Now that summer is here and the kids are home, the calls for summertime bumps and spills are starting to come in. This is the busiest time of year for most EMS systems and much of our work will be dealing with children. So let's take a look at some helpful hints when it comes to EMS for kids.
We should start with the recognition of the fact that children are not just "little adults." Their systems are totally different and they are different from adults in the way they respond to injuries, treatment and you.
The difference in responding to a call for a sick or injured child starts before you even reach the scene. The first thing to think about en route is how you felt as a kid when you saw or heard emergency apparatus in the neighborhood. You wanted to run out and see, right? Well, nothing has changed. Your lights and siren rank right up there with the bells on the ice cream truck in their power to attract a crowd of children running toward the curb. Unless there's a really good reason to arrive with all the bells and whistles, consider shutting down your equipment as you near the scene. Not only will you reduce the risk of a tragic accident but you may find a much calmer scene when you arrive. This is especially true if you're responding to a playground or a day-care center. Hysteria spreads quickly among groups of children.
First impressions count for a lot when dealing with children. You can assume that your patient and the caretakers will be equally scared, and your first job may be just easing the tension.
There are times when a few minutes spent calming the parents will go a long way toward making your treatment of the child easier. Unless the call is for a life-threatening situation that requires immediate intervention, it's usually not necessary to rush in, grab the child and start primary care. For the average sick or injured child call, you can do a good job of triage with your eyes and ears, while getting basic information from the parents.
Chances are good that you'll hear your patient before you even get to the door. And that's a good sign. The yowling and screeching immediately tells you that you have an alert, conscious patient with a fully functioning airway. As any parent can tell you, it's the quiet child who's usually really sick or badly hurt.
One of the best questions you can ask the parents is, "How does he/she normally act?" The answer will go a long way toward helping you find out how much of your patient's reactions are the result of the illness or injury, and how much is just a kid being a kid.
The age of your patient will have a lot to do with your approach. Babies, of course, are easy. In many cases, an anxious parent will hand you the baby, sometimes before you're really ready to deal with it. Soft, quiet talk, and a smile will calm most babies, and as you check the baby over, keep your eye on the baby's face. Babies can't tell you where they hurt but they'll flinch, grimace or let out a howl when you touch a tender spot.
Toddlers from about 2 to 6 are curious about everything that's going on. This can work to your advantage. Tell them what you're doing. Children this age also respond really well to cuddly toys. A Teddy bears can often be a big help in checking out a toddler. The child who won't let you touch him will sit quietly if Teddy does the exam.
Children from 6 to 10 or 11 are usually bubbling over with information. Your biggest challenge may be getting them to be quiet long enough for you to check them out. But some of this chattiness also may mask a lot of fear. If you present an image of knowing what you're doing, and have the ability to explain it as you go along, you'll get along fine with this age group. But be careful not to fall into "EMS-speak." Telling an 8-year-old that you're going to "evaluate his pupillary status" won't get very far. How about, "I'm going to shine this light in your eyes for a second."
Teenagers are something else ... in more ways than one. From 12 on up, the average youngster is mainly concerned with his or her own mobility and appearance. Nothing terrifies a teen more than the prospect of permanent injury or disfigurement. As a rescuer, the chances are that you'll find many of your teenage victims in car wrecks, where such a tragedy is a real possibility. It's going to take a lot of patience and maturity on your part to ease the fears of an injured teenager.
When the situation is serious, the difference between children and adults becomes very important. It's vital to keep in mind that a child's blood volume is much smaller than that of an adult, and what appears to be minor blood loss can be critical if the patient is an infant or small child. Be alert to the amount of bleeding you see or suspect and be prepared to act quickly. A traumatized child be awake one minute and in profound shock seconds later.
Finally, we can't avoid the issue of child abuse. The EMS system is a first line of defense for children at risk. Be alert on the scene, if a story doesn't add up or if an illness or injury doesn't match other available evidence. If you suspect that abuse may be involved in a situation, don't confront the parents. Try to get the child out of the environment. Report your suspicions to the hospital staff.
There is probably nothing as heart-warming in EMS as doing the best you can on a call involving a child and being rewarded with a big, happy smile from a young person whose fears or pain you have eased. That makes it all worthwhile.
Rich Adams, a Firehouse® contributing editor, is a volunteer EMT with the Bethesda-Chevy Chase Rescue Squad in Montgomery County, MD. He operates RDA Associates Inc., a public safety video production and consulting firm in Silver Spring, MD.
