Patient safety risk: First responders often unprepared to treat children

First responders lack experience in emergencies involving children, and it puts patient safety at risk for out-of-hospital medical errors, causing significant injury or death in 4 percent to 17 percent of hospital admissions, according to a study published in The Journal of Pediatrics.

Researchers, led by Jeanne-Marie Guise, M.D., of Oregon Health & Science University, analyzed a national sample of more than 750 emergency physicians and emergency medical services professionals' perceptions of what caused out-of-hospital medical errors. Some of the top concerns included airway management, anxiety and insufficient clinical skill.

First responders also described frequent difficulties with pediatric patients who have chronic conditions and/or need home equipment.

Many of these issues may be connected to the profession's standard use of equipment designed for adults, Guise told the Statesman Journal. For example, airway management equipment is generally sized for adults, she said. Devices and procedures that could be personalized for children, such as intubation, often require complex skills that the average first responder doesn't necessarily have, she added.

Interference from family and bystanders was also a major complaint among first responders, according to Guise. To avoid chaos, she recommended they designate a single civilian to talk to first responders, with all other civilians keeping their distance.

"Either in or out, less attention is paid to children's emergencies," Guise told the Portland Business Journal. "What we know from the patient safety area in general in hospitals is that if something doesn't occur commonly and it's potentially life threatening, it's riskier for patient safety events."

On a more positive note, problems such as medication errors or lack of communication, while frequent concerns in hospital settings, were not major issues for out-of-hospital settings, according to the study. "These findings raise considerations for quality improvement and suggest important roles for pediatricians and pediatric emergency physicians in training, medical oversight, and policy development," the study concluded.

Despite these concerns, many areas have found success using first responders to keep patients out of the emergency room, FierceHealthcare previously reported. For example, Reno, Nevada, using a $9.8 million federal grant, increased paramedic training and prevented nearly 3,500 emergency department visits.

 To learn more:
- read the study abstract
- here's the Statesman Journal article
- check out the Portland Business Journal coverage

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