Does your hospital have an EMS or ambulance intake room/area? Consider printing the PEARL each week and posting for EMS to review while charting or after offloading patients.
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Encourage others to sign up for the PEDReady weekly newsbrief, the PE
2
ARL, by sharing this link:
http://bit.ly/flpearl
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Coping with Pediatric Death
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The Florida EMSC Program, FL PedReady and EMLRC/FCEP extend our heartfelt sympathy to those that have recently experienced a pediatric death or had to break the news to a family that their child has died. The siblings of the child that died must also be remembered.
This issue of the PE
2
ARL is dedicated to coping with death and grieving. Experiencing the death of a child in the field or ED is rated as one of the top most stressful situations emergency care providers will ever face. Sometimes the impact hits months or years after the event. Be watchful.
Death rates for children have dropped significantly over the years due to advances in immunizations, injury prevention, safe sleep, etc. Everyone expects children to live until adulthood, and child death is an increasingly unexpected part of life.
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The death of a child can be an extremely difficult event to cope with for families and providers. There are
two scenarios:
dealing with acute, unexpected death, such as a car accident or house fire, and dealing with a slow chronic death, such as spinal muscular atrophy or cancer.
For providers, there are many factors that come into play when managing pediatric deaths:
- Dealing with painful symptoms in pediatric patients
- Family care and communication
- Dealing with cases in which the family may have caused the death intentionally or made bad decisions
- Deciding when to halt or not to initiate resuscitative efforts
- Carrying on with work after dealing with pediatric death
Many providers do not receive formal training in dealing with the emotional aftermath of the death of a pediatric patient. This can lead to feeling guilty or inadequate after a failed resuscitation of a child. It can also be difficult for providers to refocus on other patients for the remainder of their shift. It is vital to have procedures in place to help work through the death process, especially since pediatric deaths are uncommon.
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Dealing with Pediatric Death in the EMS Setting
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The best resources for EMS are provided by the
Compassionate Options for Pediatric EMS (COPE) program
, which was funded by an EMSC Targeted Issues grant. The site includes resources for families and EMS providers.
Click here
for more information.
The site includes five great training videos for EMS:
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Dealing with Death in the ED Setting:
Most of the time, EMS does not pronounce the death of child in the field unless there are signs of obvious lividity or catastrophic injuries. The majority of cases pronounced in the ED go on to become medical examiner cases, which opens up a can of legal and process issues. Always preserve the child’s clothing and belongings and document detailed notes.
There is a balance between preserving evidence and advocating for the grieving parents. Always ask if law enforcement was at the scene? Should DCF be notified? In chronically ill patients, was hospice involved? EDs should have policies in place regarding the death of a child and the availability of bereavement resource materials for parents or caregivers. Most hospice agencies offer bereavement groups or materials.
The
2014 AAP technical report
on the Death of a Child in the Emergency Department
includes the following table regarding preserving evidence and family rights:
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Death Communication and Delivering Bad News
Speaking with the family of a pediatric patient who is being resuscitated or has died can be very difficult. Sometimes we just don’t know what to say. Although there is no single approach that works for every situation, the following
GRIEV_ING mnemonic
can be very useful to have on-hand when preparing to approach the family of a dying or deceased pediatric patient.
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*adapted from Hobgood, C. The educational intervention "GRIEV_ING" improves the death notification skills of residents. Acad Emerg Med. 2005 Apr;12(4):296-301
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Watch out for your team and remember:
We are the “Watchers in the Night.” Stay safe out there PEDReady Champions and Angels!
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Painting by Thomas Blackshear
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Upcoming Pediatric Emergency Events
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Free Workshop: Florida Resuscitation Academy
Multiple dates & locations
The Florida Resuscitation Academy teaches high-performance CPR to EMS personnel, hospitalists and local health care providers through a free, one-day training program. This course will transform the way you think about and manages cardiac arrests.
Upcoming sessions in Florida:
- Monroe County: August 16
- Walton County: August 21
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Free Webinar:
What Every Pediatrician Needs to Know About Child Passenger Safety
August 21, 2019 | 1:00-2:00 pm
Hosted by: Pediatric Care Online
Speaker: Benjamin Hoffman, MD, FAAP, CPST-I
Topics include basic principles of child passenger safety (CPS) science; five ways car safety seats help prevent injury to children; best practice recommendations for appropriate child passenger restraint; and identification of CPS community resources, including children with special health care needs.
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Caring for Critical Kids Conference
August 22-23, 2019 | Gainesville, FL
Hosted by: UF Health ShandsCair
Join UF Health ShandsCair to learn more about caring for children with critical medical and trauma needs. Thursday is lecture day; Friday is skills lab day.
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Children's Disaster Services Workshop
October 11-12, 2019 | Tampa, FL
Hosted by: Child Life Disaster Relief
This is a specialized training for Certified Child Life Professionals only. Certified child life specialists are invited to register. Ten PDU’s are available.
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Pediatric Care After Resuscitation (PCAR) Course
Dec 2-3, 2019 | Jacksonville, FL
The mission of TCAR (Trauma Care After Resuscitation) Education Programs is to expand the knowledge base and clinical reasoning skills of nurses who work with injured patients anywhere along the trauma continuum of care, particularly in the post-resuscitation phase.
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Thanks for being a Pediatric Champion!
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The Florida PEDReady Program
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