Emergency Medical Services for Children (1993) / Chapter Skim
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4 LEARNING HOW TO PROVIDE GOOD CARE: EDUCATION AND TRAINING
4 LEARNING HOW TO PROVIDE GOOD CARE: EDUCATION AND TRAINING
Pages 108-148
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From page 108... ...
Evidence exists, however, that errors in various phases of emergency care for injured children have led to unnecessary loss of life (Ramenofsky et al., 1984~. Education to prevent such errors in caring for injured or ill children must be a high priority for the public and for health care providers.
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From page 109... ...
Who Should Be Included Parents and Other Responsible Adults Public information and education programs on emergency medical care for children should ultimately reach the entire population, including children themselves. In planning such efforts, reaching adults who are involved most directly in the care, education, and oversight of children should be the highest priority.
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From page 110... ...
Injury prevention efforts should address the sources of risk for injury, explain the degree of risk of injury and death, and identify specific steps that can lessen the risks. Nationally, the greatest risks of injury-related death for children under the age of 15 come from motor vehicle crashes (involving occupants, pedestrians, and bicyclists)
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From page 111... ...
Organizations such as the AHA and the American Red Cross, as well as community hospitals and EMS agencies, can provide this kind of training. Important topics include rescue breathing, CPR, airway management, control of bleeding, wound care, and burn treatment.
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From page 112... ...
Fire Administration, NHTSA provides materials for a public education program called "Make the Right Call," which addresses awareness of the role of EMS and of when and how to use the EMS system (U.S. Fire Administration and NHTSA, no date)
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From page 113... ...
Ideally, much of this information is provided in the course of routine v-~s and can be rued when children are seen for minor injuries and illnesses. Primary care providers also must be prepared to give more immediate and specific guidance when seriously ill or injured children are brought to the office and when parents seek advice over the telephone.
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From page 114... ...
An annual fair for children on safety and health, which is organized by the Southern Region EMS Council in Anchorage, Alaska, includes participants from the police and fire departments, the state police, hospital programs on health and safety, and the Alaska School Nurses Association (Stringer, 1992~. In the Boston area, a medical center's nurses, emergency medical technicians (EMTs)
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From page 115... ...
For example, the AAP's TIPP, which generally provides resources for pediatricians to use in advising parents during office visits, has also developed a public education program to encourage use of bicycle helmets. In 1991, the AAOS began a public education program that, in its initial phases, is focusing on playground safety (AAOS, 1991~.
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From page 116... ...
Meeting Local Needs To be most effective, public education programs should address both a core of universally appropriate material and issues of specifically local concern. Guidance in using the EMS system, for example, must always take
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From page 117... ...
San Diego, for example, developed materials for school staff on the importance of rapid contact with the EMS system through 9-1-1 when there is any possibility that a child (or school staff member) may need emergency care (San Diego County Division of Emergency Medical Services, 1991~.
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From page 118... ...
Specifically, the committee recommends that states and localities develop and sustain programs to provide to the general public of all ages adequate and ageappropriate levels of education and training in safety and prevention, in first aid and cardiopulmonary resuscitation, and in when and how to use the emergency medical services system appropriately for children. It recommends further that: .
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From page 119... ...
; the Pediatric Emergency Medical Services Training Program (PEMSTP) and the Pediatric Emergency Nursing Education Program, both developed by Children's National Medical Center; a Pediatric Emergency Nursing Course developed by the Emergency Nurses Association (ENA)
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From page 120... ...
Addressing psychosocial aspects of pediatric emergency care is especially important, because they are a significant component of the emergency and will influence the care given to a child. From infancy to adolescence, children pass through characteristic developmental stages that affect how they respond to injury or illness and how they respond to efforts by strangers to care for them (Eichelberger et al., 1992; Seidel and Henderson, 1992~.
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From page 121... ...
In training prehospital providers to care for children, attention should focus on characteristic features of pediatric emergencies and on specific difficulties that providers may encounter. Providers should be well versed in caring for trauma, seizures, and respiratory distress.
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From page 122... ...
were taken on only half of the children treated (Gausche et al., 1990; Emerman et al., l991~.5 Prehospital providers should receive pediatric training that emphasizes the procedures that their EMS system has authorized them to perform. Training should prepare them to do those procedures under the adverse conditions often encountered at the scene of an emergency.
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From page 123... ...
Needs of ED Staff ED staff are at the heart of the emergency medical care system. The most extensive training is needed by the physicians and nurses, as they have the greatest responsibilities for patient care.
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From page 124... ...
An informal survey of ACEP members with experience' training, or 'interest in emergency medic~ne and pediatrics found Cat 75 percent- of those who responded were practicing in the ED of a general hospital and 25 percent had no residency training in either emergency medicine or pediatrics (Eitzen et al., 1990~. Apart from the clinical elements of training, ED staff should be wellinformed about the workings of the EMS system and links that should exist between emergency care and other areas of health care.
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From page 125... ...
The newly published AAP (1992e) manual, Emergency Medical Services for Children: The Role of the Primary Care Provider, specifically addresses many such EMS system is sues.
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From page 126... ...
Initial Qualifying Training for Prehospital Providers A key step forward, in the committee's view, is to ensure that attention to pediatrics is adequate in all the training courses that qualify prehospital providers. This specifically includes paramedics and EMTs at both the basic and intermediate levels; ideally, it would also include first responders and dispatchers.
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From page 127... ...
Organizations such as the National Association of Emergency Medical Technicians (NAEMT' and the National Council of State EMS Training Coordinators are other important national channels through which changes in prehospital training curricula should be pursued. Because the committee believes that training in the emergency care of children must be seen as an essential component of training for prehospital personnel, it recommends that organizations that accredit training programs for prehospital care providers require that the curricula for EMTBasic, EMT-Intermediate, and EMT-Paramedic provide training in pediatric basic life support; in the medical, developmental, and social needs of all children; and in caring for children with special health care needs.
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From page 128... ...
Thus, it recommends that appropriate accrediting organizations require that the primary curricula for all health care professionals include training in basic resuscitation skills and the use of the emergency medical services system. These curricula must give specific attention to the unique medical, developmental, and social needs of children.
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From page 129... ...
The ENA is also scheduled to begin offering in early 1993 a newly developed Pediatric Emergency Nursing course (Etcetera, 1992~. Nurses play a significant role in two other aspects of EMS system operation.
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From page 130... ...
Training in trauma management, which is typically the responsibility of surgeons, has been suggested for emergency medicine residencies as well (Hailer, 1993~. The committee is persuaded that current requirements for training in pediatric emergency care in residency programs for these specialties are not sufficient.
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From page 131... ...
A Further training in pediatric emergency medicine is available through postresidency fellowship programs. ABEM and ABP received approval to offer subspecialty certification in pediatric emergency medicine, with the first certification examination offered in 1992.
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From page 132... ...
Specialized Continuing Education Courses As the attention to pediatric emergency care grows, efforts to provide appropriate education and training are producing specialized courses to meet the needs of the many providers already in practice. These specialized continuing education courses are currently the source of most EMS-C training.
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From page 133... ...
They have considerable advantages and potential, but certain drawbacks and obstacles to expansion and success in meeting the broad educational needs identified by this committee also exist. The remainder of this section surveys such continuing education programs.
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From page 134... ...
Some experts believe that a hybrid course would be ideal, but whether that would come to pass remains open to question. No pediatric trauma course comparable to APLS and PALS has been developed, but material specifically on the care of injured children is included in the Advanced Trauma Life Support (ATLS)
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From page 135... ...
CNMC offers a threeday Pediatric Emergency Nursing Education Program aimed at nurses in community hospitals and can arrange for nurses to participate in an additional clinical rotation in the CNMC ED (CNMC, 1991, 1992~. The lectures?
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From page 136... ...
Such diffusion also may occur well beyond EMS personnel; for instance, emergency nurses who acquire specialized pediatric training may similarly become sources of help and experienced advice for nurses in the rest of a hospital or for the physicians without training in emergency medicine with whom they come In contact. Out of the variety of courses that now exist, it may become possible to define a core curriculum in pediatric emergency care that can encompass the training needs of EMS providers of all types.
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From page 137... ...
This committee, as noted elsewhere, is sympathetic to the view that practice guidelines attuned to state and local settings can and perhaps should in certain circumstances take precedence over national or federal guidelines; it acknowledges, however, that unreflective local adaptation of guidelines, recommendations, and educational materials can lead to potentially unreliable and inappropriate programs and activities. Fourth, to the extent that developing "add-on courses" diverts attention from incorporating appropriate training into the basic curricula for health professionals, the committee is concerned that long-term training needs will not be adequately addressed.
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From page 138... ...
illustrates this situation: it chose to support the nationally recognized PALS course to train providers after determining that no organization in the state was able to make a commitment to continue the unique course that had been developed by the project. The response to increased availability Qua training in pediatric emergency care has generally been er~husiast~c, but providers face demands for additional training in other areas as well.
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From page 139... ...
A"low-tech" approach to providing local training is reflected in the previously noted pediatric emergency nursing course being developed jointly by EMS-C grantees and the ENA (Henderson and Brownstein, forthcoming)
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From page 140... ...
Providing the Right Course to the Right Audience Even with the growing number of special courses on pediatric emergency care, health care providers in various settings may still face difficulties in obtaining the most appropriate training. In fact, the continuing development of new courses often reflects the fact that available options do not meet the needs of specific students or the need for specific kinds of training.
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From page 141... ...
has commented that, as valuable as PALS is for paramedics, a course specifically designed for paramedic training would be ever better. For the many EMTs and other prehospital providers with only BLS skills, the value of PALS and other courses that emphasize more advanced levels of care may be seriously limited.
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From page 142... ...
Retaining Knowledge and Skills A particular concern regarding EMS-C education and training is that the public and most health care professionals who work outside pediatric specialty facilities will encounter relatively few seriously ill or injured children. This circumstance gives them little opportunity to apply the knowledge and skills that they may acquire; without use, expertise and competence in practical tasks may wither away.
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From page 143... ...
Optimal intervals for periodic retraining should be investigated. Providing Incentives for Education and Training Many health care providers have eagerly sought additional training in pediatric emergency care as it has become available.
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From page 144... ...
Start-up costs are associated with developing public education programs, revising curricula for health care providers, conducting initial training for the current provider population, and acquiring necessary equipment to support training efforts. Maintenance costs arise from continuing programs of public education, monitoring and revising provider curricula in accordance with changing practice guidelines, providing continuing education courses needed to maintain provider skills, and maintaining training equipment.
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From page 145... ...
Attention should be given to the initial qualifying training for prehospital providers, to the beginning years of education for other health professionals, to curricula for graduate and residency training programs for physicians and nurses, and to specialized continuing education courses. The current reliance on special courses to enhance the skills of existing practitioners is not sufficient by itself as a long-term approach to providing needed training.
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From page 147... ...
5. In taking vital signs in pediatric cases, prehospital providers are least likely to take blood pressure measurements, especially among younger patients.
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From page 148... ...
10. Joint residency training in pediatrics and emergency medicine combines in a five-year program the major components of each specialty's three years of residency.
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