Deborah Mulligan-Smith

Death of a child in the emergency department

The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of the death of a child in the acute setting, providing a closing ritual at the time of terminating resuscitation efforts, and managing the child with a terminal condition who presents near death in the ED.

Education of Out-of-Hospital Emergency Medical Personnel in Pediatrics: Report of a National Task Force

The Pediatric Education Task Force has developed a list of major topics and skills for inclusion in pediatric curricula for EMS providers Areas of controversy in the management of pediatric patients in the prehospital setting are outlined, and helpful learning tools are identified.

Pediatric care recommendations for freestanding urgent care facilities

Treatment of children at freestanding urgent care facilities has become common in pediatric health care. Well-managed freestanding urgent care facilities can improve the health of the children in their communities, integrate into the medical community, and provide a safe, effective adjunct to, but not a replacement for, the medical home or emergency department. Recommendations are provided for optimizing freestanding urgent care facilities’ quality, communication, and collaboration in caring for children.

EMSC partnership for children: National Association of EMS Physicians model pediatric protocols.

Our emergency medical services (EMS) system is founded on the principle of delegated practice. Medical oversight establishes a certain standard of emergency patient care, which is then carried out by prehospital providers in the field. Broadly speaking, the term “medical oversight” encompasses both direct and indirect facets of medical control. Direct medical control is the online guidance provided by designated physicians to prehospital providers during emergency calls. Indirect medical control consists of training programs, patient care protocols, and quality assurance measures that are initiated by local, regional, state, and agency medical directors or advisory boards. Throughout this document, the term “medical direction” represents all forms of medical oversight as applied by any state, region, or agency. To make a delegated system work, medical direction must ensure that all prehospital providers are equipped to meet appropriate standards of patient care. This requires education and training, treatment protocols to guide rescuers’ actions in the field, and support from qualified online medical control physicians as needed. The responsibilities of medical direction include authorizing an accepted scope of practice for emergency medical technicians (EMTs) of varying skill levels; verifying that EMTs have received the necessary training to render field care swiftly and skillfully; and developing and approving protocols that delineate the proper steps in patient management. Protocols represent an important element in furthering the quality of prehospital care. While they cannot replace sound clinical judgment, they facilitate rapid and effective treatment. They serve to standardize management actions so that prehospital providers will know how to proceed in a given patient presentation. They also provide an unambiguous gauge by which adherence to EMS practice standards may be measured. Putting the Protocols to Use