Determining the paediatric educational needs of prehospital providers: part 2

Abstract

Caring for paediatric patients presents unique challenges to prehospital personnel who may have limited training, experience and confidence caring for children. These challenges exist worldwide. Specific recommendations for paediatric educational content and learning strategies are lacking. The purpose of this study was to characterize the paediatric educational needs, barriers, and preferences of prehospital providers in Oregon and to examine these findings in the context of international emergency medical services (EMS) training. This was a qualitative analysis of 9 focus group discussions with a total of 64 prehospital providers from the state of Oregon. An iterative process of theme identification was used to generate themes, and then inter-rater checking was applied to confirm themes and assure inter-rater reliability. A review of the literature was conducted to compare the paediatric training of prehospital providers in the US and the UK. Participants identified a need for more paediatric training and they described knowledge gaps in assessing medically ill children, working with children with long-term medical conditions, and dealing with issues related to communication and the emotional difficulty of caring for children. Barriers included distance and cost, especially for rural providers, as well as time for training and lack of availability of courses designed specifically for the prehospital provider. Participants recommended increasing time spent with children during training by involving local schools and paediatricians. They recommended expanding the courses to include the areas where they felt less comfortable and increasing hands-on training opportunities. Simulation and online training were suggested as effective modalities to augment their trainings. Our findings support previous studies that show prehospital providers feel less comfortable providing care to children and face barriers such as time, cost, distance, and availability of relevant paediatric education. Although identified challenges are likely related to the demographics of Oregon, providers offered suggestions that may be applicable to prehospital providers more broadly, and include: 1) spending more time with children in a variety of setting and increasing the emphasis on assessing medically complicated children; 2) assuring local, affordable and relevant paediatric training opportunities; and 3) using online training modules and simulation to bring flexible ‘hands-on training to providers. Both the challenges and recommendations from this study have potential applicability to prehospital paediatric training in the US and UK.

Improving Pediatric Education for Emergency Medical Services Providers: A Qualitative Study

“…One previous study used qualitative research methods to evaluate pediatric EMS education. 32,33 The findings of this study are consistent with the previous study in describing barriers of cost, distance, and time for rural EMS providers who seek…”

“…Finally, the findings are consistent with and complement a recent national report, the 2011 National EMS Assessment 34 . This report highlighted multiple pediatric equipment and communication deficiencies, including: (1) the lack of pediatric specific equipment on ambulances; (2) insufficient attempts by EMS teams to contact medical direction when treating a pediatric patient; and (3) the lack of hospital capability of treating pediatric trauma patients (only 28% nationally).…”

Improving Paramedic Confidence with Paediatric Patients: A Scoping Review

“…Two articles identified exposure to children as a beneficial form of education, whether through parenthood or placements in local schools, paediatrician clinics or paediatric hospitals (18,35). All articles examined barriers to paediatric education, the most common being cost, time and quality of training (18,(32)(33)(34)(35).…”

“…Both subjective focus group studies and objective surveybased studies found that paramedics are less comfortable with paediatric patients than adults (18,32,33). In Fleischman et al's (32) survey of 219 pre-hospital care providers, 72% of respondents reported feeling less than 'comfortable' across 17 topics in paediatric care.…”

“…All articles demonstrated that pre-hospital care providers desire more education in paediatric care (18,(32)(33)(34)(35). The duration and amount of training preferred however, is less clear ranging from 1 to 16 hours in duration (32,34).…”