Beyond the Basics: Trends and Changes in Pediatric Care

CEU Review Form Trends and Changes in Pediatric Care (PDF)Valid until June 8, 2007

Changes in the standard of care for pediatric patients are not something the medical community takes lightly. In the world of medicine, clinical care guidelines are typically developed around sound clinical research; however, there is an exception to this rule when developing clinical care guidelines for use with the pediatric patient. Although this is counterintuitive, it does make sense; there are fewer research projects involving children and, as a result, less science to support changes in clinical care guidelines.

     Interestingly enough, the lack of evidence-based medicine in pediatrics draws a direct comparison between pediatric medicine and EMS. In the early days of EMS, clinical care guidelines were based simply on the current practices of the day and a physician or surgeon deciding that an intervention had merit in the out-of-hospital environment.

     This article reviews some of the scientifically published articles that affect children and relate to EMS. The reviews in this article are not intended to be recommendations for change in your clinical practice. If you are interested in implementing any changes to your protocols based on information contained in this article, we suggest you review the literature and any peripheral studies related to the guideline you hope to change and involve your medical director early in the process.

Evidence-Based Medicine
     Evidence-based medicine (EBM) is defined as judicious use of the best current evidence in making decisions about the care of an individual patient. The intent of EBM is to integrate clinical expertise with the best available research evidence while observing the psychosocial needs of the child.

     Evidence-based medicine follows four steps:

1. Formulate a clear clinical question from a patient's problem>
2. Conduct a literature search of peer-reviewed journals for relevant clinical articles
3. Evaluate the literature for its value to EMS practice and collaborate with your medical director
4. Implement changes to the patient care protocols.

Family-Centered Care
     The concept of family-centered care was initially introduced by Foote Hospital in Michigan and prompted former U.S. Surgeon General C. Everett Koop's initiative for family-centered, community-based, coordinated care for children with special healthcare needs and their families in 1987. Family-centered care suggests that healthcare providers acknowledge and utilize the family's knowledge of their family member's condition and make use of the family's abilities to communicate with their family member.

     Although the concept of family-centered care is not new, it is new to EMS. This initiative is championed by EMS for Children (EMSC). EMS providers must garner an appreciation and understanding of family-centered care, of which a major principle is the need to understand normal growth and psychosocial development. With a comprehensive understanding of the principles of growth and development, EMS providers will be able to anticipate the physiologic needs of children based on the effects of illness or injury. Furthermore, family-centered care advocates open communications with family members throughout the assessment and management of the child.

Pediatric Trauma Care
     One of the most important considerations in management of the pediatric trauma victim is transport destination. It is critically important for EMS providers to understand that there are significant differences between adult and pediatric trauma centers. Although we recognize that certain parts of the country do not have readily available access to a pediatric trauma center, many do have access to rapid air medical capabilities that can provide transport to a pediatric trauma center.