Paediatric Training

[yulbrynner]

I was just wondering what everyone’s thoughts were on CFRs responding to paediatric patients. At the last co-ordinators meeting I attended we were told we would no longer be asked to attend calls to patients under 8yrs old and if by some mistake a call did slip through the net we were to refuse it.

Or group in Suffolk is only 2 yrs old and none of our members have received CFR training (we do have some members including myself that are members of St John) to treat paediatrics although some of our surrounding groups have.

I understand that to attend a seriously ill child, say for example one struggling to breath or unconscious is more distressing than an adult. After all its far less common to see children in this state & you would most likely also have some extremely distresses parents looking on too.

There is also however, the case of finding out a child in your community, maybe one that you know, had been seriously ill or god forbid died and the feeling that maybe you could have been able to do something about it.

I’m guessing that some CFRs wouldn’t feel comfortable attending paediatric calls and certainly don’t think they should be made to feel inferior because of it but going from the feeling at the Co-ords meeting there are obviously many that think we should attend.

So what are your thought?

Does your group attend Paediatric calls?
If so how do you feel about them and if not would you like to be able to attend?
Should there be a blanket covering for all groups when it comes to this do you think it should be down to individual members or groups if they want to be paediatric trained?

Any paramedics, technicians, doctors, nurses etc out there I’d really like to hear your thoughts on this too. Do you think CFRs should attend paeds or do you think it’s an area best left to the professionals?

I hasten to add I am not rallying for or against this, its just a topic that raised a lot of interest at the meeting I attended and I’m wondering what thoughts are on a wider scale.

[medatrain999]

Hi yulbrynner!!

My personal thoughts are that CFR's shoud not attend paeds at all. For medical purpose, that is under 12's. My reasons for this is that children have a fantastic habit of compensating, or looking well(ish), until the very last minute and then they go very BIG sick.

This means that each CFR should be competent in spotting the acutely ill child... this is something that some HCP's struggle to do, so should CFR's attend such patients?

I agree with you. If a child in my street for instance, falls seriously ill, I would want to be there to help. However, just how much can you do for the child? I'm not saying you wouldn't be able to do it, I'm saying it is a risk. It would take just one child to die for things to go horribly wrong.

I think we need to make CFR's better at what they currently do instead of (in most Trust's) increase the criteria for calls.

[marjar]

Just to add to the debate rather than to come down on one side or the other...what do you think about the information already in the public domain by way of the latest revision (9th edition) of the First aid manual and its emphasis on things like psychosocial support at the time of an incident? And the rather surprising in my view of the advice to use an adult AED if nothing else is available - where did that come from!

If nothing else we could support the family and hopefully establish a link between the incident and Control without quite as much emotional involvement.

[bungle]

May 15, 2009 9:35:58 GMT medatrain999 said:

Hi yulbrynner!!

My personal thoughts are that CFR's shoud not attend paeds at all. For medical purpose, that is under 12's. My reasons for this is that children have a fantastic habit of compensating, or looking well(ish), until the very last minute and then they go very BIG sick.

This means that each CFR should be competent in spotting the acutely ill child... this is something that some HCP's struggle to do, so should CFR's attend such patients?

I agree with you. If a child in my street for instance, falls seriously ill, I would want to be there to help. However, just how much can you do for the child? I'm not saying you wouldn't be able to do it, I'm saying it is a risk. It would take just one child to die for things to go horribly wrong.

I think we need to make CFR's better at what they currently do instead of (in most Trust's) increase the criteria for calls.

Up these parts we are sent to peads, including newborns, i would be fool if i didnt say that they scare me sensless, but, we can provide bls, o2 ect.. aed in most cases will be pointless as it is unusual for a child to go into a vf arresst and is more likelly to be asystolic . As cfr's we are a safety net here, helping with the abc's and more importantly showing mum and dad that peeps are on the way. Most likely most crews (techs,para's) will scoop and run, as only advanced intervention is really going to help the poor mite.

[yulbrynner]

Cheers for your thoughts Medatrain, Marjar & Bungle, all very valid points. This is why I wanted to see people’s thoughts in the first place. This topic really caused quite a stir at my last Co-Ords meeting and was something people really felt quite emotional about. I suppose because many of us have kids, our most valued of possessions, we would like to think that should they be ill someone would be there to help. I think the questions are could we help, how could we help and what are the dangers of us making things worse.

As Medatrain says, kids can hide how bad they really are, they are quite resilient after all and we don't want to be giving the wrong treatment or, cold as it may sound, appearing negligent in front of distressed parents for overlooking something that takes a sudden turn for the worse.

However as Marjar and Bungle have said, if nothing else there is the supportive role to those distressed parents and some reassurance that they are not alone in their kids hour of need, even if we are limited in what help, if any, we would be able to give.

There is also the effect this could have on the responder in question, if they were on a call that was going badly because the required treatment was above their skill level. Could the feeling of helplessness have an adverse effect on them?

I think another issue was that a large amount of “Joe Public” in general, despite it being publicised to the contrary, still assumes that we go to anything. This could be particularly hard in smaller communities when one of us is stopped in the street by distressed or grieving parents because nobody went out to "little Johnny" when he couldn't breath. We are after all on the front line in the community and would be the first line of "Cannon Fodder" for a local with a grievance although that alone is obviously not enough of a reason to change a decision like this one.

One point I found particularly hard to swallow was being told that the CAD couldn’t filter ages on automatic calls so in theory we could still get a text through for a paediatric call but have been told we cannot attend. To think that a child in my community, possibly at an address I knew, was in trouble and I couldn't go would make me feel terrible. If I'm not allowed to go I'd rather not know than get the text and spend the rest of the day stewing about it.

There really are so many points to take into consideration with this and already two more have been raised on here that I hadn't heard anyone else mention. I hasten to add again I'm not rallying for or against this and the last thing I would want to do as a CFR is bowl into a call and make matters worse or have ideas above my station. Its just that it obviously provoked some very strong reactions and I wanted to get as many thoughts as possible before it is discussed at our groups next training evening.

[bungle]

May 15, 2009 11:51:53 GMT yulbrynner said:

Cheers for your thoughts Medatrain, Marjar & Bungle, all very valid points. This is why I wanted to see people’s thoughts in the first place. This topic really caused quite a stir at my last Co-Ords meeting and was something people really felt quite emotional about. I suppose because many of us have kids, our most valued of possessions, we would like to think that should they be ill someone would be there to help. I think the questions are could we help, how could we help and what are the dangers of us making things worse.

As Medatrain says, kids can hide how bad they really are, they are quite resilient after all and we don't want to be giving the wrong treatment or, cold as it may sound, appearing negligent in front of distressed parents for overlooking something that takes a sudden turn for the worse.

However as Marjar and Bungle have said, if nothing else there is the supportive role to those distressed parents and some reassurance that they are not alone in their kids hour of need, even if we are limited in what help, if any, we would be able to give.

There is also the effect this could have on the responder in question, if they were on a call that was going badly because the required treatment was above their skill level. Could the feeling of helplessness have an adverse effect on them?

I think another issue was that a large amount of “Joe Public” in general, despite it being publicised to the contrary, still assumes that we go to anything. This could be particularly hard in smaller communities when one of us is stopped in the street by distressed or grieving parents because nobody went out to "little Johnny" when he couldn't breath. We are after all on the front line in the community and would be the first line of "Cannon Fodder" for a local with a grievance although that alone is obviously not enough of a reason to change a decision like this one.

One point I found particularly hard to swallow was being told that the CAD couldn’t filter ages on automatic calls so in theory we could still get a text through for a paediatric call but have been told we cannot attend. To think that a child in my community, possibly at an address I knew, was in trouble and I couldn't go would make me feel terrible. If I'm not allowed to go I'd rather not know than get the text and spend the rest of the day stewing about it.

There really are so many points to take into consideration with this and already two more have been raised on here that I hadn't heard anyone else mention. I hasten to add again I'm not rallying for or against this and the last thing I would want to do as a CFR is bowl into a call and make matters worse or have ideas above my station. Its just that it obviously provoked some very strong reactions and I wanted to get as many thoughts as possible before it is discussed at our groups next training evening.

ive known of several cfr incidents where resus has been given by them in our trust, thankfully not our scheme. Without question, the support has been awsome. A phonecall straight after incedent from the trus para cfr co-ord, which is backed up later with debreif in person.

[st1100]

Have always attended Paediatric calls since I started, youngest so far has been 7 days old, my CFR training covered infants.

Paul

[Ron23454]

Scary as it may be (and it should be), I think as responders we should all strive to be the best we can and meet the skills criterea, if people cannot they can refuse the job, or perhaps those that are not up to it and cannot retrain could fulfil non responding roles like fund raising etc.
In the main a lot of Responders can at least help for those first few minutes. True, crews tend to scoop and shoot but parents like to have someone/anyone present as, with a child, panic sets in, I have been called to neighbours with sick children and just to be there is worth the world to them. All I did was calm them down and cool down the fitting child with a wet towel, history of snotty with high temperature and just started to fit, outcome was stopped fitting and mother called the GP (in the days when GP's actually visited and didn't refer to 999) and all was happy. Good training is needed but it should be within each CFR's scope to work to required protocols.