Trauma-informed Approach and Acute Care | Patient Centered Care and Trauma Informed Care for Pediatric Patients

Pediatric Medical Traumatic Stress

As a physician who is very invested in my patients' overall health, but also an Emergency Medicine doc who needs to move patients through our system quickly, I sometimes wonder how trauma informed approaches can accomplish both.

An example of this may shed some light here. During one evening shift EMS rolled in with a 4 year old boy in a board and collar after a 3 foot fall. He was not responding to their commands, and was staring straight ahead without crying or speaking. The resident in the ED quickly evaluated him, determined that his mental status was way off, and ordered a CT scan.

I went back in the room with the resident and found exactly what she and EMS had described. He was accompanied by an older, grandmotherly woman who was in fact his current guardian. Something seemed a bit off, as most kids don't have concussion or internal bleeding after a minor fall. We asked a few pointed questions to the grandmother, specifically about how the child responds to being yelled at or threatened (he just "clams up") and asking if he "had a pretty hard life" before she got custody ("yes, quite a hard life"). As things started to gel around this line of questioning and we came to understand his response to distressing situations, we enlisted our child life worker to "work her magic" with toys and bubbles. Within a few minutes he was interactive, talking, and we took advantage of this to clear his c-spine and enable him to sit up and play in his stretcher.

Taking a minute or two to understand how his life trauma affected his response to the mayhem of prehospital and hospital care had saved him a lot of radiation, lowered the cost of his visit, and more effeciently opened up an ED room for a new patient in the waiting area. The DEF approach (understanding his Distress, supporting him Emotionally, and involving the Family) certainly came into play here, and actually saved time and cost in our acute care setting.

Involving the family in our ED care is a safety issue, not just a social one. See more about family-centered care and patient safety.

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