Pediatrics and Your Practice

EpiEMS · Jan 17, 2017

Seeing this abstract got me thinking - how many of my patients are pediatrics? I reviewed my charts and came up with a figure of about 1 in 8 (~12.5%), where pediatric is defined as under age 21. Yes, 21.

I know that I'm far from an expert in pediatric care, and I wanted to get a sense for what others are seeing as pitfalls in EMS training and treatment for peds patients.

I think my biggest deficiency is a lack of awareness of pediatric-specific conditions and performing a "social assessment".

DesertMedic66 · Jan 17, 2017

I am in an area with a very low number of kids. I don't have access to my charts or the system to pull up % but I would say easily under 10%.

Peds are probably my weakest area simply because we don't come in contact with them often.

NomadicMedic · Jan 17, 2017

A fair number of kids in my area, due to military fanalies living off base. Lots of first time moms means a fair amount of febrile seizures and what presents as an ALTE every week or so. (Usually a mom who's nervous when the kiddo chokes after feeding too quickly.) I don't get scared by kid calls, but I treat them with a healthy dose of respect and always remember that kids can go from looking fine to just about dead really quickly.

Being a dad helps. Knowing how to pick up and handle kids is pretty important. Knowing what a "normal" kid looks like really helps you recognize a sick kid quickly.

VentMonkey · Jan 17, 2017

Agreed, and similar system to DE, sans the military bases. ALTE actually just became a "thing" here, though SoCal has implemented and taken measures for it for many years now.

I'm more inclined to treat these babies as a work up, particularly if the parent(s) seem seriously lacking, the kids presentation just isn't quite adding up to multiple ED blow offs, or any other symptoms I find abnormal. They can be a huge pendulum swing anywhere from nothing to an undiagnosed CHD.

I too was once very apprehensive around kids, and for me it was admittedly because I had none. As a father of two asthmatic girls in a city known for sporadic dust storms I have become the resident auscultator of their chests when my wife feels the need. This has helped me clinically as well for more than one reason, and has definitely given me greater insight, and empathy with worrying parents of sick children.

To answer the percentage of calls question, Ep, I haven't a clue. A patient is a patient to me typically at this point. It's my job to educate myself to all patient populations we may encounter, so my assessments variation should reflect the same.

As a side, I hate when my young, childless partners roll their eyes at frightened parents. I deem this more irritating than being an overzealous first time parent.

StCEMT · Jan 17, 2017

The amount of ped calls I get is small. Usually abdominal pain/nausea and vomiting. I feel like to a degree some of them have been the use of EMS and ED's as a primary doc substitute and considering where a lot of these calls came from, that isn't unheard of.

I have only have had 2 true "oh **** " moments with kids. Kids don't scare me necessarily, they're probably my favorite group to work with. However, I realize I am no expert in pediatric conditions and kids can go south faaaaast. Those critical, very sick kids are the ones that definitely have a healthy dose of fear/respect from me. The simpler ones though are honestly a nice change, I love working with the babies when I get a chance too. They are less ****ty than some adults I have to deal with and can be fun to talk too.

nater · Jan 17, 2017

I do more peds in my CCT role than I did on a 911 truck, but it is still a small percentage of ours runs. We do NICU transports as well, but usually have their team with us as well. We still have to maintain NRP in addition to PALS.

Tigger · Jan 17, 2017

My AMR operation came out with some statistics the other day, of the 38,830 patients seen last year, 1,661 were peds. That's less than 5%, and we are an average midwestern medium city with several large military bases.

Aprz · Jan 18, 2017

I rarely see pediatric patients, but I don't feel super uncomfortable with them. I learned about the Handtevy method (from Tom B sharing it on ems12lead I think) awhile ago, even before I temporarily worked at Paramedics Plus Alameda County (they taught it to my academy class when I got hired), and usually have an idea of weight and drug dose based off the dispatched age. I'll usually still confirm the age, weight, and use the length base resuscitation tape. For the most part, I know that there is usually a heavy emphasis on airway and breathing (drilled in from PALS), we don't have a lot of drugs so not a lot of different doses to know, and I think you get used to it once you actually run pediatric calls. From what I've seen, a lot of people are afraid to start IVs, give medications, or even touch the patients. They usually don't know vitals signs, especially the lower blood sugar part, so pediatric calls are generally transport focused even on cardiac arrest calls unfortunately. It seems like providers are afraid they'll harm the patient if they even touch them. It's all good to have the mom move the patient to the gurney, but it seems like providers can go a whole call without actually touching the kiddo.

I have never ran a critical pediatric call, but I hope that doing more than transport only on basic pediatric calls will carry over to my more critical ones.

EpiEMS · Jan 18, 2017

So much great stuff, guys! Thanks!

DesertMedic66 said:
Peds are probably my weakest area simply because we don't come in contact with them often.

I think this is a big concern, and based on the figures folks are coming up with, it seems like a danger to me. I know that a lot of my CME doesn't focus on pediatrics - though it probably should address them more.

@DEmedic & @VentMonkey, it seems like time spent with kids is probably as helpful (or more?) than learning about pedatric care. I think the point about considering the state of the first time parent is important - especially as a non-parent, I have a high index of suspicion when a child is/was/appeared to be sick, so I'll up-triage calls like that even if it seems unwarranted, particularly if social conditions don't seem great (just like one might do for somebody in a not-so-great nursing home).

VentMonkey said:
As a side, I hate when my young, childless partners roll their eyes at frightened parents. I deem this more irritating than being an overzealous first time parent.

I'll keep this in mind - and I try to be good about it. It's hard to be a parent, and I bet it's even harder the first time!

Aprz said:
From what I've seen, a lot of people are afraid to start IVs, give medications, or even touch the patients.

While #1 and #2 don't apply (too much) to me, #3 sure does. I think this could be because of a couple things, namely that a bunch of our peds training in the EMT curriculum is "don't aggravate them" in relation to croup and epiglottitis?

EpiEMS · Jan 18, 2017

Apropos to the topic of this thread, FYI, national figures are circa 10%*.

(*HRSA & IOM seem to suggest that circa 10% of EMS calls involve peds, for what it's worth. I see similar figures from an earlier period.).

VFlutter · Jan 18, 2017

Never dealt with pediatrics until my current job and even with the additional training they are still extremely intimidating. Unfortunately the peds patients we see are traumas or really sick IFTs. I have not had one yet but coworkers have had to deal with some bad peds flights lately. One of us also rides along with some of the pediatric transport teams but we are just there for safety more than anything else. We are technically back up for the teams but there are an abundance in the area so usually not an issue.

EpiEMS · Jan 18, 2017

Chase said:
One of us also rides along with some of the pediatric transport teams but we are just there for safety more than anything else.

How're those staffed? Medic/Medic + facility RN?

VFlutter · Jan 18, 2017

EpiEMS said:
How're those staffed? Medic/Medic + facility RN?

Usually RN/RT for the Peds team then whoever from our team is up to go RN/Medic. Sometimes the pediatrician will fly.

Tigger · Jan 18, 2017

I carry the Pediwheel to have an easily accessible reference. The PediSafe App is cool too.

nater · Jan 18, 2017

Chase said:
Usually RN/RT for the Peds team then whoever from our team is up to go RN/Medic. Sometimes the pediatrician will fly.

Our normal crew for ground and flight is medic/RN. For NICU calls, the RN usually stays behind and we pick up an RN and RT from the NICU. On the ground, they sometimes send an NP or MD as well. Us medics are more for safety, but are expected to back up the crew as requested.

SpecialK · Jan 18, 2017

My experience with, and exposure to, paediatric patients is very small. I also believe it is very poorly taught in undergraduate education. Out of the three years of the degree you do two shifts in the paediatric ED and may have the opportunity to do another for example either in PED or on a paediatric medical ward.

The CPGs however are excellent and they really try to give as much information as possible. For example, they have a special section called "considerations in young children", the paediatric assessment triangle and a specific table of paediatric drug, fluid and defibrillation doses.

Pediatrics and Your Practice

What proportion of your patients are pediatric patients?

Less than 10%

More than 10% but less than 20%

More than 20% but less than 30%

More than 30% but less than 40%

More than 40% but less than 50%

More than 50% but less than 60%

More than 60% but less than 70%

More than 70% but less than 80%

More than 80% but less than 90%

More than 90%

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