EMTs and pediatric emergencies
In Harvard, almost 25 percent of the population is under 15 years old. Pediatric calls pose many unique challenges to an emergency response that we, as EMTs, have been trained to face. Medically, children are not simply “small adults.” Understanding the baseline differences between these patient populations and knowing how both the EMTs and parents can respond to pediatric emergencies are vital to a positive experience for the child while enhancing the likelihood of a good outcome.
Pediatric anatomy and physiology differ in many significant ways as compared to those of adults. Some of the most important differences pertaining to emergency care are located around the head, neck, and spine. Anatomically, a child’s airway is significantly more vulnerable to closure because the tongue is relatively large in proportion to the total volume of the mouth. The tongue can easily fall back in an unconscious pediatric patient, and other airway structures (such as the epiglottis) can become critically inflamed, and quickly result in an airway obstruction.
Additionally, an infant’s head is bigger in proportion to the neck and body, and neck muscles are less well developed. When protecting or securing a child’s airway, EMTs compensate for these differences by aligning all critical airway structures via careful positioning of the patient. Often, a small child will be positioned with a towel underneath his or her head or shoulders to place the child in the neutral or “sniffing” position. With the child positioned correctly, the EMT may insert a properly sized nasal or oral airway (aka adjunct) to facilitate spontaneous breathing or assisted ventilation.
Timing is another critical factor. Pediatric patients have a significantly limited pulmonary reserve once spontaneous breathing is affected. 911 should be called immediately for any concerns related to airway compromise. The importance of airway maintenance is underscored by the fact that most children who suffer cardiac arrest do so as a secondary effect to a preceding respiratory arrest.
It is also important to note that children have different baseline vital signs from adults. Don’t be startled if you witness a child experiencing vitals that are not in sync with what you would consider healthy for your own body.
EMTs inherently factor in both the patient’s physical and emotional needs when interacting with pediatrics. For small children, any pain that they experience is, in their eyes, an emergency. They may react dramatically, and because of this, the child’s behavior may make it more difficult for EMTs to effectively care for emergent needs. Furthermore, after being taught valuable lessons on “stranger danger,” children can be fearful of the EMTs and shy away from their assistance.
Parents can help by promoting a sense of calm and providing comforting reassurance. Parents should let their children know that the EMTs are there to help them feel better. Simple parental acts, such as allowing the small child to sit on their lap, bringing along a child’s favorite toy, or holding oxygen up to their child’s face can make a huge difference. EMTs are trained to acknowledge the pediatric patient’s chief complaint and concern. Depending on the child’s age, the EMTs will position themselves and use language that is most amenable to gaining the confidence of and rendering effective care for the young patient.
For EMTs, the most important aspects of emergent pediatric care are to recognize the child’s level of distress and to develop a plan for care that factors in their unique physical and physiological differences. Parents can provide valuable assistance to EMTs by providing a concise and accurate chronology of events leading up to the emergency and any relevant past medical history, as well as comforting their child to keep stress levels down. Working together in this way, EMTs and parents will enhance the likelihood of a favorable outcome and a positive experience for all.
