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Patient Care

Helping EMS Responders Cope with Pediatric Fatalities

The emotional and psychological stress of encountering a pediatric fatality is unimaginable for those who haven’t experienced it, and difficult to overcome for those who have. To assist both families and EMS providers that are faced with such a tragedy, the Health Resources and Services Administration (HRSA) has funded a grant to develop effective tools and practices for EMS providers to handle the psychological and emotional effects experienced by themselves and families when a child fatality occurs outside of the hospital.

The project, called Compassionate Options for Pediatric EMS, or COPE, is one of six Targeted Issue grants that focus on research to improve prehospital pediatric outcomes, which are awarded by HRSA, an agency within the U.S. Department of Health and Human Services. Diane Pilkey, RN, MPH, the HRSA project lead for COPE, says the grant will help EMS providers manage the significant stress that comes with these kinds of events.

"The stress has led some EMS providers to leave the field," Pilkey said. "In the [hospital emergency department] setting, there is usually a support system available for families at the time of death, but this is much less likely if the death occurs in the field."

Mary Fallat, MD, division director of pediatric surgery at the University of Louisville, is leading the project. For nearly three decades, Fallat has been involved in the care of pediatric trauma patients, with particular interest in the care these patients receive before they arrive at the hospital. Her involvement in EMS began with the HRSA-funded Emergency Medical System for Children (EMSC) program; she has served as a dedicated program director of the EMSC Partnership Grant to Kentucky since 1996. Earlier this year, U.S. Transportation Secretary Anthony Foxx appointed Fallat to the National EMS Advisory Council.

The COPE grant is a natural extension of a concept Fallat has been researching for years, in which EMS providers treat victims of cardiac arrest on the scene, rather than "scoop and run."

Fallat contributed to another initiative in which, she said, she "led a multi-organizational literature review to try to better define some guidelines for terminating resuscitation on children who are trauma victims out of the hospital, as many states are primarily rural and long distances from trauma centers."

Those guidelines, published last year in the journal Pediatrics, emphasize the need for family-centered care to be included in the decision-making process for deaths that occur outside of the hospital. When children die outside of the hospital, EMS providers are often the ones on the scene handling these incidents. Appropriate training and resources are imperative in order for EMS providers to offer the best care and communicate appropriately with families and other responders.

The COPE team plans to develop a mobile app to train EMS providers to better handle pediatric accidents and deaths. The app will provide videos and a variety of other tools and resources to help EMS providers console grieving parents and also care for themselves in dealing with the sorrow and stress that remains after leaving the scene.

In the first year of the three-year grant, the team led statewide focus groups with EMS providers and bereaved parents in Kentucky to identify common themes and appropriate strategies to develop effective resources. The team also wrote several manuscripts that share the results of their focus groups and specific guidance for providers, which are currently being prepared for submission to peer-reviewed journals and for incorporation into the app.

To ensure that the resources are valuable, the COPE team used the results of these focus groups and interviews to create scenario-based simulations. All aspects of the simulations were carefully evaluated to ensure they would be beneficial to users; project members met with experts to draft scripts that incorporated teachable moments and with EMS educators for detailed video critiques. The videos will be downloaded to handheld devices for use in the field.

Currently in its second year, the program’s next initiative is to "study the educational value of the app using simulation exercises," Fallat said. "EMS providers, educators and medical directors will have an opportunity to participate" at the National Association of State EMS Officials meeting in Louisville this October.

Building on the app capabilities, the COPE team will also add the ability for EMS agencies to customize the app to include phone numbers to contact law enforcement, social services, the coroner, funeral homes and clergy, helping EMS providers connect families with the resources they need after the death of a child.

The app will be field-tested in 2016, and will initially be developed for the Android platform. The team’s vision for the future is for the app to be available on all platforms and available nationwide. They also hope that the concepts and strategies shared in the app will one day become part of standard EMS curricula so providers have access to effective resources and receive the most appropriate training before facing these tragic and difficult situations in the field.

The COPE project is supported by the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), Emergency Medical Services for Children (EMSC) Targeted Issues grant program, Grant No. H34MC26204 for $849,246. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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