Tia Dickson, RN, BSN

Primary Children's Hospital

Child life services are professionals who provide developmental, educational, and therapeutic interventions for children and their families.

• Employed by hospitals/clinics with significant pediatric focus
• Psychosocial preparation for diagnosis, tests, surgeries, and procedures

While the American Academy of Pediatrics released this policy statement in 2014; Child life services (CLS) should be delivered as part of integrated patient- and family-centered model of care and included as a quality indicator in delivery of services for children and families in health care settings, many EDs cannot provide CLS nor can EMS. As a pediatric level one trauma center, Primary Children's hospital (PCH) employs child life specialists on every unit. We can learn from them the basics. These practices will help us care for our pediatric patients.

Samantha Hensel, MS, CCLS

Excerpts from April 8, 2024 PETOS

A pediatric patient walks into your ED or rig. (Yes, it sounds like the opening to a bad joke.) Take a breath! There is a great acronym to get you started in interacting with this little person. Begin with the FACTS.

Let your patient know the next steps.

• Use first, then language. "First we will take an x-ray, and then make a plan on how to help your arm."
• Be honest with kids. If you don't know the plan that's okay.
• Never promise something is the last thing. "This is the last ouch." Instead use a phrase like, "This is one step closer to going home."

Provide information to the patient that matches their understanding

• Infants: baby talk, soft touch before vitals or a procedure.
• Toddlers: use simple statements, let them see, feel, and play with equipment.
• Preschoolers: do not say the word needle. Use "poke or straw." Instead, remind them of their job and what they might feel.
• School aged: compare sensations or steps to things they know (medicine straw instead of IV).
• Teens: similar to that of an adult patient. Ask if they have questions.

Offer appropriate choices when you can.

• Example: “Would you like me to listen to your heart or lungs first?”
• Rather than saying “sorry” say, “I wish there was another way to do this but doing xyz are steps that get you closer to going home.”
• Do not offer a choice when there is not one.

Talk to the patient. Find toys for them to play with and stop and play with them for 5 minutes. Be open and honest.

Give patients the chance to say how they feel. Validate them and how to deal with those feelings.

• “I hear you are mad about having to spend the night at the hospital. You get to be upset. You can crumple up this piece of paper and throw it in the garbage.”
• If patients are too young to name an emotion, say what you see. “I see the tears. I can see you are sad. It’s ok to be sad.”

Help the patient find something they spot with all senses. Tell me something you can . . .

• Feel
• Taste
• Smell
• See
• Hear

Model deep breaths and help the child picture a shape in their mind as a guide. Many kids learn this in school. Here is an example of mindfulness cards you could carry in the ambulance.

The biggest indicator of resiliency in pediatrics is how quickly a patient returns to their previous affect. Within 15-20 minutes following a procedure or event is an indicator of strong resilience. If that does not happen there are things you can do to lessen the effects of trauma on that child.

• Decrease stimulation. Turn down lights and sounds in the ambulance.
• Give them a hand to hold
• Validate their emotions and allow patient to express those emotions in a safe way.
• Play is truly therapeutic. It is how children process. Allow time and toys for this important healing.
  
• Drawing pictures is a form of child expression.
• Any concerns or feeling shared with you should be reported to the next providers so they can direct the patient to the right resources like child life and case managers.
• Remember healing inside and out takes time.
• Provide resources for follow up.
• Consider professional help (see below).

At PCH we frequently hand out and read a book by Margaret Holmes, A Terrible Thing Happened. At the end of this book there is a guide for parents.

Another favorite is by Tom Percival, Ruby Finds a Worry

Primary Children's, Intermountain Healthcare, Behavioral Health Outpatient Clinics offer high-quality care for adults, kids, and teens. Caregivers diagnose and treat several health conditions such as depression, anxiety, bipolar disorder, PTSD, and more. They also offer several treatment methods like counseling, psychiatry, and Mindfulness courses.

Unsure where to start? Call Behavioral Services Navigation 1-833-442-2211 during business hours. Press option #2 for those younger than age 18.

For additional guideline direction check out the UPTN website or the new app, "Utah PTN" on android and apple devices.

Training officers may review the topic above as a team training AND perform a simulation/skills check as directed here. Once complete, send a roster of participants to Utah.PETOS@gmail.com and those listed will be issued 1-hour of CME credit from the DHHS Office of EMS and Preparedness.

Individuals who don't have a training officer can get CME credit on their own by viewing the PETOS in our archives associated with this topic and completing the instructions on the webpage.

1. Work as a team to research and compile a list of local mental health and support resources that you can hand out on calls, especially after traumatizing events. This list should be included when you submit your roster for CME credit.

• The Wait to Nowhere: When a Crisis Goes Untreated—Speak Our Minds documentary

This year, as we recognize the 50th anniversary of the first National EMS Week, we honor those who came before us, especially those who challenged the status quo and raised the bar for all of us. At the same time, we look forward, building on their efforts and committing ourselves to forge a future for the next generation of EMS professionals to serve their communities.

National EMSC has a newsletter filled with fantastic pediatric information, resources, and links. Check it out!

Primary Children's Emergency Management received an education grant to provide pediatric skills training for EMS in Utah and Salt Lake counties. These workshops will be announced soon.

June at PCH-Lehi

Contact Rebekah Hoffner with any questions

If your agency is interested in Jeff's autism training or in receiving the free John Wilson autism kits, contact Jeff @jeffwilson122615@gmail.com.

The Medical Home Portal is a unique source of reliable information about children and youth who have special health care needs (CYSHCN) and offers a “one-stop shop” for their:

· families

· physicians and medical home teams

· other professionals and caregivers

Being trained, equipped, and prepared for children in accordance with national recommendations can help reduce anxiety and increase confidence on pediatric calls. Research suggests becoming “pediatric ready” may also improve outcomes. EMS and fire-rescue agencies across the nation are encouraged to participate in the Prehospital Pediatric Readiness Project Assessment to help them understand their pediatric capabilities and gaps. The online assessment is open now through July 31 for EMS and fire-rescue agencies that respond to public 911 calls. It takes an average of 30 minutes to complete. Participating agencies will receive benchmarking information to help them compare their results with other similar agencies and a gap report to help guide improvements. Learn more about or complete the assessment at https://emspedsready.org/. You may also reach out to our state program manager with any questions, Jared.wright@utah.gov.

At this site you will find tools to help you explain the survey to your agency leadership. Make sure they understand the importance of this data collection.

https://emscimprovement.center/domains/prehospital-care/prehospital-pediatric-readiness/spread-word/

PECCs, the Western Pediatric Trauma Conference returns to Utah this year and is an excellent opportunity to associate with the state's trauma and ED MDs while learning all the latest in pediatric trauma. While live attendance is pricey, there is a special virtual option for EMS that is just $25 (RN's virtual option is $100). Spread the word and consider participating yourselves.

July 10-12, 2024 in Sundance, UT.

https://www.pedtrauma.org/

Did you receive the PECC newsletter and resources email sent out on February 26? If not, contact us at jaredwright@utah.gov

For hospital PECCs

• EMSC has launched its first pediatric emergency care coordinator (PECC) learning module for ED-based PECCs. You are invited to view the module and provide feedback.

For EMS PECCs

• EMS PECC resources can be found on the EIIC website here.

Pediatric education for the prehospital provider

Register online at www.peppsite.com. Look up classes in Utah and find the 1 that works for you. Once you find the class, go to jblearning.com, and look up pepp als in the search tool. Purchase the number ($21.95). Return to peppsite.org to register for the class and follow the prompts.

If you have any questions, email Erik Andersen at erikandersen@utah.gov or text/call 435-597-7098. Continue to watch the website for additional classes.

The Emergency Medical Services for Children (EMSC) Program aims to ensure emergency medical care for the ill and injured child or adolescent is well integrated into an emergency medical service system. We work to ensure the system is backed by optimal resources and that the entire spectrum of emergency services (prevention, acute care, and rehabilitation) is provided to children and adolescents, regardless of where they live, attend school, or travel.

Email: tdickson@utah.gov
Website: https://bemsp.utah.gov/
Phone: 801-707-3763
Facebook: facebook.com/Chirp-UtahDepartmentofHealth