As a pediatric nurse for more than 20 years I could never understand how anyone could hurt a child. Then, in my 40s, I became a mother. Never has my patience been more tested. Suddenly, and for the first time in my career, I sympathized with many of those young parents who were in my ER after having caused a shaking injury to their infant. I will never understand those who willfully and continuously abuse a child, but as a parent, I now have a better perspective toward those statistics indicating abuse occurs at every socioeconomic level, across ethic and cultural lines, within all religions, and at all levels of education.

• 1 in 5 children are abused in this country.
• Utah DCSF reported in their 1st Quarterly Report FY2020 they have received 10,648 Child Protective Service (CPS) referrals (see below).

You are a "mandated reporter." As a first responder, you are charged by law to report to DCSF any encounter or suspicion of child abuse. If one in five children is being abused, you should be screening every child you come across. You are in a unique position. Unlike everyone else in health care you are invited into their home, you are part of their community. You are perfectly positioned to catch cases of abuse.

There is a fantastic training module developed by Colorado EMSC that offers 2 free CME hours in Utah. Upon completion you will truly understand how to recognize child abuse.

www.identifychildabuse.org

Involve law enforcement at the earliest opportunity. Collect evidence and ensure chain of evidence as this can make or break a case.

Describe the scene rather than interpret it

• Avoid words that imply opinion or judgement

“garbage on floor, spoiled food on counter” is more useful than “dirty apartment"

• Document who is present, their condition, and any actions they have taken

“parent slurring words, smells of alcohol” is more useful than “parent drunk”

• Document direct quotes when possible

EMS providers should indicate suspicion of abuse or neglect to emergency department personnel. However, this does not discharge the need to also report it.

1-855-323-DCFS (3237)

• Have demographics of patient, including address and location of the alleged events, ideally have parents’ names
• Tell them who you are and provide your contact information

Pediatric abuse calls affect us not only during them but in many years to follow. My mind can automatically recall the pediatric patients I have taken care of over the course of my career. How quickly, clearly, and vividly abuse calls come back to me, even though in some cases it's been well over twenty years.

We are seeing a national epidemic among responders, one that is not exclusive of any department size, location, provider level, or paid/volunteer status, that of responder suicides. A google search for “responder PTSD resources” yields approximately 1.1 million results, yet even with all of these available resources, the problem is growing. The first question is: Do we have the RIGHT resources?

This profession puts us in a unique position. We may think we aren't allowed to be human. If your neighbor happens upon an auto/ped fatality on the way to work it may take them months to process and cope. As first responders, we don't allow ourselves that same courtesy. In a "not-so-rare" day you may wake up to a SIDS baby call, deliver the baby to the hospital, and grab breakfast on the way home. Later that day, after training, you head to a drug overdose fatality, or a rollover ejection, and then try to decide what Redbox movie you'll grab on the way back to the station. These compounding events, along with an inability to properly decompress, contribute greatly to our suicide epidemic.

I have to wonder if our problem is a resource problem or a cultural problem? Do we add too many roadblocks to working our way through the experiences we encounter? Are we perpetuating the stigma that asking for help is a sign of weakness? Often we wear being “broken” as a badge of honor and fear labels such as "PTSD" or "mental illness. These may deter many from seeking the help they need.

When a group of EMS managers and directors was recently polled, the consensus of the group was that those who ask for or seek help are a liability. Additionally, all of those polled expressed concerns about their fitness to return to duty after receiving mental health care, citing potential liability to the department or agency should an event occur. When team members suffer a broken limb, we have the ability to verify their condition with an x-ray and determine whether they can return to work. Adversely, when we suffer a mental issue no x-ray or lab testing can verify the condition is "healed."

As leaders, managers, mentors and peers we must change this unhealthy culture. Early help and intervention is not a sign of weakness. We should admire the strength it takes to ask for help. It is time we allow ourselves to be human.

Do you have a question for our EMSC Medical Director, Hilary Hewes, MD, PCH, ER Attending Physician about this newsletter topic or anything pediatric related? Shoot an email to the address below and look for her response in our next newsletter.

tdickson@utah.gov

Help improve your agency and emergency department’s readiness to take care of pediatric patients and participate in a national quality improvement project!

The national EMS for Children program, with the help of the National EMSC Data Analysis Research Center (NEDARC), is preparing to launch two national surveys in 2020.

The 2020 EMS Annual Data Collection will start on January 7th, 2020. On that day, the survey for your state will be open for respondents at emscsurveys.org. This survey will ask basic demographic information about each agency including number of staff, level of certification, annual number of calls, number of pediatric calls, as well as critical information about whether your agency has a Pediatric Champion or Pediatric Emergency Care Coordinator (PECC). It will also ask what kind and how often agencies do skills checking on pediatric equipment. Please help to ensure someone in your agency completes this survey. It is important for us to see how Utah agencies are doing in general and how we compare with similar agencies across the country.

The data collection will run through March 31, 2020.

On June 1, 2020, the National Pediatric Readiness Project will launch the 2020 Assessment. This assessment will be sent to nurse managers and medical directors of all emergency departments across the country to evaluate structural processes and policies in place to be ready for pediatric patients. Those who take the assessment will get immediate feedback with a gap report comparing your score with previous scores (if taken in the past) and comparing you to similar emergency departments across the country. These scores have been linked to outcomes such as mortality from critical illness, and participation in the project is very important for the Utah Department of Health to understand the state of pediatric preparedness in Utah.

Topic Related

Study Finds Risk of Injury Deaths Among Children Greatest for Infants

Intimate Partner Homicide of Adolescents

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Child Abuse Awareness for the EMS Provider

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