Cracking the code to pre-hospital pediatric care

By Peter Antevy MD on Pediatric Emergency Standard

The single most common cause of anxiety-provoked tachycardia in prehospital care is the mere thought of a pediatric call. In EMS departments across this country the fear of treating a sick child is equally pervasive amongst experienced and inexperienced providers. If you have experienced this type of call, you can easily understand that the combined emotional energy of the provider, parent and child is a recipe for substandard care, both on scene and en-route to the hospital. The first question you should ask yourself is how comfortable are you staying on scene to treat an adult cardiac arrest patient? Instinctively, most prehospital providers say they feel very comfortable with this scenario and there is a growing trend towards staying on scene until either ROSC (return of spontaneous circulation) is achieved or until termination of resuscitation is determined.1 Several leading EMS agencies have implemented protocols with a 20 to 25 minute mandate for on-scene resuscitation. Progressive departments, such as Wake County EMS, consider 40 minutes to be appropriate for select patients. This evolution in adult care has led to significant improvements in outcomes, specifically with noted increases in neurologically intact survival.2 Staying on scene for adult arrests has become common practice and with the pit-crew approach to CPR, teams feel comfortable in their roles, and their urge to rush a nonROSC patient to the hospital has subsided.

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