The Value of Restraint

     It's been a long day, but by 2300 hours Attack One is back at the station. The crew is about to eat its long-since-cold dinner when someone starts banging on the front bay doors. It's a young mother with her child, who is making a lot of noise as he breathes. The crew brings the pair into the building. Because of the child's distress, they ask the mother to carry him into the patient compartment of the ambulance unit in the station. There they place the child on oxygen and prepare a nebulizer treatment.

     The child is 2, and his mother says he's been having trouble breathing for the last hour. He was ill the evening before, but seemed to get better during the day. He fell asleep, but his mother noted him making more and more noise as the evening went on, and finally she decided to take him up the street to the fire station. He's a generally healthy child, and no one else in the home has been ill.

     The toddler does not want to leave his mother's arms, and barely lets the crew give the nebulizer to mom to hold in place. He is using his chest and neck muscles to breathe and seems to have a barking cough. When the paramedic listens to the child's lungs, he hears a lot of airway noise, including wheezes. The child is not drooling, and his mom says he drank a little juice before they walked to the station. He has not vomited or choked on anything she's aware of. Finally getting the child to cooperate, the crew places a pulse oximeter on his finger, and finds his oxygen saturation to be in the high 80% range.

     A 2-year-old male in respiratory distress. He feels warm to the touch.

     Airway: Child is making noise with respirations and has a barking cough.

     Breathing: In moderate distress in an upright position. Improves after nebulizer treatment.

     Circulation: Normal capillary refill, pink skin.

     Disability: Normal toddler behavior, no deficits.

     Exposure of Other Major Problems: Patient doesn't want to leave his mother, but can't be transported safely in her lap.

     Allergies: None.

     Medications: Over-the-counter cold medication; immunizations not up to date for age.

     Past Medical History: No prior medical problems or history of pneumonia.

     Last Intake: No recent food intake.

     Event: Severe respiratory distress, with barking cough and wheezing. The crew communicated the possibility of epiglottitis to ED staff.

     The mother here gave a clue that education was needed regarding restraining the child in her own car: When she said she usually had the child sit on her lap as she drove, she revealed a need for a follow-up visit to install a child safety seat and educate her on its proper use. There are other general safety opportunities that may be appropriate to review with parents when EMS is in a child's home and there are no pressing emergency medical needs. Toddlers face risks from open upper-floor windows, unsecured cabinets with chemicals or medications inside, stairs and dangerous cords and electrical outlets. EMTs providing service in homes where toddlers are present can observe such dangers and suggest measures to prevent later tragedies.

     There's no need to delay transportation any longer, so the transport crew sets the patient up for the 15-minute ride to the hospital. The child is most comfortable in an upright position, so the child safety seat is attached to the patient cot, and the mother will be secured at the head of the cot in the captain's chair.

     The mother asks that the child be allowed to ride to the hospital in her lap. "He's so comfortable sitting here with me," she says. "Why can't he just stay here for the ride? He always sits on my lap in the car."