Parent’s Participation during a pediatric immobilization procedure | Case Report

What can we do to reduce anxiety and stress on a pediatric patient from the parent on the scene? In these emergency situations the parents’ anxiety derives not only from their worry, but also from their frustration about being helpless during the rescue.

Autors: D. Cassatella, M. Magri

CASE REPORT: September 2019, Italy. Reported dynamic: road accident, bike vs car collision. Boy, 8-years-old, conscious.

4.30pm – Ambulance arrive on the scene and secure the area. A by-stander has contacted parents yet. 

Patient evaluation – 8-year-old boy, African, conscious, normal breathing, GCS 13 (4-5-4), O2: 98%, suspected fracture on right left (high-pain during the first approach). Minor injuries on right elbow, and hands. After a call with the 118 Dispatch, the crew start the immobilization procedures with pediatric devices. The Medical Response Car arrive on the scene and support the crew in the immobilization procedures. It also takes once again parameters and overtake the organization of the health operation with a nurse assistance.

4.35pm – As the crew go ahead with the immobilization procedures, parents arrive on the scene, alerted by the bystander (parents were not on the scene because the child was in a friend’s house for the afternoon).  The child starts to breathe speedily for a panic crisis. Immobilization procedures stopped to calm the patient and the parents, who scream and cry during the basic maneuver. The parents do not speak Italian language well. Rescuers are in need of a translator to understand the language of the parent. There are little communication problem with the patient, who understand instruction and follow the medical indication rapidly.

4.40pm: Different attempts of communication fail until from the ambulance the crew extract the instruction manual of the pediatric cervical collar. It is constructed as a graphic album with instruction regarding the medical procedures the crew is performing. The parents now understand the situation, with the help of a volunteer that speak French fluently. 

4.45pm: After calming the parents, the patient is now ready to be transported in the local hospital for an RX exam. One parents go inside the ambulance with the patient, using the cervical collar stikers as a joke. It is a simple idea to support the psychological wellness of the family during transportation.

5.10pm: Ambulance and MRV arrive on the hospital. After few minutes, the RX exams evidence a compound fracture on the right tibia.

Conclusions

This kind of situation has been referred to us by various rescuers and together with them we have come up with different solutions. Problem number one: calm the young patient down in order to immobilize him.
In actual fact, calming the young patient down requires the parents’ intervention. Remember you will always be a stranger for the child and the uniform, sirens and ambulance won’t make it any easier.

You will notice that the child’s gaze is always seeking out their parents’ gaze as it is through this that they learn to explore and interpret their surrounding environment by emulation. So if the parents look calm or happy, the child will be too. If they look worried, the child will cry and be scared.

So, what can we do? In these emergency situations the parents’ anxiety derives not only from their worry but also from their frustration about being helpless during the rescue.
They will feel helpless due to the fact that they can’t help their child and have to hope the rescuers doing it are doing it right.

Solution: make the parents an active part of the rescue. We have come up with what we think is a good way to achieve this. Together with our paediatric cervical collar WJ you’ll find a fun album with animal stickers to distract the child during a rescue. Thus you gain two benefits: first parents play an active role in the rescue and won’t get in the way during your rescue maneuvers, second, you will probably have a calmer child. Another rescuers’ request that we have satisfied is helping in communicating with foreigners who don’t speak our language.
In fact, on the back of the album, you’ll find a series of questions that you may need to ask the parents translated into the most common languages in the world. This will help communication with the parents.

CITATIONS

[1]: B.Beovic – Improving paramedic confidence with paediatric patients: A scoping review – Australasian Journal of Paramedicine

[2]: M. Ahmadi – The effect of mother’s voice on pain and physiological parameters during arterial blood sampling in children hospitalized in PICUs – Anaesthesia, Pain & Intensive Care

[3]: Marcello Mortillaro – Simulation-Based Training of Communication and Emotional Competence for the Improvement of Physician-Patient Relationship – ANNUAL REVIEW OF CYBERTHERAPY  AND TELEMEDICINE