Pre-Hospital Providers

In the midst of a medical emergency, or in the aftermath of a car crash or violent incident, the care provided by pre-hospital professionals is often the first interaction that children and their families have with the healthcare system. EMTs, paramedics, and all first responders have the opportunity to make a difference in children's experience of these events.

Why provide trauma-informed pre-hospital care?

In addition to having an impact on emotional well-being, child (and family) traumatic stress reactions can make it harder to provide effective emergency care - i.e., getting in the way of obtaining an accurate assessment of history and current status or impeding the child's ability to cooperate with treatment procedures.

A trauma-informed approach to pre-hospital care for children can:

decrease traumatic stress related to unfolding illness, injury, and treatment
reduce distress exacerbated by any pre-existing trauma exposure for the child or family
promote effective emergency care

Trauma-informed pre-hospital care includes :

Realizing the potentially traumatic impact of the situation - sights, sounds, experiences that may be scary or distressing for children and families
Recognizing reactions and behaviors that may indicate pediatric medical traumatic stress, and factors that might place some children at higher risk
Responding by taking action to reduce Distress, promote Emotional support, and address Family immediate needs (See more about the "D-E-F" framework)

Caring for children is different

Pediatric readiness in emergency medical services requires a set of additional skills and knowledge beyond the care of adults, yet most pre-hospital providers have limited experience working with pediatric patients, who often make up <10% of their cases. And even seasoned EMTs and paramedics report that caring for a seriously ill or injured child can sometimes be emotionally challenging.

In a 2017 international survey of pre-hospital providers, the majority recognized the importance of psychosocial aspects of care as part of their job. While most felt moderately confident about their skills to provide this care for children, nearly 90% wanted additional training.

A trauma-informed and patient- and family-centered approach allows pre-hospital providers to address the physical and emotional needs of pediatric patients, while providing excellent medical care.

Tools and resources for trauma-informed pre-hospital care

See tools for implementing the D-E-F framework
The Engage-Calm-Distract Resource Kit from the Colorado Department of Public Health and Environment provides information, strategies, and activities to help pre-hospital providers respond to the emotional needs of children and parents in crisis. The Kit includes a quick reference guide for use in the field, color-coded based on child age and development.

Secondary traumatic stress and pre-hospital providers

ALL healthcare providers can experience secondary traumatic stress reactions related to their work. Specific challenging aspects of the job may add to pre-hospital providers' stress and their risk for secondary trauma:

Walking into unknown, uncontrolled environments
Long shifts / Overwhelmed with calls
Braving the elements / unknown environmental exposure
Communication challenges due to language, child developmental stage, family member distress
Not having all necessary resources available
Seeing the sometimes tragic beginning of the story, but not knowing the full outcome
Inadequate training or not feeling prepared (e.g. caring for children when pediatric cases are infrequent)

An international survey of pre-hospital providers found that more than 50% had psychosocial distress related to their work. This survey also pointed to potential ways to mitigate distress - LOWER distress was related to

feeling supported by managers and colleagues, and
having time to recover after particularly challenging incidents.

Tools and resources for secondary traumatic stress

Download a slideset on secondary traumatic stress to share with your team
Take a 1 hour online course on secondary traumatic stress
Learn about quick tools for coping with stress related to COVID-19

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Pediatric Medical Traumatic Stress

Patient Education

Screening & Assessment

Intervention

Trauma-Informed Care

COVID-19

Resources