EMS Magazine's Resource Guide: Pediatric Care

Pediatric Reinjury Study: Siblings at Risk

Who is most at risk for sustaining an injury? Someone who has just been injured within the last two weeks. If “accident prone” has been the common misnomer to explain this transient high-risk group, what do you call it when the risk for reinjury reaches past the patient, into the whole family?

Striking new findings in King County, WA, by Brian Johnston, MD, MPH, and his colleagues at the University of Washington Dept. of Pediatrics suggest that the phenomenon of increased risk for a second injury is shared by the entire sibling group when one child has gotten hurt accidentally.

Johnston’s team studied children between infancy and 15 years of age enrolled in various managed-care institutions between 1992 and 1997 who received medical treatment for severe unintentional injuries. Other visits to the ED due to minor injuries, follow-up care and intentional injuries were eliminated from the study.

They found that almost twice as many injured children were siblings of another child who had been treated for injuries recently. Risk for the second injury was greatest during the first 6–10 days, tapering off to normal in about a month; brothers between four and 10 years old had a higher risk for injury than other children.

While the reasons for family injury clusters are unknown, and likely due to a number of factors, researchers’ comments indicate the study might reveal an opportunity for EMS to provide preventive support to a family with children when treating one child for an injury. “Childhood injury prevention may be more effective if targeted toward families that are passing through periods of exceptional injury vulnerability,” says the statement from Harborview Injury Prevention and Research Center (HIPRC). Answering the call for an injured child should alert EMS to a family entering a “period of high injury risk,” which could be offset by “a brief but intensive social support intervention” to decrease that risk.

For more information, visit HIPRC Current Projects at http://depts.washington.edu/hiprc/projects/risk/hrperiods.html or http://articles.findarticles.com/p/articles/mi_m0950/is_3_105/ai_60794256/print.

Role of the Emergency Physician in EMS for Children

Emergency physicians have a duty to advance the care of their pediatric patients. With this principle in mind, in 2003, the American College of Emergency Physicians (ACEP) passed a policy statement outlining the leadership role that emergency physicians play in EMS-related activities, including integrating EMS for children into EMS systems.

In effect, the policy statement says that emergency physicians affect the EMS-EMSC continuum in important ways by providing:

• Leadership in the area of injury and illness prevention.
• Leadership in local, regional and state EMS and EMSC systems by involvement in the provision of medical direction (oversight), education of providers, quality improvement and legislative advocacy.
• Collaboration with other physicians and healthcare professionals, including providing referrals to primary care, specialized care and rehabilitation services.
• Research in the design and function of EMS systems, education of providers, out-of-hospital and emergency care interventions and outcomes of emergency care.
• Expertise for and collaboration with the National EMSC Program (Maternal and Child Health Bureau in collaboration with the National Highway Traffic Safety Administration).

In 2003, an in-depth article supporting the policy statement was published in Annals of Emergency Medicine.1 Its goal, according to the authors, is to educate emergency physicians about the federal EMS for Children Program and the efforts being made to improve out-of-hospital and ED care for children; to provide guidance to emergency physicians on advocacy efforts for children in their communities; and to provide emergency physicians with the information, tools and resources developed by the EMS for Children Program and its advocates.