Pediatric education and training.

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Recently, during a PNCCT class I participated in, we were discussing the realizations of the inadequate training most medics receive in the specialization of pediatrics. Even in the case of some veteran medics, I found that general pathophysiology of disease and pharmacology was profoundly weak. I have also found that few received formal clinical exposure to a pediatric specific environment. I'm interested in finding out what formal pediatric education is available to you and what you would like to see and feel would be beneficial.

Let's discuss it!

Is Paramedic school enough? Is PALS or PEPP sufficient? Do we need to consider rotations on a pedi specific unit? What can we do to adequately treat and care for our future generation?
 
Is Paramedic school enough? Is PALS or PEPP sufficient?
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No. There is more to pedis that can be covered in a couple hours of class. I never realized that children were no just smaller, but are vastly different than adults before I started talking to certain members here.
 
Our Medic courses do have Peds rotations at a major trauma center but, I agree, there isn't enough ER time spent on Peds. I would love to see more pediatric A&P time too. We do add PALS, a mini PEPP course and I personally add JumpSTART to the program as well. I'm not sure about other courses but, I know we spend upwards of about 3 weeks on Peds.
 
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No, we dont get near enough pediatric education even with the program, PALS and PEPP combined. PEPP though i felt was worthwhile in comparison to PALS which i felt was a waste. Simply ACLS with lower drug dosages and the substitution of epi for atropine.

Unfortunately, my ped's rotation didn't help much either as the ped's census was low during my time there
 
We can't ever have enough education on any subject matter.
 
We et to do a Ped ER rotation. I am pretty excited. Along with that, PEPP and PALS, and the Peds part of our text, I am sure there will be much more to be desired.

I foresee a good CE class or lecture.

PS I hate the whole triangle thing.
 
Is only 1 ped ER required for your class, daed?
 
I still do a 12 hour rotation in the peds ED, every other month. This is on my own time. I feel that it helps keep things freash in your mind and you are always learning new things in there.

BAck when I did medic, we were required to do 72 hours in the peds ED and have PALS. PEPP was not around then.
 
I hear the general response being "no" current education and training is subpar. So what are your recommendations? With your experience in the field, what would you have liked to see then or even now?

PALS has a purpose. It is a bare bones, very basic course on the resuscitation of kids. Just as NRP is a bare bones course for the neonates. Personally, I focus my education emphasis on the two leading causes of medical cardiac arrest, hypoxia and electrolyte disturbances. Being proactive and having a physiological understanding of these issues can and will prevent an arrest from ever occuring. There are so many disease processes and congenital issues that are specific to children that need to be introduced to our new medics (and even our old salty ones). Think to your self, how many calls have you been on that you had absolutely no clue what the disorder process was in your patient? I know its happened to me before on several occasions.

The irony is that many of these high acuity pediatric patients are better taken care of by their parents than by the responding EMS crews. In addition, the parents know a heck of a lot more than we do!

I think we should try to change that and actually expand our knowledge base. I know UMBC is trying to push the PNCCT course pretty hard. I highly recommend the course as it is currently the most involved educational opportunity currently available to medics in the pediatric realm. It also has a great intro into the world of neonates. Speaking of neonates, another course that is great to learn from is S.T.A.B.L.E if you can find one. It will really open your eyes to the true level of minimal education that we receive overall.................
 
You mean they are not just small adults?











But on a serious note no not at all. I have over the last year been working with a higher than normal number of kids. Everything is different. Event just social interation as opposed to the medical differances would be a great start.
 
PALS, PEPP and so forth are nice adjunct continuing education or refrehers but that is about it. Unfortunately, Advanced Pediatric Life Support (APLS -"apples") is not taught as active as it once was and alike its counter part ATLS one can only audit it.

No pediatric is not taught well enough neither is obstetrics (how many check fetal heart tones?) Again, how could one say that any of the areas is well taught if we only use one text?

Where I teach at, require 4 days ER ata pediatric trauma center and 2 PICU and 2 NICU. When they are through they do recieve all the alphabet cards (PALS, PEPP, NRP).

R/r 911
 
APLS - Advanced Pediatric Life Support
PALS - Pediatric Advanced Life Support

What's the difference besides the placement of the A? (Honest question)






My school does 2 shifts Pedi- ED, 1 shift Pedi ICU, 1 shift pedi CCT, and a day at an elementary school (plus the aforementioned PALS)
 
Linuss said:
APLS - Advanced Pediatric Life Support
PALS - Pediatric Advanced Life Support

What's the difference besides the placement of the A? (Honest question)
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See for yourself................

http://www.aplsonline.com/

APLS is much more intense and covers a broader spectrum of topics regarding pediatric emergencies. PALS is a simple resuscitation class (one you cannot fail at that!)

I'd love to see more PICU and Peds ER time for students. It is refreshing to see some exposure is available to folks.

BTW Rid, we carry the FetalGard Lite for FHT monitoring. OB is another area that needs attention as you stated. Maybe in time..............
 
When I started working as a tech I was always willing to jump on peds shifts, many of the other techs did not like working on the peds side of the ER. Everyone has their likes and dislikes in all areas of life. I personally don't really like geriatric and LTC settings. The experience of working with kids of all ages and all levels of need has been phenomenal. My comfort level in the field was improved ten fold. I have three of my own kids but have never had a traumatic injury to deal with and just having had kids is not the same as caring for someone else's child. I highly recommend as many clinical rotations as possible in the peds ED. And for those of you who are looking to tech, always jump on the peds shifts if they are made available.

I have noticed the medic schools in our area are having their students do peds ED clinical rotations,I don't remember seeing students come through the peds side in the past,if this is a new policy its a great decision and a real plus for all involved. We must remember that when children are involved there are often more patients than we might first expect, many times the parents of an injured child are more of a challenge than the child themselves. This is an area where gaining experience in the confines of a professional institution is best done.
 
My biggest complaint with PALS is it can be taught by someone who just wants another instuctor's cert and has very little experience working with children. Unfortunately this is true for some Paramedics. The Paramedic program did not adequately prepare them for peds. They also may have not seen many peds in their truck and some may not have ever intubated or even used a BVM on a live (or coding) child. I heard from one participant in a PALS class that was disheartened when he finally had to ask the Paramedics instructing the class if they had even worked a pedi code, intubated a child or had even been around critically ill children and the answer was no. This question only came up when it was evident the Paramedics instructing the class were following the book and struggling if they had to refer back or had a mixed scenario. It became painfully obvious this was not their level of expertise except for what the book had provided them. For this reason NRP only wants people who have actual experience although many Paramedics have tried to challege that position just so they can have a complete set of certs. These classes should be a little more than just a few skills and memorization.
 
VentMedic said:
My biggest complaint with PALS is it can be taught by someone who just wants another instuctor's cert and has very little experience working with children. Unfortunately this is true for some Paramedics. The Paramedic program did not adequately prepare them for peds. They also may have not seen many peds in their truck and some may not have ever intubated or even used a BVM on a live (or coding) child. I heard from one participant in a PALS class that was disheartened when he finally had to ask the Paramedics instructing the class if they had even worked a pedi code, intubated a child or had even been around critically ill children and the answer was no. This question only came up when it was evident the Paramedics instructing the class were following the book and struggling if they had to refer back or had a mixed scenario. It became painfully obvious this was not their level of expertise except for what the book had provided them. For this reason NRP only wants people who have actual experience although many Paramedics have tried to challege that position just so they can have a complete set of certs. These classes should be a little more than just a few skills and memorization.
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Ironically, this was another subject discussed as several students in the PNCCT class were complaining about being denied access to an NRP instructor class. The answer provided was exactly the same. It would be nice to implement the same standards, but lets face it, the AHA courses do not hold a lot of weight anymore. Many agencies are shying away from them in favor of their own in house education. ACLS, PALS, BLS are all nothing more than sitting through a class and getting a red, blue, or purple card.
 
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While it sounds as if I had a bit more peds info presented to me during medic class than alot of others, I still feel as if it was woefully inadequate. Along with PALS and PEPP, we also had a study unit on high-tech kids - the ones with chronic illnesses and/or syndromes who are on home vents and some of the other countless home medical equipment you see these days. As far as clinicals go, we had to spend time at the pediatric hospital (Riley Hospital for Children) in the ER and on the burn unit. We also spent one day in the OR, intubating kids. (In fact, over half of my tubes required for class were peds tubes. Not that we had to get that many total tubes to begin with - only 10.)
 
I am not really sure what I can add...my Medic class required 3 shifts in a ped ER. I was lucky I had a children's hospital in my city where we were required to do our time. 1 shift I had a great MD who pulled me aside and told me, I was his shadow. He also instructed the RN's to have me do the IV's as well. and after visiting with each Pt he would discuss it with me, ask my opinion and EXPLAIN things. I wish all the MD's in all of my clinical time would take the time to discuss cases and EXPLAIN things. many did, but many could not be bothered with medic students.

1 thing I know we all need is more education (like everyone else said) but also MD's and RN's that are willing help and instruct us instead of looking at EMS students (of any level) as burdens or pointless. ER staff need to realise we are not going anywhere any time soon.
 
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