thoughts on this procedcure with kids?

[MikeRi24]

Our corporate guidelines state that the only people allowed in the back of the ambulance are us and the patients (or of course whatever fire personnel or police we need). If the pt is out with their friends when we get them, too bad they can get to the hospital another way. 1 family member, if present at time of transport, is allowed to come on the ambulance, but they have to ride up front. I think this is fair, understandable, and the way most companies do things.

Now, what about kids? I have heard this a lot in the classroom, and actually witnessed it on a call yesterday, kids do not like to be separated from their parents. So, when you're treating a pediatric patient, how do you go about doing this? I will use the example from the call I ran yesterday. we had a 4 year old outside shoveling the driveway with his dad and playing in the snow, and he slipped on the ice and fell and split his lip open pretty good. the kid is screaming and bleeding everywhere and the whole 9 yards. mom and dad are there comforting him and he's fine with us doing whatever to him as long as his mom is there. we get him in the ambulance, and we arrange for the mom to come with is, and she has to go outside the ambulance to arrange for the dad to follow us and everything, and while she is gone the kid is going nuts and we cant get near him. as soon as the medic i was this sees this, she has the mom get in the back and sit on the stretcher with him and even goes so far as to involve her in the care of the pt. everything went really smoothly after that as long as the kid was with his mom we were good.

This is obviously going against our own standard, but in the end, the patient was not critical, and everything went a LOT smoother with the parent in the back. so what do you guys think about making that "exception to the rule" for pediatric patients, and whats your usual procedure as far as that goes?

 

[Outbac1]

We often have a parent ride in the back with us on pediatric calls. In our service it is left to the paramedics judgement where or if a parent comes in the ambulance. It often has the effect you describe of calming down the pt.

 

[MSDeltaFlt]

Depends on the situation. Remembering what was covered in EMT/medic/PALS class in regards to the growth and development of the pediatric patient, children in certain age ranges do not tolerate being separated from their primary caregiver.

Usually I'll have mom ride up front, but sometimes she's in the back with me and the pt. It's a judgement call.

 

[KEVD18]

sometimes, you have to throw the rules out the window.

 

[Katie]

Generally we try not to separate the child from the parent. It can also slow a lot of things down and cause problems when the parent has to follow the ambulance in. First off is the parent's own safety. Family members can be killed trying to follow an ambulance in. When your kid is sick you're not normally thinking the way that you would normally. Second is the whole issue of consent. My instructor was going over the other day, if the parent is with the child you can get consent faster. So it makes the hospital's job easier too. Then there's the whole issue of medical history, etc. Generally as long as the parent isn't contributing to the problem and freaking the kid out they can come along. If there's not room in the back have them sit up front. That's what we do anyhow

 

[skyemt]

i doubt that rule was made for minors... makes absolutely no sense...

as has been stated, small children do much better with the parents in the back.

but also, getting history, information, and consent must involve that parent... the child is not able to do so him/herself..

 

[Epi-do]

Like already mentioned, it really depends upon the situation, the age of the kid, and the affect the caregiver is having on the patient. If the caregiver is calm and is making it easier to do my job, then I typically let them ride in the back with the child.

Another time where I take into consideration the interactions between family members is for psych patients. There have been a handful of times where I did allow someone ride in with us, in the patient compartment for these patients as well. I transported a girl one time that was suicidal, and the only way I could keep her calm was to keep her "mom" in her line of sight. Otherwise she was uncontrollable. Fortunately, the bystander was willing to go to the hospital with us, and was a huge help when it came to getting anything done and keeping the patient calm.

 

[LucidResq]

I doubt that those guidelines were meant to apply to peds too. It just wouldn't make sense. Think about how scary it would be to be 2-years-old in the back of an ambulance. You're sick or hurt, you're getting poked and prodded by a bunch of strangers in a weird moving environment, and you're over-stimulated from all the new sights and possibly sirens and lights. The least you can do for these pts is allow them to stay with their parents, in my class it was mentioned pretty early on that most of the time you have mom or dad in the ambulance. The only circumstances I can think of that I would not want a parent to stick around would be if the parent was hysterical, interfering with care, or if the kid was unconscious or very, very sick.

Besides making things easier on the kid, having mom or dad around can help you a lot too. It's often extremely difficult to understand what a young child is saying, but the parents can usually translate. Would you want to miss a kid telling you that he feels cold, or his tummy hurts, or that he's going to throw up?

By the way, distraction is a really good tool when you're dealing with small children. If you want proof, find a toddler throwing a full-on temper tantrum and blow some bubbles in front of them. 99% of the time they'll shut up, stop crying, and watch in wide-eyed drooling wonder. I was doing triage at the ER last week for a clinical and I was getting vitals on this 1-year-old girl. She was fine until I put the pulse ox on her toe.. she started freaking out and crying and her mom couldn't console her, so I pushed her foot up a little and said "ooooh look at the pretty red light." She was fascinated and sat still just long enough to take the reading.

 

[Ridryder911]

Use common sense. With that said all children have to be in appropriate car seats and carriers.

Does you EMS have enough? Doubt it and please don't post you would strap them to the mother on the stretcher. This would be non-sense and would not be a safe restraint. EMS is not above the law of child restraints (even though most EMS, LEO and FD are exempt)

This is why we carry a ped mate stretcher car seat and one additional car seat. If more than one child they go with an officer or another arrangements are made. The child will get over not being with their parent for a few minutes.

The only time I allow a parent in the back is when they have epiglottitis or it would make the matter worse. Most kids do fine, if you talk and work with them.

R/r 911

 

[Ops Paramedic]

Thoughts on this procedures with kids

It does make things a bit diffrent, does'nt it??

As rid made an interesting point about the car seats and it it being law for them. I can most sertainly assure you that there is no ambulance in this country with a car seat for a pead, and to be honest, i don't think it is law (I could be wrong). It is a favourate past time here to drive with your kid in the car unrestrained!!!

When treating a child one of the more important objectives would be to go down to the level (physically & mantally)of the patient. Also if you can, don't go barging in there through the door with the entire bus on your back. To the kid, you appear large, hence the threat, as he/she percieves it is greater, which will in turn lead to more "chaos". As per normal, start your head to toe survey at the feet, and try take the child's attention away from what is goinig on, i.e. give the kid a toy (it can be a syringe or a blown up glove with a face drawn on it, etc.). If you're two crew on your bus and you need to perorm any procedure where you will cause pain, try "role play" between the two you, whereby one is a "goodie" and one is a "badie". The "badie" obviously performing the pain inducing procedures and the "goodie" winning the trust of the patient.

Involve the parent to a certain degree, whereby should you need to administer a neb to the paient, let the parent put it to his/her face first (Not to inhale while doing this) while the kid is looking, to see that it does no harm. Kids will often allow to get near them if they see that the parents trust you. However, should you win the trust of the kid, and you think that this was way to easy, it most likely was. Ensure that you then rule out any form of child abuse, and if there is any doubt in your mind, rather advise the authorities than not.

Should your efforts to win the kid's trust fail, then my advice to you is to consult with your supervisor if you are not permitted to have a family member in the back.

 

[BossyCow]

I have allowed parents to ride with their children in the back of the ambulance. But I document the reason why. Child required parental accompanyment. Sometimes that we were unable to treat child until parent accompanied them or words to that effect.

 

[LucidResq]

As per normal, start your head to toe survey at the feet, and try take the child's attention away from what is goinig on, i.e. give the kid a toy (it can be a syringe or a blown up glove with a face drawn on it, etc.).

Oh yeah, glove balloons are great. When I was 7 or so my grandma was in the ED for a stroke, and a doc played glove balloon volleyball with me. It calmed the entire family down so much, and I'll never forget the impression it made on me. I loved that guy, and his willingness to take time out of his schedule to just cheer me up definitely was a factor in why I became interested in EMS at such a young age.

 

[Jon]

Rid... great point about the safety seat.

my new employer's policy manual specifies that the parent must ride up front.... but I've already seen that "bent".

If the child WANTS / NEEDS the parent there... then the parent should be there, if possible. If the parent is a problem, then the parent can ride up front or NOT RIDE.