Understanding safety in prehospital emergency medical services for children

Erika Cottrell, Kerth O'Brien, Merlin Curry, Garth D. Meckler, Philip P. Engle, Jonathan Jui, Caitlin Summers, William Lambert, Jeanne-Marie Guise

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective. For over a decade, the field of medicine has recognized the importance of studying and designing strategies to prevent safety issues in hospitals and clinics. However, there has been less focus on understanding safety in prehospital emergency medical services (EMS), particularly in regard to children. Roughly 27.7 million (or 27%) of the annual emergency department visits are by children under the age of 19, and about 2 million of these children reach the hospital via EMS. This paper adds to our qualitative understanding of the nature and contributors to safety events in the prehospital emergency care of children. Methods. We conducted four 8- to 12-person focus groups among paid and volunteer EMS providers to understand 1) patient safety issues that occur in the prehospital care of children, and 2) factors that contribute to these safety issues (e.g., patient, family, systems, environmental, or individual provider factors). Focus groups were conducted in rural and urban settings. Interview transcripts were coded for overarching themes. Results. Key factors and themes identified in the analysis were grouped into categories using an ecological approach that distinguishes between systems, team, child and family, and individual provider level contributors. At the systems level, focus group participants cited challenges such as lack of appropriately sized equipment or standardized pediatric medication dosages, insufficient human resources, limited pediatric training and experience, and aspects of emergency medical services culture. EMS team level factors centered on communication with other EMS providers (both prehospital and hospital). Family and child factors included communication barriers and challenging clinical situations or scene characteristics. Finally, focus group participants highlighted a range of provider level factors, including heightened levels of anxiety, insufficient experience and training with children, and errors in assessment and decision making. Conclusions. The findings of our study suggest that, just as in hospital medicine, factors at the systems, team, child/family, and individual provider level system contribute to errors in prehospital emergency care. These factors may be modifiable through interventions and systems improvements. Future studies are needed to ascertain the generalizability of these findings and further refine the underlying mechanisms.

Original languageEnglish (US)
Pages (from-to)350-358
Number of pages9
JournalPrehospital Emergency Care
Volume18
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Emergency Medical Services
Safety
Focus Groups
Pediatrics
Communication Barriers
Hospital Medicine
Patient Safety
Child Care
Hospital Emergency Service
Volunteers
Decision Making
Anxiety
Communication
Medicine
Interviews
Equipment and Supplies

Keywords

  • Child health services
  • Delivery of care
  • Emergency medicine
  • Health services research
  • Safety

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Medicine(all)

Cite this

Understanding safety in prehospital emergency medical services for children. / Cottrell, Erika; O'Brien, Kerth; Curry, Merlin; Meckler, Garth D.; Engle, Philip P.; Jui, Jonathan; Summers, Caitlin; Lambert, William; Guise, Jeanne-Marie.

In: Prehospital Emergency Care, Vol. 18, No. 3, 2014, p. 350-358.

Research output: Contribution to journalArticle

Cottrell, Erika ; O'Brien, Kerth ; Curry, Merlin ; Meckler, Garth D. ; Engle, Philip P. ; Jui, Jonathan ; Summers, Caitlin ; Lambert, William ; Guise, Jeanne-Marie. / Understanding safety in prehospital emergency medical services for children. In: Prehospital Emergency Care. 2014 ; Vol. 18, No. 3. pp. 350-358.
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