Emergency Medical Services Provider Perspectives on Pediatric Calls: A Qualitative Study
Emergency Medical Services Provider Perspectives on Pediatric Calls: A Qualitative Study
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DOI：
10.1080/10903127.2018.1551450
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发表时间：
2019-07-04
影响因子：
2.4
通讯作者：
Stevens, Andrew C.
中科院分区：
文献类型：
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作者：
Jeruzal, Jessica N.;Boland, Lori L.;Stevens, Andrew C.
目的：以往的研究表明，911反应涉及儿童的事件是特别痛苦的紧急医疗服务（EMS）临床医生。本定性研究是为了增加对儿科呼叫响应困难的理解，并获得有关组织如何更好地支持EMS提供者管理潜在困难呼叫的信息。方法：来自美国单一救护车服务的护理人员和紧急医疗技术人员被邀请参加关于应对涉及儿科患者的911呼叫的焦点小组。来自农村和都市服务区的总共17名提供者参加了在社区会议场所举行的6个焦点小组。采用半结构化焦点小组指南来探讨(1)儿科呼叫困难的因素，(2)到达前的准备做法，(3)儿科呼叫困难后的应对经验，以及(4)对提供和期望的资源或支持的看法。对焦点小组进行录音，并在定性分析软件（NVivo）中使用标准编码、记忆和内容分析方法对文本进行分析。结果：对儿科呼叫困难因素的回答分为以下几个主题：(1)儿童的特殊社会价值，(2)儿科患者的临床困难，(3)增加了已经具有挑战性的呼叫的敏别性，(4)护理人员作为次要患者，(5)与患者或患者家属的认同。到达前的准备方法包括对假设的场景进行心理或口头回顾，并将神经或情绪重新集中到工作的技术方面。参与者描述了利用现有资源的情况，这些资源主要采取社会支持的形式。关于增加资源的建议包括：增加获得外部反馈的机会；更频繁的儿科临床培训；困难电话后的恢复时间制度化；改进了儿科设备的储存和标签。结论：本研究提供了关于应对儿科呼叫的困难和支持临床医生所需资源的定性数据。本研究结果可用于指导EMS领导者设计和实施机构举措，以加强对院前临床医生提供儿童护理的培训和支持。
Objective: Previous research indicates that 9-1-1 response to incidents involving children is particularly distressing for emergency medical services (EMS) clinicians. This qualitative study was conducted to increase understanding about the difficulties of responding to pediatric calls and to obtain information about how organizations can better support EMS providers in managing potentially difficult calls. Methods: Paramedics and emergency medical technicians from a single U.S. ambulance service were invited to participate in focus groups about responding to 9-1-1 calls involving pediatric patients. A total of 17 providers from both rural and metro service regions participated in six focus groups held in community meeting spaces. A semi-structured focus group guide was used to explore (1) elements that make pediatric calls difficult, (2) pre-arrival preparation practices, (3) experiences with coping after difficult pediatric calls, and (4) perspectives about offered and desired resources or support. Focus groups were audio recorded and transcripts were analyzed using standard coding, memoing, and content analysis methods in qualitative analysis software (NVivo). Results: Responses about elements that make pediatric calls difficult were organized into the following themes: (1) special social value of children, (2) clinical difficulties with pediatric patients, (3) added acuity to already challenging calls, (4) caregivers as secondary patient, and (5) identifying with patient or patient's family. Pre-arrival preparation methods included mental or verbal review of hypothetical scenarios and refocusing nerves or emotions back to the technical aspect of the job. Participants described using available resources that largely took the form of social support. Suggestions for additional resources included: increased opportunities for external feedback; more frequent pediatric clinical training; institutionalization of recovery time after difficult calls; and improved storage and labeling of pediatric equipment. Conclusions: This study provides qualitative data about the difficulties of responding to pediatric calls and resources needed to support clinicians. Findings from this study can be used to guide EMS leaders in designing and implementing institutional initiatives to enhance training and support for prehospital clinicians providing care to children.