This past month, I talked to you about current research looking at prehospital treatment of pediatric patients (click here to read “Small Expectations”). There’s more to talk about, so this month we’ll look at what else the literature says about prehospital pediatric trauma care.

Mass casualty planning
This is a popular area of prehospital care. From the national incident management system to community planning for mass casualty events, people are making careers out of telling us how to plan for next the big incident. At the conference I spoke at in Dubai this past month, one of the presenters actually made part of the case of my presentation for me. In his discussion on setting up field hospitals, he described pediatric patients as a significant portion of disaster relief. But, he also said it was an unanticipated piece of military field hospital response. As war finds its way into the places where people live, children are becoming victims and finding their way into field hospitals as the health care systems collapse in the conflict. Interestingly, the research has found a hole in our disaster planning regarding pediatrics.

In their paper, “Prehospital preparedness for pediatric mass-casualty events”, Shirm S, Liggin R, Dick R and Graham J surveyed nearly 4,000 EMS agencies regarding their disaster planning. They found that although 72% had a written mass casualty plan, only 13% had pediatric-specific plans. They also found 69% reported they didn’t have specific plans for mass casualty events at schools. In addition, just 62% included plans for patients with special needs. Only 19% reported using pediatric specific pediatric triage protocols. Based on their findings they concluded, “Although children are among the most vulnerable in the event of disaster, there are substantial deficiencies in the preparedness plans of prehospital emergency medical services agencies in the United States for the care of children in a mass-casualty event.”

This study drives us to look more closely at how we plan for disasters. Couple that with the experience of military field hospitals and the pediatric population they serve, and it’s clear we need to go back to the planning drawing board. Children are victims — perhaps the neediest victims of disaster — and we need to plan better to respond to their need.

Patient safety
Errors in treatment are always a concern, and we have steps in place to minimize risk. Again, research points to problems regarding pediatrics in this area. In their study, “Pediatric patient safety in the prehospital/emergency department setting”, Barata IA, Benjamin LS, Mace SE, Herman MI and Goldman RD concluded that, the pediatric population is particularly exposed to emergency department (ED) errors and that few standard practices exist for the safety of care. They discussed endorsing a culture of safety, as well as training all health care professionals to work as a team. The authors suggest medication errors can be reduced by using organizational, manufacturing and regulatory systems. Their consensus is that a safe environment with a high quality of care will reduce pediatric morbidity and mortality.

Again, science tells us we’re missing the mark when it comes to protecting pediatric patients. The mechanisms for us to do better exist. We need to include them in our protocol and planning for better outcomes.

Next month we’ll talk about mechanism of injuries and outcomes.