Work with paramedics to improve care for kids

A child’s tracheostomy tube had become displaced. Thanks to special emergency training, the EMT was able to resuscitate the child, who fully recovered.

"The child’s parents, who are both physicians, credited the training received by the EMTs as being instrumental in their child’s good outcome," says Thomas Lawrence, NREMT-P, program director for the Rhode Island Emergency Medical Services (EMS) for Children at Hasbro Children’s Hospital in Providence.

It’s critical for EDs to work with paramedics to improve care of children, especially those with special needs such as chronic illnesses, according to Marianne Gausche-Hill, MD, FACEP, FAAP, director of emergency medical services at Harbor-University of California at Los Angeles Medical Center in Torrance.

"It is key for prehospital providers to be educated about children with special needs because more and more of these children are being integrated back into society," she says.

Technological advances have allowed more children to survive various illnesses and injuries, Gausche-Hill notes. "These children offer special challenges to prehospital providers because of a need for devices to assist with daily living. Also, medications may have side effects which could affect their care."

EMS providers generally are not well-trained or experienced in pediatrics, Lawrence says, and that lack of training causes their anxiety levels to be high, even in situations with uncomplicated sick or injured children. Add the pressure of a child with special needs, and the presence of an emergency care plan is even more important, he stresses. "Giving paramedics some explanation of the child’s condition becomes invaluable."

The following are some ways to work with prehospital providers to improve emergency care of special-needs children:

  1. Instruct paramedics in managing problems that may occur.
    When children with special needs are being transported to the ED, communicate with paramedics to alert them to potential problems, Lawrence suggests. "You may be put in the position of being the medical control and have to address complications arising during long transport times," he says.

    If your out-of-hospital colleagues have access to basic information about the patient, they will be able to anticipate problems that might occur in the field, he advises. For example, a child with a ventricular peritoneal shunt with an obstruction might be having seizures and altered consciousness. If information is on file, paramedics can be alerted that it’s not a simple seizure but instead is related to increased intracranial pressure, which requires a different approach, he explains.
  2. Link your ED’s database to 911 systems.
    At Hasbro Children’s Hospital, a Pediatric Emergency Dispatch Information System for Telephone Assistance and Treatment (PEDI-STAT) program works with paramedics to improve care of special-needs children.

    The system identifies and enrolls children with special health care needs in a computer database and makes information available to EMS providers and ED physicians who treat those patients. Currently, 61 children are enrolled, Lawrence reports. The system is linked to Rhode Island’s statewide enhanced 911 system.

    "Although we had hoped to have an actual connection between enhanced 911 and our computer database, we have had to settle for less," he explains.

    911 receives alert on special-needs child
    A flag system on the 911 telecommunications screen alerts them that there is a child with a special health care need at that address. "This flag comes up regardless of the nature of the call to 911," Lawrence says.

    The information is communicated to the dispatch center, which then conveys it to the responding ambulance, he says. "The only information the ambulance receives is that a child with special needs lives at that house. They may also be advised to call the Hasbro Children’s Hospital ED for additional information."
  3. Provide training to prehospital providers.
    At Hasbro, training in the care of children with special needs during medical emergencies is provided to EMTs, Lawrence reports. Rhode Island EMS for Children, a federal grant-funded program, provides the training, which focuses mainly on the care of tracheostomies, from clearing a blocked tube to changing the tube, he says. "This, in particular, is an area that is not covered in many EMT courses, if any. The use of an adapted pediatric mannequin allows for hands-on training." 

    EMTs are taught to focus on the basic life support (airway, breathing, and circulation) method of patient care and to add tracheostomies to their list of ways to manage an airway, he says. "We have also had parents of a child with a complex medical history bring their daughter to the class so students can see for themselves how to care for trachs on real patients."

    Other topics discussed during the sessions are the importance of background information on children with special health care needs, information on types of medical conditions that are included in the definition, and an overview in assessment and care, says Lawrence.


  • Marianne Gausche-Hill, MD, FACEP, FAAP, Harbor-University of California at Los Angeles Medical Center, 1000 W. Carson St., Box 21, Torrance, CA 90509. Telephone: (310) 222-3501. Fax: (310) 782-1763. E-mail:
  • Thomas Lawrence, NREMT-P, Hasbro Children’s Hospital, Rhode Island Emergency Medical Services for Children, Grads 209, 593 Eddy St., Providence, RI 02903. Telephone: (401) 444-8210. Fax: (401) 444-7030. E-mail: