How to Treat Children in Emergency Situations
Children differ from adults in terms of their physiology, anatomy, and developmental stages, which necessitates specialized care and attention when providing emergency medical treatment. With these distinctions in mind, there are unique challenges and considerations in treating children in emergency situations. For example, children’s bodies are still growing and developing, which leads to variations in vital signs, drug dosages, and responses to medical intervention. Children often have limited communication skills, making it challenging to assess their symptoms accurately. Obtaining informed consent can be complicated, especially if the child is too young or in distress, requiring healthcare providers to collaborate closely with parents or legal guardians. Additionally, children will most likely be experiencing fear and confusion during emergencies, so addressing their emotional needs is crucial to ensure effective treatment and minimize psychological trauma.
Due to these unique considerations, Pediatric Emergency Medical Technicians (EMTs) are trained to handle the unique challenges associated with pediatric patients and ensure that appropriate care is administered. Their roles include the specialty of assessing the severity of a child’s condition and determining the appropriate level of care required. Pediatric EMTs are trained to communicate in a manner that is age-appropriate, helping to alleviate anxiety and fear. Moreover, Pediatric EMTs are sensitive to the emotional needs of children and are equipped to manage distressed or uncooperative patients. Their ability to establish rapport and build trust contributes to better patient outcomes.
Preparing for Pediatric Emergencies
Proper training and certification for pediatric Emergency Medical Technicians (EMTs) are crucial for several reasons. Pediatric patients have unique medical needs and vulnerabilities, require precise medical interventions and attention, and need to be spoken to in a way that is aligned with their developmental level. Adequate training ensures that EMTs can confidently and competently manage emergencies without compromising patient safety.
Pediatric ambulances must be equipped with child-specific equipment and medications to ensure optimal care. Ambulances should have appropriately sized airway devices to ensure effective ventilation, child-sized defibrillators and monitors for accurate readings, and a range of medications with accurate dosing for children. In addition, child-specific immobilization devices are necessary to safely secure pediatric patients during transport, preventing further injuries.
Furthermore, communication and collaboration are paramount in pediatric emergencies. Involving parents and caregivers in decision-making fosters trust and ensures that essential medical history and information about the child’s condition are communicated accurately.
Approach to Pediatric Patients
Pediatric development encompasses several critical stages, each with distinct physiological and psychological characteristics that significantly influence emergency care. Infants have underdeveloped airways, necessitating careful airway management to prevent obstruction. Preschoolers’ limited communication skills can complicate symptom assessment, while school-age children may experience anxiety and fear during emergencies. Adolescents’ cognitive development allows for better understanding and cooperation but might also involve concerns about body image and peer perception. Tailoring interventions and communication to these stages ensures efficient and compassionate pediatric emergency care.
Building rapport and gaining trust from young patients during emergencies requires a sensitive and child-centered approach. Here are 10 tips to help EMTs effectively establish a connection with young patients:
- Use Friendly and Approachable Body Language: Approach the child at their eye level, maintaining an open and friendly posture.
- Introduce Yourself: Begin by introducing yourself with a smile and using the child’s name. This simple gesture can help create a sense of familiarity.
- Offer Reassurance: Let the child know that you are there to help and that you understand they might be scared or confused.
- Engage with Playfulness: Incorporate age-appropriate humor, games, or simple questions about their interests to engage their attention and ease their anxiety.
- Respect Personal Space: Allow the child to become comfortable with your presence before initiating physical contact. Always ask for permission before touching, especially during medical procedures.
- Empower Choices: Whenever possible, give the child choices to help them feel a sense of control. For example, you could offer options about which arm they’d like for a blood pressure cuff or which teddy bear they’d like to hold.
- Listen Actively: Pay attention to the child’s questions, concerns, and any information they share about their feelings. Respond empathetically and show that you value their input.
- Provide Age-Appropriate Information: Tailor your explanations to the child’s age and developmental level. Use analogies or comparisons to make medical concepts easier to understand.
- Involve Parents or Caregivers: Encourage parents or caregivers to participate in the conversation and be present during procedures if the child is comfortable with it.
- Praise and Positive Reinforcement: Offer praise and positive reinforcement for their cooperation and bravery during medical procedures.
Communicating effectively with children of different ages requires tailoring your approach to their developmental levels. For infants and toddlers, use soothing tones, gentle touch, and maintain eye contact to provide reassurance. Use simple words and short sentences with preschoolers and engage in role-play to make medical procedures less frightening. School-age children appreciate explanations of procedures and inviting them to ask questions and express concerns. Adolescents benefit from more mature conversations, acknowledging their autonomy while providing clear information about their condition and treatment options.
Pediatric Assessment and Vital Signs
EMTs follow a modified assessment process when evaluating pediatric patients due to their unique physiological and developmental characteristics:
- Initial Assessment: EMTs begin by assessing the child’s general appearance, responsiveness, and breathing, looking for signs of distress, abnormal skin color, and any difficulties in breathing.
- Airway Assessment: Pediatric airways are narrower and easily obstructed. EMTs evaluate for signs of airway obstruction or difficulty breathing.
- Breathing Assessment: EMTs observe the child’s breathing rate, depth, and effort. Note any retractions, nasal flaring, or use of accessory muscles.
- Circulation Assessment: EMTs check the child’s pulse rate and quality, also assessing skin color, capillary refill time, and signs of poor perfusion.
- Disability Assessment: EMTs evaluate the child’s neurological status, including responsiveness, pupillary reaction, and motor responses.
- Exposure and Environmental Control: EMTs must ensure the child is appropriately dressed for their age and comfort. Maintain a warm environment to prevent hypothermia.
- Detailed Physical Examination: EMTs perform a systematic head-to-toe assessment, paying attention to any injuries, deformities, or potential sources of bleeding.
- History Taking: If possible, EMTs gather information from parents, caregivers, or the child (if age-appropriate), obtaining information about allergies, medical history, medications, and events leading to the emergency.
- Monitoring and Reassessment: Continuously monitor the child’s condition, reassessing vital signs and clinical status frequently. Adjust interventions as needed based on changes in the child’s condition.
Age-appropriate vital signs for pediatric patients differ from adult parameters due to developmental variations. For example, infant heart rates are higher (120-160 bpm), gradually decreasing with age as the child develops into a toddler, preschool, and school-age child. Similarly, infants have higher respiratory rates (30-60 breaths/min), which decrease with age as does pediatric blood pressure. It’s essential to use age-appropriate blood pressure cuffs and reference charts to determine normal ranges.
Monitoring pediatric patients closely during transportation is critical for several reasons. Pediatric patients’ conditions can deteriorate rapidly, and close monitoring helps assess the effectiveness of interventions and treatments. Children may become more anxious during transportation and monitoring their comfort and providing reassurance can help alleviate stress and enhance cooperation. EMTs can also communicate with parents or caregivers about the child’s status, promoting trust and collaboration. Lastly, accurate monitoring data is essential for maintaining a comprehensive medical record and providing accurate information to the receiving medical facility.
Common Pediatric Emergencies
Children are susceptible to a range of medical emergencies that require prompt and specialized care. Some of the most frequent emergencies affecting children fall under six main categories, 1) respiratory distress, 2) circulation, 3) seizures, 4) allergic reactions, 5) blunt trauma, and 6) dehydration. While there may be considerable overlap, all of these pediatric emergencies require careful assessment and appropriate management. Let’s take a closer look at these pediatric emergencies and how EMTs address them.
1. Respiratory Distress
Respiratory distress is a concerning symptom in children, often indicating an underlying medical issue that requires immediate attention. Common causes of respiratory distress in children encompass a range of respiratory infections, conditions, or obstructions. Viral or bacterial infections can lead to airway inflammation and constriction. Asthma exacerbations can trigger wheezing and shortness of breath. Allergic reactions, such as anaphylaxis, can cause rapid swelling of the airways, leading to respiratory distress and potentially life-threatening consequences. Also, foreign body aspiration can obstruct airflow and cause choking.
Administering oxygen therapy and using respiratory support devices like the bag-valve-mask in pediatric patients requires skill, precision, and a thorough understanding of the child’s condition.
Here are the steps EMTs should follow in administering oxygen therapy:
- Assessment: Assess the child’s respiratory rate, effort, and oxygen saturation levels using a pulse oximeter if available. This helps determine the need for oxygen therapy.
- Preparation: Ensure the oxygen source is functioning correctly and the appropriate delivery device is selected based on the child’s age and condition (nasal cannula, oxygen mask, or oxygen hood).
- Positioning: Position the child comfortably, ensuring an open airway and proper fit of the oxygen delivery device.
- Application: Gently place the selected oxygen delivery device, such as the Bag-Valve-Mask (BVM) on the child’s nose or face, making sure it fits snugly without causing discomfort or pressure.
- Oxygen Flow Rate: Set the prescribed oxygen flow rate and increase if needed.
- Monitoring: Continuously monitor the child’s respiratory status, oxygen saturation levels, and overall comfort.
- Documentation: Document the oxygen therapy administration, including the type of device used, flow rate, and the child’s response.
2. Circulation and Shock
Pediatric circulation differs from adults due to children’s smaller blood volume and faster heart rates. This makes recognizing shock in pediatric patients challenging. Pediatric patients are more likely to maintain normal blood pressure in the early stages of shock, relying on increased heart rate and peripheral vasoconstriction. Signs such as altered mental status, tachycardia, delayed capillary refill, cool extremities, and poor perfusion are more reliable indicators of shock in children.
In treating shock, the administration of fluids and medications requires careful consideration of the child’s age, weight, underlying conditions, and response to treatment. EMTs typically begin with an isotonic crystalloid solution (normal saline or lactated Ringer’s) based on weight. They assess for signs of improvement, such as improved capillary refill and mental status. If shock persists, further fluid may be needed, and dopamine or epinephrine may be required to support cardiac function if fluid resuscitation is insufficient.
When it comes to trauma, pediatric patients require unique considerations due to their anatomical and physiological differences. Focus should be on stabilizing the child’s cervical spine while maintaining an open airway, especially in situations where head or neck trauma is suspected. Use pediatric-specific equipment for immobilization and extrication to prevent further injuries. Rapidly assess for signs of internal bleeding, fractures, or head injuries, and prioritize interventions accordingly. In cases of severe trauma, anticipate the potential need for rapid transport to a trauma center equipped to handle pediatric cases.
3. Seizures and Neurological Emergencies
Seizures in pediatric patients can manifest in various ways, each requiring specific management approaches. Generalized tonic-clonic seizures are characterized by loss of consciousness, muscle rigidity (tonic phase), followed by rhythmic jerking of limbs (clonic phase). Absence seizures are brief lapses of awareness, often mistaken for daydreaming. Complex partial seizures, on the other hand, involve altered consciousness and unusual behaviors or movements. In these cases, EMTs should maintain a safe environment to prevent injury. Lastly, febrile seizures typically occur due to fever in young children. EMTs should focus on lowering the child’s fever using appropriate measures and ensuring their safety during the seizure by protecting their head and preventing falls.
During a seizure, it’s crucial to ensure the child’s safety and prevent injury. EMTs need to clear the immediate surroundings of sharp or hard objects that could cause injury during a seizure. If possible, they should gently guide the child to the floor to prevent falls, supporting their head and laying them on their side to maintain an open airway and prevent choking. It is important to note the duration of the seizure because a seizure that lasts longer than 5 minutes or if another seizure follows without full recovery in between, more medical attention is required.
Managing seizures in pediatric patients requires a combination of proactive safety measures, proper timing of interventions, and effective communication with medical professionals and caregivers. Adhering to the following guidelines ensures the child’s well-being during seizures and helps minimize the risk of injury and complications.
- Administer the correct dosage of medicine: Follow the prescribed route (oral, rectal, intranasal, etc.) accurately based on the child’s weight.
- Document: Keep track of when medications are administered and any changes in seizure frequency or intensity.
- Communication and education: Inform caregivers or school personnel about the child’s medication regimen and seizure management plan. Ensure that antiepileptic medications are accessible during emergencies.
- Monitoring: Be aware of potential side effects and complications of antiepileptic medications.
4. Allergic Reactions and Anaphylaxis
Allergic reactions in children can be triggered by various substances, including foods, insect bites and stings, medications, latex, airborne allergens, chemicals, and allergic rhinitis, which are environmental factors like dust mites, pollen, and pet dander. A severe allergic reaction, such as anaphylaxis is a potentially life-threatening reaction that requires immediate attention. It can progress rapidly, leading to respiratory and cardiovascular collapse if left untreated.
Understanding common triggers of allergic reactions, recognizing the signs of anaphylaxis, and knowing how to administer epinephrine auto-injectors are crucial aspects of managing severe allergic reactions in children. Prompt treatment is essential to prevent the progression of anaphylaxis and ensure the child’s safety and well-being. Here is a look at the key symptoms:
- Skin: Itching, hives, swelling, redness, and angioedema (swelling beneath the skin).
- Respiratory: Difficulty breathing, wheezing, shortness of breath, and throat tightness.
- Cardiovascular: Rapid or weak pulse, low blood pressure, fainting, and dizziness.
- Gastrointestinal: Nausea, vomiting, abdominal pain, and diarrhea.
- Other: Anxiety, confusion, metallic taste, and a feeling of impending doom.
Administering epinephrine is the cornerstone of anaphylaxis treatment. First, an EMT needs to administer an epinephrine auto-injector, if available, injecting it into the outer thigh muscle. Then they must keep the child lying down and monitor their condition. If there’s no improvement after 5-10 minutes, another dose of epinephrine may be needed. Even after administering epinephrine, seek immediate medical attention. Anaphylaxis can recur, and the child will need ongoing observation and treatment.
5. Traumatic Injuries
Pediatric traumatic injuries encompass a range of scenarios. For example, these types of injuries can occur from falls from heights, furniture, or playground equipment, which can result in fractures, head injuries, and soft tissue injuries. Playing sports can lead to sprains, strains, fractures, and even head injuries, particularly in contact sports. Also, car accidents can cause a variety of injuries, including head trauma, fractures, and internal injuries.
When immobilizing and transporting children with suspected fractures, certain guidelines should be followed:
- Assessment: Assess the injury and check for deformities, swelling, and open wounds.
- Immobilization: If a fracture is suspected, immobilize the injured area with appropriate splints or immobilization devices. Ensure the immobilization is stable and comfortable.
- Spinal: If a spinal injury is suspected, stabilize the head and neck by manually holding the head in a neutral position or using a cervical collar. Avoid twisting or bending the spine.
- Limbs: For limb fractures, splint the injured limb to prevent movement and minimize pain. Pad the splints to provide comfort and prevent pressure sores.
- Transportation: Gently lift and transfer the child onto a stretcher while maintaining proper spinal alignment. Secure the child and splints in place during transportation.
For trauma injuries, pain management, and emotional support are very critical. EMTs can administer pain relief medications per medical protocols, using age-appropriate pain scales to assess and manage pain effectively. Often with children, distraction techniques are required to engage the child in conversation or activities to distract them from pain and anxiety. EMTs can offer verbal reassurance, hold the child’s hand, and explain procedures in simple terms to ease anxiety. If possible, EMTs should allow parents to be present during procedures and provide emotional support to the child.
Dehydration occurs when a child loses more fluids than they consume. Infants and toddlers are particularly susceptible due to their small size and immature systems. Causes include diarrhea, vomiting, fever, inadequate fluid intake, and hot weather. Symptoms of dehydration in children, especially infants, and toddlers, include dryness of the mouth and lips, infrequent urination, or decreased wet diapers. In infants, the fontanelle (soft spot on the head) may appear sunken, and they may (along with toddlers) cry without producing tears. In addition, dehydrated children may be fussy, irritable, or lethargic.
For mild to moderate dehydration, ORS solutions can be used, which are simply beverages that contain clean water, electrolytes (also called “salts”), and carbohydrates (usually in the form of sugar). Offering fluids more frequently than usual for breastfeeding infants is recommended. For children, avoiding fruit juices and sodas is ideal, as they can worsen dehydration due to their high sugar content. Severe dehydration, marked by profound symptoms or inability to tolerate oral intake, may require hospitalization for intravenous fluids.
In addition, monitoring hydration during transportation is vital, especially for pediatric patients, as their condition can deteriorate rapidly. Dehydration can affect vital signs, such as heart rate and blood pressure, and monitoring these signs helps track a child’s condition. If rehydration measures are initiated, monitoring can help assess the child’s response to treatment and determine if adjustments are needed.
Psychological Support for Children and Families
Emergencies can have profound emotional effects on children and their families. Children may experience fear, anxiety, and confusion, as a result of the sudden and potentially overwhelming event. Parents and caregivers may also feel helpless, anxious, and distressed, especially when their child’s well-being is at stake.
Pediatric EMTs play a crucial role in providing emotional support during emergencies. Their presence, calm demeanor, and ability to communicate effectively help reassure children and families. Pediatric EMTs can establish a sense of safety and trust by introducing themselves and explaining their role. They can use child-friendly language to reduce confusion and anxiety, using playfulness and distraction techniques to divert the child’s attention from the stressful situation. In addition, it’s helpful to engage parents in the care process, encouraging their presence and providing updates to reduce their anxiety.
After the emergency situation, children and families may require ongoing care and emotional support. Child psychologists, counselors, and therapists can help children process their emotions and develop coping strategies. Joining support groups for families who have experienced similar emergencies can provide a sense of community and shared experiences. There are also online resources like websites, articles, and forums dedicated to child and family mental health that can provide information and advice. Pediatric EMTs can also offer guidance on available resources during their interaction with families, helping them access the support they need during the recovery process.
Start Your Career as an EMT
Specialized pediatric emergency care provided by EMTs is of paramount importance for ensuring the well-being and survival of children in critical situations. Children have unique physiological and emotional needs that require tailored approaches for assessment, intervention, and emotional support. Pediatric EMTs are equipped with the knowledge and skills to address these specific needs.
The field of pediatric medicine is ever-evolving, and EMTs must stay updated with the latest guidelines, techniques, and technologies to provide the best possible care. Regular training and resources ensures that EMTs are prepared to handle a diverse range of pediatric emergencies, adapt to new protocols, and enhance their communication skills to effectively address the unique needs of children and their families.
As a community, it’s essential to recognize and support the invaluable work of pediatric EMTs. By acknowledging their contributions, advocating for ongoing training and resources, and showing gratitude for their efforts, we contribute to a healthcare ecosystem that prioritizes the health and safety of our youngest members.
Learn more in this comprehensive career overview on how to become an EMT and check out these key tips for success as an EMT to get valuable advice from experienced EMS professionals. Explore the EMT Boot Camp at Unitek to get started on your EMT journey.