significance and understanding of literature search on different aspects of PEMS. To meet this criterion, PubMed, PubMed Central, Science Direct, Uptodate, Med Line, comprehensive databases, Cochrane library and the Internet (Google, Yahoo) were thoroughly searched. Results: PEMS provide out-of-hospital medical care and/or transport the patients to definitive care. The task force represents specialties of ambulance transport, first aid, emergency medical care, life saving, trauma, emergency medicine, water rescue, and extrication. Preliminary care is undertaken to save the patients from different medical exigencies. The techniques and procedures of basic and advanced life-support are employed. A large number of weaknesses are recorded in PEMS system, such as ambulance transport irregularities, deficit equipment, lack of expertise, and ignorance of the pre-hospital care providers. These are discussed with special reference to a few examples of medical exigencies. Conclusions: The appointments in PEMS should be regularized with specific qualifications, experience, and expertise in different areas. Responsibility of PEMS should not be left to pre-hospital care providers, who are non clinicians and lack proper education and training. Pediatricians should be adequately trained to play an active role in PEMS. Meetings should be convened to discuss the lapses and means of improvement. Networks of co-operation between pre-hospital providers and experts in the emergency department should be established.
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Affiliation(s)
- Abdullah Foraih Al-Anazi
- Department of Pediatric Emergency, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Bernhard M, Helm M, Luiz T, Biehn G, Kumpch M, Hainer C, Meyburg J, Gries A. Pädiatrische Notfälle in der prähospitalen Notfallmedizin. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1402-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Current World Literature. Curr Opin Anaesthesiol 2010; 23:532-8. [DOI: 10.1097/aco.0b013e32833c5ccf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jordi Ritz EM, Eich C, Gisin S, Heinzel O, Hüpfl M, Erb TO. [Paediatric simulation today and tomorrow. Perspectives and concepts]. Anaesthesist 2010; 58:1231-8. [PMID: 20012246 DOI: 10.1007/s00101-009-1642-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The confrontation with critically ill newborns, infants and small children is rare and poses a particular challenge for the medical team. Confident technical and non-technical skills are essential for successful emergency treatment. Paediatric simulators facilitate a didactic infrastructure, linking textbook theory with experience-based practice. To summarize the current status of paediatric simulation in Germany, Austria and Switzerland an online survey of all associated centres was conducted. Paediatric simulation is currently available at 24 centres, which have 39 paediatric simulators available, including 8 for newborns, 26 for infants and 5 for children. A certain congruence of standards is detectable among these centres and most instructors have completed a specialized instructor training. Of the instructors 26% are specialized nursing personnel and 67% are physicians of which most are paediatricians and anaesthesiologists. Many centres (38%) operate solely by means of the enthusiastic dedication of the employees who organize various activities during their free time. Nearly all centres (92%) place particular emphasis on non-technical skills which include the interpersonal aspects of crisis resource management. Video-supported debriefing is considered to be the basis for effective training. Within the scope of the recently established PaedSim project the curricula of paediatric simulation courses should be more structured and internationally standardized, thereby increasing both efficacy and sustainability of these training programs.
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Affiliation(s)
- E-M Jordi Ritz
- Abteilung für Anästhesie, Universitätskinderklinik beider Basel, 4005 Basel, Schweiz.
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