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Treat Pediatric Patients Without Fear

Haskell-Web

Most EMTs are scared of kids. For that matter, most nurses and doctors are scared of kids too. But because EMS folks get so much less exposure to pediatric patients in their training, most of us are really scared of kids.

We can all think of lots of reasons for this; many EMS providers are young and have had little exposure to the rug rat population. At the very most, one out of 10 of our patients is a tyke, and of those, maybe one out of 10 is seriously sick or injured.

If you work in Sun City, Ariz., or just about anywhere in Florida, the chance anyone under 60 will see the inside of your rig is very small—except, maybe, on career day at the local kindergarten. Then there’s the screaming, the crying, the wiggling and the excretions. Oh, and most of us really don’t like to see children suffer; unless, of course, they are your own teenagers.

I started working with trepidation in the emergency department (ED) at Egleston Children’s Hospital in Atlanta. In addition to all the concerns above, there’s also the broad range anatomical, physiological and epidemiological variation in this population. Transitioning from adult to pediatric medicine is like learning a whole new discipline. Luckily, I worked with many skilled, knowledgeable and, most of all, patient doctors, nurses and respiratory therapists. And I spent most of by breaks in the department library looking up strange new diseases, conditions, anomalies, symptoms, syndromes, rashes, etc.

To my own surprise, I loved it. After all, most of my patients (again, except for the incorrigible-by-definition teenagers) were innocent; they hadn’t spent their lives smoking, eating, drinking and lounging themselves into decrepitude. They weren’t asking us to fix something they had themselves trashed. And even better, we can make most children better. We could actually fix them and send them on their way.

Of course, there was real sadness as well: awful accidents, abuse, congenital pathologies, incurable diseases and sudden death. But Egleston was (it has since merged to form Children’s Healthcare of Atlanta) a Level I pediatric trauma center, and there wasn’t an instance where I didn’t believe each child had received the best, most aggressive care available.

When bad things happened, the sadness was profound. But it was tempered by two truths: 1) the large majority of children we could sew up, splint, hydrate, medicate, hug and send on their way, and 2) when we couldn’t, everything possible had been done for them.

Another buoyant characteristic of the children’s hospital is the passion of the staff. From attending physician to custodian—almost without exception—the staff is passionately dedicated to children and jealously protective of their patients. That passion made coming to work every day a pleasure.

No More Fear
Not every EMS provider gets to work at a children’s hospital. So how do we reduce the fear and hesitation that pediatric patients can produce in even the seasoned provider? Paramedic education for prehopsital providers, pediatric advanced life support and pediatric prehospital care course courses are great, and they really help. But they aren’t enough. The only thing that will help allay the fear of treating children is, well, treating children—or at least getting more exposure to these strange creatures.

So see if you can arrange to spend a shift or two with the triage nurse at a busy pediatric ED or clinic. Take histories, learn the tricks of taking vital signs (e.g., to take blood pressure, ask, “Can I see how big your muscle is?” or say, “I’m going to give your arm a hug.”). Get used to asking about vaccinations; learn how to talk to parents and calm them down, get them on your side; practice holding different sized kids; learn how to relax around these strange, alien beings.

You might even get some funny stories to tell. Like the time I took a child’s temperature with a tympanic thermometer, and mom said “so you mean THAT’S where it goes?”

After triaging about 50 kids, I can guarantee that your stress levels will go down on your next pediatric run. Hey, you might even enjoy it!
 

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