Mental Health Aspects of Emergency Medical Services for Children Summary of a Consensus Conference
Corresponding Author
Nancy Kassam-Adams PhD
Children's Hospital of Philadelphia, Philadelphia, PA
Address for correspondence and reprints: Nancy Kassam-Adams, TraumaLink, 3535 10th Floor, Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104. E-mail:[email protected]Search for more papers by this authorJack Bergstein MD
West Virginia University Hospitals and Jon Michael Moore Trauma Center, Morgantown, WV.
Search for more papers by this authorCorresponding Author
Nancy Kassam-Adams PhD
Children's Hospital of Philadelphia, Philadelphia, PA
Address for correspondence and reprints: Nancy Kassam-Adams, TraumaLink, 3535 10th Floor, Children's Hospital of Philadelphia, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104. E-mail:[email protected]Search for more papers by this authorJack Bergstein MD
West Virginia University Hospitals and Jon Michael Moore Trauma Center, Morgantown, WV.
Search for more papers by this authorAbstract
Objective: To address the mental health needs of children involved in emergency medical services (EMS).
Methods: A multidisciplinary consensus conference convened to identify mental health needs of children and their families related to pediatric medical emergencies, to examine the impact of psychological aspects of emergencies on recovery and satisfaction with care, and to delineate research questions related to mental health aspects of medical emergencies involving children.
Results: The consensus group found that psychological and behavioral factors affect physical as well as emotional recovery after medical emergencies. Children's reactions are critically affected by age and developmental level, characteristics of the emergency medical event, and parent reactions. As frontline health care providers, EMS staff members are in a pivotal position to recognize and effectively manage the mental health needs of patients and their families.
Conclusions: Ecological changes in emergency departments, such as linkages to mental health follow-up services, training of EMS providers and mental health professionals, and focused research that provides an empirical basis for practice, are necessary components for improving current standards of health care.
References
- 1 Aaron, J., Zaglul, H., Emery, R. E. (1999). Posttraumatic stress in children following acute physical injury. Journal of Pediatric Psychology, 24, 335–343.
- 2 American Academy of Pediatrics. (1996). Adolescent assault victims needs: A review of issues and a model protocol. American Academy of Pediatrics Task Force on Adolescent Assault Victims Needs. Pediatrics, 98, 991–1001.
- 3 Athey, J., O'Malley, P., Henderson, D., Ball, J. (1997). Emergency medical services for children: Beyond lights and sirens. Professional Psychology: Research and Practice, 28, 464–470.
- 4 Basson, M., Guinn, J., McElligott, J., Vitale, R., Brown, W., Fielding, L. (1991). Behavioral disturbances in children after trauma. Journal of Trauma, 31, 1363–1368.
- 5 Bender, B., Milgrom, H., Rand, C., Ackerson, L. (1998). Psychological factors associated with medication nonadherence in asthmatic children. Journal of Asthma, 35, 347–353.
- 6 Boney-McCoy, S., Finkelhor, D. (1996). Is youth victimization related to trauma symptoms and depression after controlling for prior symptoms and family relationships? A longitudinal, prospective study. Journal of Consulting and Clinical Psychology, 64, 1406–1416.
- 7 Brown, K., Sheehan, E., Sawyer, M., Raftos, J. (1995). Parent satisfaction with services in an emergency department located at a paediatric teaching hospital. Journal of Paediatrics and Child Health, 31, 435–439.
- 8 Children's Hospital Boston. (1996). Quality improvement plan, Unpublished manuscript.
- 9 Cox, R., Davis, L. (1993). Social constructivist approaches for brief, episodic, problem-focused family encounters. Nurse Practitioner, 18(8), 45–49.
- 10 DeVries, A. P. J., Kassam-Adams, N., Cnaan, A., Sherman Slate, E., Gallagher, P., Winston, F. K. (1999). Looking beyond the physical injury: Post-traumatic stress disorder in children and parents after pediatric traffic injury. Pediatrics, 104, 1293–1299.
- 11 Di Gallo, A., Barton, J., Parry-Jones, W. L. (1997). Road traffic accidents: Early psychological consequences in children and adolescents. British Journal of Psychiatry, 170, 358–362.
- 12 Durham, T., McCammon, S., Alison, E. J. (1985). The psychological impact of disaster on rescue personnel. Annals of Emergency Medicine, 14, 664–668.
- 13 Figley C. (1995). Compassion fatigue: Toward a new understanding of the costs of caring. In B. Stamm (Ed.), Secondary traumatic stress ( 3–28). Lutherville , MD : Sidran Press.
- 14 Grover, G., Berkowitz, C., Lewis, R. (1994). Parental recall after a visit to the emergency department. Clinical Pediatrics, 33(4), 194–201.
- 15 Haines, C., Perger, C., Nagy, S. (1995). A comparison of the stressors experienced by parents of intubated and non-intubated children. Journal of Advanced Nursing, 21, 350–355.
- 16 Hanson, R., Clifton-Smith, B., Fasher, B. (1994). Patient dissatisfaction in a paediatric accident and emergency department. Journal of Quality in Clinical Practice, 14(3), 137–143.
- 17 Horowitz L., Schreiber M., Hare I., Walker V., Talley A.. (1999). Psychological factors in emergency medical services for children: Abstracts of the psychological, behavioral, and medical literature ( 1st ed.). Washington , DC : American Psychological Association.
- 18 Horowitz, L., Wang, P., Koocher, G., Burr, B., Fallon Smith, M., Klavon, S., Cleary, P. (2001). Detecting suicide risk in a pediatric emergency room: Development of a brief screening tool. Pediatrics, 107, 1133–1137.
- 19 Hurn, J., Dupper, D., Edwards, K., Waldman, C. (1991). Treatment intervention in child abuse emergency shelters: The crucial needs. Child and Youth Care Forum, 20, 133–141.
- 20 Institute of Medicine. (1993). Emergency medical services for children, Washington , DC : National Academy Press.
- 21 Institute of Medicine. (2001). Health and behavior: The interplay of biological, behavioral, and societal influences—Executive summary, Washington , DC : National Academy Press.
- 22 Keller, K., Koenig, W. (1989). Management of stress and prevention of burnout in emergency physicians. Annals of Emergency Medicine, 18, 79–84.
- 23
Koocher G. (1996). Pediatric oncology: Medical crisis intervention. In G. Koocher, Health psychology through the life span: Practice and research opportunities (pp. 213–225).
Washington
,
DC
: American Psychological Association.
10.1037/10220-014 Google Scholar
- 24 Kruger, S. (1992). Parents in crisis: Helping them cope with a seriously ill child. Journal of Pediatric Nursing, 7, 133–140.
- 25 Lapin, C., Clouthier, M. (1995). Outpatient management of acute exacerbations of asthma in children. Journal of Asthma, 32(1), 5–20.
- 26
Lewis, M.,
Holditch-Davis, D.,
Brussen, S. (1997). Parents as passengers during pediatric transport.
Air Medical Journal, 16(2), 42–43.
10.1016/S1067-991X(97)90086-9 Google Scholar
- 27 Lieu, T., Quesenberry, C., Capra, A., Sorel, M., Martin, K., Mendoza, G. (1997). Outpatient management practices associated with reduced risk of pediatric asthma hospitalization and emergency department visits. Pediatrics, 100(3), 334–341.
- 28 Madden, C., Garrett, J., Cole, T., Runge, J., Porter, C. (1997). The urban epidemiology of recurrent injury: Beyond age, race, and gender stereotypes. Academic Emergency Medicine, 4, 761–763.
- 29 McFarland, P., Stanton, A. (1991). Preparation of children for emergency medical care: A primary prevention approach. Journal of Pediatric Psychology, 16, 489–504.
- 30 Michaels, A. J., Michaels, C. E., Moon, C. H., Smith, J. S., Zimmerman, M. A., Tahari, P. A., Peterson, C. (1999). Posttraumatic stress disorder after injury: Impact on general health outcome and early risk assessment. Journal of Trauma, 47, 460–466.
- 31 Michaels, A. J., Michaels, C. E., Moon, C. H., Zimmerman, M. A., Peterson, C., Rodriguez, J. L. (1998). Psychosocial factors limit outcomes after trauma. Journal of Trauma, 44, 644–648.
- 32 Mirza, A., Bhadrinath, B., Goodyer, I., Gilmour, C. (1998). Post-traumatic stress disorder in children and adolescents following road traffic accidents. British Journal of Psychiatry, 172, 443–447.
- 33 Osberg, J. S., Kahn, P., Rowe, K., Brooke, M. M. (1996). Pediatric trauma: Impact on work and family finances. Pediatrics, 98, 890–897.
- 34 Press, B., Kahn, S. (1997). Management of the suicidal child or adolescent in the emergency department. Current Opinion in Pediatrics, 9, 237–241.
- 35 Raper, H. (1996). A cognitive approach to patient satisfaction with emergency department nursing care. Journal of Nursing Care Quality, 10(4), 48–58.
- 36 Richmond, T. S., Kauder, D., Schwab, C. W. (1998). A prospective study of predictors of disability at 3 months after non-central nervous system trauma. Journal of Trauma, 44, 635–643.
- 37 Roberts, H. (1992). Professionals' and parents' perception of A&E use in a children's hospital. Sociological Review, 40, 109–131.
- 38 Sacchetti, A., Lichtenstein, R., Carraccio, C., Harris, R. (1996). Family member presence during pediatric emergency department procedures. Pediatric Emergency Care, 12, 268–271.
- 39 Schwarz, D., Grisso, J., Miles, C., Holmes, J., Wishner, A., Sutton, R. (1994). A longitudinal study of injury morbidity in an African-American population. Journal of the American Medical Association, 271, 755–760.
- 40 Seidel, J. (1991). Emergency medical services and the adolescent patient. Journal of Adolescent Health, 12, 95–100.
- 41 Seideman, R., Watson, M., Corff, K., Odle, P., Haase, J., Bowerman, J. (1997). Parent stress and coping in NICU and PICU. Journal of Pediatric Nursing, 12, 169–177.
- 42 Spirito, A., Lewander, W., Levy, S., Kurkjian, J., Fritz, G. (1994). Emergency department assessment of adolescent suicide attempters: Factors related to short-term follow-up outcome. Pediatric Emergency Care, 10, 6–12.
- 43 Stallard, P., Velleman, R., Baldwin, S. (1998). Prospective study of post-traumatic stress disorder in children involved in road traffic accidents. British Medical Journal, 317, 1619–1623.
- 44 Thompson, D., Yarnold, P., Williams, D., Adams, S. (1996). Effects of actual waiting time, perceived waiting time, information delivery and expressive quality on patient satisfaction in the emergency department. Annals of Emergency Medicine, 28, 657–665.
- 45 U.S. Consumer Product Safety Commission. (1997). Hospital-Based Pediatric Emergency Resource Survey, Bethesda , MD : Division of Hazard and Injury Data Systems.
- 46 U.S. Surgeon General. (1999). Mental health: A report of the Surgeon General, Washington , DC : U.S. Government Printing Office.
- 47 U.S. Surgeon General. (2000). Report of the Surgeon General's Conference on Children's Mental Health: A national action agenda, Washington , DC :U.S. Government Printing Office.
- 48 Velin, P., Puig, C., Dupont, D. (1992). Parents' view on the care of their children at a pediatric emergency department in 1991. Pediatrics, 47, 631–634.
- 49 Wasilewski, C., Clark, N. M., Evans, D., Levison, M., Levin, B., Mellins, R. B. (1996). Factors associated with emergency department visits by children with asthma: Implications for health education. American Journal of Public Health, 86, 1410–1415.
- 50 Weil, C., Wade, S., Bauman, L., Lynn, H., Mitchell, H., Lavigne, J. (1999). The relationship between psychosocial factors and asthma morbidity in inner-city children with asthma. Pediatrics, 104, 1274–1280.
- 51 Wesson, D., Scorpio, R., Spence, L., Kenney, B., Chipman, M., Netley, C., Hu, X. (1992). The physical, psychological, and socioeconomic costs of pediatric trauma. Journal of Trauma, 33, 252–257.
- 52 Wilman, D. (1997). Neonatal transport: The effect on parents. Journal of Neonatal Nursing, 3(5), 18–22.
- 53 Winje, D. (1996). Long-term outcome of trauma in adults: The psychological impact of a fatal bus accident. Journal of Consulting and Clinical Psychology, 64, 1037–1043.
- 54 Woodward, G., Fleegler, E. (2000). Should parents accompany pediatric interfacility ground ambulance transports? The parent's perspective. Pediatric Emergency Care, 16, 383–390.
- 55 Woodward, G., Fleegler, E. (2001). Should parents accompany pediatric interfacility ground ambulance transports? Results of a national survey of pediatric transport team managers. Pediatric Emergency Care, 17, 22–27.
- 56 Written asthma plans cut hospitalization in half. (1997). Healthcare Benchmarks, 4, 180–181.