Tips for Teaching Pediatric Care in EMS: ‘Listen, Be Honest With Patients, and Look Out for Your Peers’
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Emergency Medical Services professionals endure a wide variety of upsetting and challenging circumstances in the field. But there is likely no more upsetting or challenging circumstance than responding to a scene involving an injured or sick child.
More than 7,000 children and teens died as result of unintentional injuries in 2019, the latest year for which data was published, according to the Centers for Disease Control and Prevention. Pediatric deaths decreased 11 percent from 2010 to 2019, but the 2019 figure still represents about 20 deaths each day.
Mike McEvoy, PhD, NRP, RN, CCRN, is a co-editor for Pediatric Education for Prehospital Professionals, Fourth Edition developed by the American Academy of Pediatrics. In terms of emergency medical care—particularly as it pertains to managing incidents involving children—McEvoy is arguably one of the most experienced individuals in the United States.
McEvoy is the EMS coordinator for Saratoga County, New York, and a paramedic supervisor with Clifton Park & Halfmoon Ambulance. He is a nurse clinician in cardiothoracic surgical intensive care at Albany Medical Center, where he also chairs the Resuscitation Committee and teaches critical care medicine. He is a noted conference speaker and contributor to several publications that serve the EMS community.
Public Safety Group, which publishes the PEPP textbook series, interviewed McEvoy, focusing on how to teach pediatric care in the classroom and how to take that learning into the field. Watch the video to better understand his perspective on pediatric care or read below.
Teaching the Basics in Pediatric Care
The American Academy of Pediatrics established the PEPP course in 1998, making 2023 the 25th anniversary of the landmark program. One of the mainstays of PEPP and caring for children across the spectrum is the Pediatric Assessment Triangle (PAT), according to McEvoy. PAT instructs EMS professionals to examine three things: an injured or sick child’s appearance, breathing, and circulation to skin.
Within each side of the triangle, EMTs and paramedics must look out for a series of signals. For example, is a child able to keep his or her focus (appearance), breathing sounds normal (breathing), and is the skin normal, mottled, or turning bluish in color (circulation)?
McEvoy says this is still a core principle within pediatric care, and important for instruction.
“Those three things form really the key assessment of any children regardless of whether you’re seeing them at home or in a critical care setting,” he says. “From those three things you can then make choices on what you need to do.”
As an example, he says an injured or critically ill child experiencing breathing problems may need to receive oxygen. If a child’s appearance is considerably off, the EMS or paramedic must consider neurological problems or blood pressure problems, and if there are circulation problems, that may suggest there is some degree of shock.
McEvoy also stresses maintaining an injured or sick child’s temperature. He says EMTs and paramedics should be taught to keep a child warm during care.
“When they become ill, turning cold is really not helpful to them,” he says. “This is a big element we sometimes overlook when caring for children.”
Consider the Parent or Caregiver—and Be Honest
Children are very often accompanied by a parent or caregiver at a scene, McEvoy says. When responding to a scene involving a sick or injured child, teach EMTs and paramedics to consider the parent or caregiver as a scene, particularly for toddlers aged 1 to 3.
“Many times, the parent or care provider is going to have much better ability to console the child and, oftentimes, does best when they hold the child while the EMT/paramedic does the assessment,” McEvoy says.
It can be difficult for a professional to even take a blood pressure of a sick or injured child, so incorporating the parent or caregiver is key.
McEvoy also says that teaching EMTs and paramedics to be cognizant of the developmental level and age range of a child is important. This can be as simple as smiling at very young children and distracting them with noises or learning to converse with older children and get reliable information.
Most importantly, McEvoy says, “Be honest with children.”
“There’s never an opportunity with any patient, including children, to ever be dishonest with them,” he says. “You want to be frank about what you’re doing, what the consequences of that are going to be, and how you plan to take care of them.”
He adds that one of the ways an EMT or paramedic can assess whether a child will be a reliable historian in conversation is when a child asks to try some of the equipment being used at the scene.
“When they ask, ‘Could I try that stethoscope? Could I see what that monitor is doing?’ Now you know you have a person who can think in the abstract and has reached the point in their development where they’re probably going to give you a reliable history,” he says.
Learn to Be Aware of Behavioral Health Disorders
One thing EMS providers do not necessarily think about are behavioral health disorders, particularly when it comes to children aged 2 to 8, McEvoy says. For example, a child may be bullied at school or have other problems interacting socially and require specific treatment.
“Reminding ourselves that even though we’re looking at a person who is not an adult doesn’t mean there couldn’t be a mental illness or behavioral disturbance that requires professional help,” he says.
He says teaching EMTs and paramedics to talk to children about their social situation, their interactions with peers, and their relationships with their families are all important skills to develop.
“Anxiety, depression. People with issues with acting out and becoming violent. These are all behavioral health issues that could benefit from some professional help,” McEvoy says. “I think an awareness of that on the part of everyone who interacts with children is important. We don’t necessarily think of children as a population that has those sorts of problems.”
He adds that the latest edition of the PEPP textbook is the first to include an entire chapter dedicated to behavioral management and behavioral disturbances in children.
Addressing Mental Health of EMS Peers: ‘Look Out for Your Brothers and Sisters’
Responding to incidents involving children can be among the most traumatizing and distressing for an EMS professional. McEvoy says that leaders are actually the wrong people to assess whether colleagues and staff are suffering from post-traumatic stress disorder (PTSD) or other mental health issues following an incident.
“I think the people that are better qualified to recognize those things are their peers,” he says. “The person who sits in the ambulance with the paramedic. The person who rides in the police car with a patrol officer.”
McEvoy says the most important thing to teach staff is to be open about their struggles if they’ve gone on a call that has impacted them. But it’s also up to peers to identify and ask the right questions in the right ways.
“The worst thing to ask is, ‘Are you OK?’” he says, “because how do we respond to that question? We say ‘yes.’
“A more appropriate question is: “I notice you’re not quite yourself…Is there something that’s bothering you?” he adds.
McEvoy says he feels we’re in a new era in which people are more accepting of the fact that mental health help may be needed from time to time. When a peer looks out for another peer who may be going through mental health issues in the aftermath of an incident, discussing that incident with that peer is just being a good partner and watching out for “your brothers and sisters.”
“This is a bad business to be in when your job is to go out and see people every single day who are having problems they can’t solve on their own, and they’re waiting for you to get there to solve them,” McEvoy says. “That’s what we’re asking EMS providers to do day in and day out. Clearly that has an impact from time to time on people. We have to be attentive to that.”
Download sample content from Pediatric Education for Prehospital Professional, Fourth Edition.
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