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Drs. Watkins, Glomb and Fallat share lessons learned from EMSC Day webinar

By Michelle Murphy, MBA, EMT-P
On EMS for Children (EMSC) Day, May 18,2022, the EMSC Innovation and Improvement Center (EIIC) hosted a webinar for prehospital care providers on caring for the pediatric behavioral and mental health patients, and highlighted resources available for EMS professionals who experience the on-scene death of a child.
The webinar, “COPE-ing with the Challenges of Pediatric Behavioral and Mental Health Emergencies,” presenters included Kenshata Watkins, MD; and Nicolaus Glomb, MD; from UCSF Benioff Children’s Hospital, in Oakland, California; and Mary Fallat, MD; from the University of Louisville and Norton Children’s Hospital, in Louisville, Kentucky.
New research performed by Dr. Glomb and colleagues in Alameda County, California, has shown that through proper assessment in the field, EMS providers can determine which children with a behavioral or mental health emergency can safely be diverted to a psychiatric care facility and away from an emergency department.
The presenters provided valuable tips on treating children and families with compassionate care. The basic tenets of equity, diversity and inclusion ideals were reviewed in the context of caring for a youth in a mental health crisis. The presenters also included the care of a family that has suffered the devastating loss of a loved one, with clear and concrete actions that EMS professionals can take to provide supportive and sensitive care to a family in mourning, as well as how to take care of themselves after the event.
Following are top quotes from the presenters on mental and behavioral for the pediatric patient and EMS professional:
Following are 4 takeaways on mental and behavioral care for children in the prehospital setting.
1. EMS professionals play a powerful and critical role in the care of the pediatric behavioral health patient
As the first point of contact, EMS professionals play an important role in setting the tone of the interaction between a patient and the rest of the emergency medical continuum. Understanding equity, diversity and inclusion (EDI) in a prehospital context is vital in building patient trust.
To support EDI concepts, prehospital practitioners can practice the following ABCDE acronym:
2. Implementation of pediatric behavioral health emergency field-screening protocols by EMS can reduce hospital involuntary holds and allow for timely mental health evaluations
A retrospective review on pediatric mental and behavioral health encounters in Alameda County, California, demonstrated that implementation of EMS field-screening protocols to safely identify and medically clear pediatric patients with low-risk behavioral health emergencies (BHE) can ensure appropriate transportation directly to a pediatric psychiatric emergency services facility and minimize hospital involuntary hold encounters.
Over the course of five years, over 7,500 children less than 18 years of age were screened, of which approximately 40% were taken to a pediatric psychiatric emergency facility with <1% requiring transfer to a hospital for care within 24 hours.
3. A new resource is available for prehospital providers when responding to one of the most challenging patient encounters: the on-scene death of a pediatric patient
With Health Resources and Services Administration EMSC Program Targeted Issue grant funding, Dr. Mary Fallat developed the Compassionate Options for Pediatric EMS or “COPE” program. This program developed a series of educational videos and now has a new pocket card available to prehospital practitioners to serve as a quick reference guide when responding to a call involving the death of a child. The pocket card walks providers through the steps of communicating with family and caregivers and provides healthy guidance for the provider to cope following these difficult encounters with a link to a more comprehensive website.
4. Stress and provider burden is significant for EMS providers, but there is help and resources available
Suicide among EMS providers is five times greater than that of the average population. The Code Green Campaign calls a Code Aler’ on the mental health of prehospital providers and is breaking the silence about mental illness in EMS and public safety by sharing the stories of those who have been there.
Watch the full recording of the EMS for Children Day webinar “COPE-ing with the Challenges of Pediatric Behavioral and Mental Health Emergencies” here.
Learn more about caring for pediatric patients’ mental health needs and death notification with these resources:
Michelle Murphy, MBA, EMT-P, is a project manager for the EMS for Children Innovation and Improvement Center (EIIC) at the University of Texas. Her prior work experience is in emergency medical services at Stony Brook Medicine as a hospital-based paramedic where she coordinated patient transfers, transported high acuity patients, and responded to 911 calls. Michelle obtained a Master of Business Administration in Health Care Management from St. Joseph’s College.
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Recognizing the paucity of adequate pediatric emergency care nationwide, the 1984 Congress authorized the federal Emergency Medical Services for Children (EMSC) Program. Housed under the U.S. Department of Health and Human Services (HHS) within the Health Resources and Services Administration (HRSA) and Maternal and Child Health Bureau (MCHB), the EMSC Program has strived for over 30 years to reduce pediatric mortality and morbidity across the nation.
The EMSC EIIC Pre-Hospital Care domain focuses on pediatric care from education and prevention to incident recognition, treatment at an emergency scene and transport to an emergency department. The major emphasis of this domain is the establishment and support of Prehospital Pediatric Emergency Care Coordinators (PECC).
We use improvement science as the basis for our collaborative efforts to improve outcomes for children in emergency situations. Our collaboratives are networks designed for shared learning, driven by an evidence base and known gaps to facilitate rapid translation of research into clinical practice. We support these collaboratives through varied learning systems, coaching, project management, information technology infrastructure, data management, and analytics.
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