Children with Special Health Care Needs: Template for Prehospital Protocol Development
Abstract: Because of the dynamic and fragile nature of the medical conditions typically borne by children with special health care needs (CSHCN), the need for emergency care is not uncommon and prehospital providers are increasingly likely to encounter this population. With the support of grant funding from the federal EMSC program, a project was undertaken by investigators in the Center for Prehospital Pediatrics at Children's National Medical Center to develop prehospital protocols for CSHCN. This report details the protocol development process, discusses suggestions for their use, and presents the detailed protocols. The protocols are intended to serve as a resource template for the development and/or revision of jurisdiction-specific, customized practice guidelines.
Definitions and Assessment Approaches for Emergency Services for Children (Pediatrics)
Pediatric Life Support (PLS) courses and instructional programs are educational tools developed to teach resuscitation and stabilization of children who are critically ill or injured. A number of PLS courses have been developed by national professional organizations for different health care providers (eg, pediatricians, emergency physicians, other physicians, prehospital professionals, pediatric and emergency advanced practice nurses, physician assistants). PLS courses and programs have attempted to clarify and standardize assessment and treatment approaches for clinical practice in emergency, trauma, and critical care. Although the effectiveness of PLS education has not yet been scientifically validated, the courses and programs have significantly expanded pediatric resuscitation training throughout the United States and internationally. Variability in terminology and in assessment components used in education and training among PLS courses has the potential to create confusion among target groups and in how experts train educators and learners to teach and practice pediatric emergency, trauma, and critical care. It is critical that all educators use standard terminology and patient assessment to address potential or actual conflicts regarding patient evaluation and treatment. This article provides a consensus of several organizations as to the proper order and terminology for pediatric patient assessment. The Supplemental Information provides definitions for terms and nomenclature used in pediatric resuscitation and life support courses.
Pediatrics December 2016; 138 (6): e20161073. 10.1542/peds.2016-1073.
The Pediatric Assessment Triangle: A Novel Approach for the Rapid Evaluation of Children
Abstract: The Pediatric Assessment Triangle (PAT) has become the cornerstone for the Pediatric Education for Prehospital Professionals course, sponsored by the American Academy of Pediatrics. This concept for emergency assessment of children has been taught to more than 170,000 health care providers worldwide. It has been incorporated into most standardized American life support courses, including the Pediatric Advanced Life Support course, Advanced Pediatric Life Support course, and the Emergency Nursing Pediatric Course. The PAT is a rapid and simple observational tool suitable for emergency pediatric assessment regardless of presenting complaint or underlying diagnosis. This article describes the PAT and its role in emergency pediatric assessment.
The Prehospital Care of Children with Special Health Care Needs
There is an ever-growing population of children with special health care needs ranging from children with pervasive developmental disorders to technology-dependent children. The prehospital provider, local emergency medical services agencies, and the state and federal entities involved in the prehospital care of children require focused programs to ensure safe and effective care and transport of these children. This article discusses the key factors involved in the prehospital care of these children including the use of registries to identify these patients in the community, the use of caregivers and emergency information forms as resources, and the existence of specialized training programs to educate prehospital providers about the special care needs of this population. Additional discussion includes the importance of medical homes for these children and special considerations regarding their transport. Finally, we will discuss the issues that arise in this community during a disaster and show how all the previously discussed aspects of care can be integrated into a comprehensive disaster plan.