EMS providers are often the first line to console grieving parents who have lost a child because of a traumatic event or illness outside the hospital. Moreover, the initial encounter with grieving parents of pediatric fatalities is overwhelming to EMS providers because they feel inadequately prepared to handle the incident which has resulted in EMS providers leaving the profession. The goal of this project is to develop a systems approach to out-of-hospital (OOH) pediatric death that equips EMS providers with the knowledge, tools and skill set needed to manage emotional and psychological effects for the grieving families they encounter as well as for themselves. Objectives include to: (1) understand and characterize a plan to improve EMS services in the management of OOH pediatric deaths, (2) create the first iteration of the COPE mobile app for management of OOH pediatric death by first responders, (3) study EMS use of the COPE mobile app in a validated simulations program with feedback from EMS and parents, and (4) field test the COPE mobile app toward dissemination of the EMS tool.
Perceptions by Families of Emergency Medical Service Interventions During Imminent Pediatric Out-of-Hospital Death
Author(s)/Presenter(s)
Mary Fallat, Anita Barbee, Richard Forest, Mary McClure, Katy Henry, Michael Cunningham
Abstract/Description
OBJECTIVE: To understand how family members view the ways Emergency Medical Services (EMS) and other first responders interact with distressed family members during an intervention involving a recent or impending pediatric death. METHODS: In depth interviews with 11 grieving parents of young children and survey results from 4 additional grieving parents of adult children were conducted as part of a larger study on effective ways for EMS providers to interact with distressed family members during a pediatric death in the field. The responses were analyzed using qualitative content analyses. RESULTS: Family reactions to the crisis and the professional response by first responders were critical to family coping and getting necessary support. There were several critical competencies identified to help the family cope including: (1) that first responders provide excellent and expeditious care with seamless coordination, (2) allowing family to witness the resuscitation including the attempts to save the child's life, and (3) providing ongoing communication. Whether the child is removed from the scene or not, keeping the family apprised of what is happening and why is critical. Giving tangible forms of support by calling friends, family, and clergy, along with allowing the family time with the child after death, giving emotional support, and follow-up gestures all help families cope. CONCLUSION: The study generated hypothetical ways for first responders to interact with distressed family members during an OOH pediatric death.
Keywords
child; death; emergency medical services; family-centered care; resuscitation
Compassionate Options for Pediatric EMS (COPE): Addressing Communication Skills
Compassionate Options for Pediatric EMS (COPE): Addressing Communication Skills
Author(s)/Presenter(s)
Aaron Calhoun, Erica Sutton, Anita Barbee, Beth McClure, Carrie Bohnert, Richard Forest, Peter Taillac, Mary Fallat
Abstract/Description
INTRODUCITON: Each year, 16,000 children suffer cardiopulmonary arrest, and in one urban study, 2% of pediatric EMS calls were attributed to pediatric arrests. This indicates a need for enhanced educational options for prehospital providers that address how to communicate to families in these difficult situations. In response, our team developed a cellular phone digital application (app) designed to assist EMS providers in self-debriefing these events, thereby improving their communication skills. The goal of this study was to pilot the app using a simulation-based investigative methodology. METHODS: Video and didactic app content was generated using themes developed from a series of EMS focus groups and evaluated using volunteer EMS providers assessed during two identical nonaccidental trauma simulations. Intervention groups interacted with the app as a team between assessments, and control groups debriefed during that period as they normally would. Communication performance and gap analyses were measured using the Gap-Kalamazoo Consensus Statement Assessment Form. RESULTS: A total of 148 subjects divided into 38 subject groups (18 intervention groups and 20 control groups) were assessed. Comparison of initial intervention group and control group scores showed no statistically significant difference in performance (2.9/5 vs. 3.0/5; p = 0.33). Comparisons made during the second assessment revealed a statistically significant improvement in the intervention group scores, with a moderate to large effect size (3.1/5 control vs. 4.0/5 intervention; p < 0.001, r = 0.69, absolute value). Gap analysis data showed a similar pattern, with gaps of -0.6 and -0.5 (values suggesting team self-over-appraisal of communication abilities) present in both control and intervention groups (p = 0.515) at the initial assessment. This gap persisted in the control group at the time of the second assessment (-0.8), but was significantly reduced (0.04) in the intervention group (p = 0.013, r = 0.41, absolute value). CONCLUSION: These results suggest that an EMS-centric app containing guiding information regarding compassionate communication skills can be effectively used by EMS providers to self-debrief after difficult events in the absence of a live facilitator, significantly altering their near-term communication patterns. Gap analysis data further imply that engaging with the app in a group context positively impacts the accuracy of each team's self-perception. https://kbems.kctcs.edu/emsc/COPE-PECcommunicationskills.pdf
Inspiration and innovation go hand in hand. Throughout history tragedies, including those personal and life altering, have inspired susceptible minds to find innovative ways to educate and tackle difficult problems. This address is first about origins. It weaves the story of how incredible individuals and events have shaped similar circumstances into not only our profession of pediatric surgery beginning with William E. Ladd, but also the emergency and trauma care system in this country. The address circles back to look at the past and future of our profession of pediatric surgery. Predictive models forecast that we are training too many pediatric surgeons in the traditional sense. The address describes how we might envision a paradigm shift in training using a different model and capitalizing on the talents of more young surgeons who want to take care of children. We are an incredible profession, but many have abdicated a need to include trauma patients and critical care in their practice of pediatric surgery. The model would include different pathways of training, enable more surgeons to be capable in aspects of children's surgical care, and provide optimal general surgical care for more children in the United States. This is an opportunity to redefine Ladd's path.
EMS Treatment of Families in an Ambiguous Out-of-Hospital Child Death: The Role of Attribution Errors
EMS Treatment of Families in an Ambiguous Out-of-Hospital Child Death: The Role of Attribution Errors
Author(s)/Presenter(s)
Anita P. Barbee, Becky F. Antle, Mary E. Fallat, Richard Forest & Mary E. McClure
Abstract/Description
Sometimes children die from maltreatment. However, when first responders enter a scene to save the life of a dying child, the cause of the health problem cannot be immediately determined. EMS professionals are taught to enact the medically appropriate protocols in a family-centered way. This study examines five case studies of infant deaths. When there is ambiguity as to why the death might have occurred, EMS and other emergency personnel seem to be more judgmental and this attitude affects their behavior toward family members. Family members have a more difficult time coping with the loss as a result. https://kbems.kctcs.edu/emsc/JLT-EMStreatmentoffamilies.pdf
Keywords
Attributions, child death, coping, EMS
EMS Perspectives on Coping with Child Death in an Out-of-Hospital Setting
EMS Perspectives on Coping with Child Death in an Out-of-Hospital Setting
Author(s)/Presenter(s)
Anita Barbee, Mary Fallat, Richard Forest, Mary McClure, Katy Henry, Michael Cunningham
Abstract/Description
To understand the ways that EMS providers cope with pediatric death in an out-of-hospital setting, eight focus groups were conducted with 98 urban, rural, and suburban EMS providers. Sixty-eight of the participants also completed a short questionnaire about a specific event. In both the focus groups and questionnaire, participants were asked how they individually coped with the death, how they coped as a team, and what coping strategies were most and least helpful. Specific coping strategies were found to be helpful to EMS providers, and could be classified as Solve, Solace, Dismiss, and Escape based on whether they approached or avoided the problem or the emotion. https://kbems.kctcs.edu/emsc/EMSperspectivesoncoping.pdf
Family Centered Practice During Pediatric Death in an Out of Hospital Setting
Family Centered Practice During Pediatric Death in an Out of Hospital Setting
Author(s)/Presenter(s)
Mary Fallat, Anita Barbee, Richard Forest, Mary McClure, Katy Henry, Michael Cunningham
Abstract/Description
OBJECTIVE: To understand effective ways for EMS providers to interact with distressed family members during a field intervention involving a recent or impending out-of-hospital (OOH) pediatric death. METHODS: Eight focus groups with 98 EMS providers were conducted in urban and rural settings between November 2013 and March 2014. Sixty-eight providers also completed a short questionnaire about a specific event including demographics. Seventy-eight percent of providers were males, 13% were either African American or Hispanic, and the average number of years in EMS was 16 years. They were asked how team members managed the family during the response to a dying child, what was most helpful for families whose child suddenly and unexpectedly was dead in the OOH setting, and what follow up efforts with the family were effective. RESULTS: The professional response by the EMS team was critical to family coping and getting necessary support. There were several critical competencies identified to help the family cope including: (1) that EMS provide excellent and expeditious care with seamless coordination, (2) allowing family to witness the resuscitation including the attempts to save the child's life, and (3) providing ongoing communication. Whether the child is removed from the scene or not, keeping the family appraised of what is happening and why is critical. Exclusion of families from the process in cases of suspected child abuse is not warranted. Giving tangible forms of support by calling friends, family, and clergy, along with allowing the family time with the child after death, giving emotional support, and follow-up gestures all help families cope. CONCLUSION: The study revealed effective ways for EMS providers to interact with distressed family members during an OOH pediatric death. https://kbems.kctcs.edu/emsc/Familycenteredpractice.pdf
Termination of Resuscitation Efforts for Children How Do You COPE?