Table.
Domains, Themes and Representative Quotations
| Domain | Theme | Illustrative Quotation |
|---|---|---|
| Error Reporting | Reporting is uncommon | "What happens in the back [of the ambulance] stays in the back." |
| "You don’t want to rat on friends and you want to save your own ass as well." | ||
| "Some ambulance corps are so small that no one gets fired, so reporting errors doesn’t matter." | ||
| Blaming errors on others | "Hypoglycemic child, medical control ordered adult dose, EMS corrected medical control about pediatric dose." | |
| "Nurse did not listen to EMS provider and pulled out the [pacing] plug and placed it into theirs [which was not compatible] and the patient died." | ||
| "Missing drug box because the previous crew forgot. It was not noticed because there were no calls where the box was needed." | ||
| Children are Different | Provider Stress/Discomfort | "A lot of people get nervous with pediatrics" |
| "A pediatric patient is so much different than an adult" | ||
| "EMS often see doctors and nurses arguing about Peds patients in the hospital, so they are obviously not comfortable or there are different ways to treat, and those are the people who are suppose to specialize in these things." | ||
| "Providers are scared of kids, don’t like to see them. They often kick it up a notch – adrenaline rushes. Plus they don’t have any experience on peds calls – maybe like 1 out of 15 cases are kids?" | ||
| "Nobody likes to see a child that is seriously injured" | ||
| "It is absolutely more emotional situation no matter whether it is an arrest call or trouble breathing. Any kind of pediatric call compared to the same call for an adult." | ||
| "Pediatric patient at MVA, pressure by fire chief to work up child. Would have called it on scene. Patient not salvageable." | ||
| Errors of Omission | "A lot of times I find paramedics are almost too hesitant to do anything in pediatrics, which I think is a lack of comfort or a lack of experience." | |
| "Pediatric patient (3 y.o. male) call dispatched as general illness/patient would not stop crying. BLS dispatched, transported patient to hospital with little actual care. Patient was found to have bilateral femur and humerus fractures consistent with abuse, and was transported to another hospital for treatment. EMS providers did not do a complete physical exam or splint any of the limbs during transport." | ||
| "The ALS medic was scared of kids (this one was 15 month old) and did not want to put in IV." | ||
| "A 5-year old was hit by a car at 30 MPH, thrown 20 feet, landed on her head. They were on their way in and not going to start an IV because her dad didn’t want them too." | ||
| "Policy is parents ride along. This is not the best thing, it can interfere with treatment, parent often hysterical." | ||
| Lack of Pediatric Training | Limited training | "The paramedic [students] here, they come into our ED and the nurses don’t have them in there doing IV’s" |
| "My Pediatric ED time was, I wouldn’t say limited, but I didn’t get a chance to do a lot." | ||
| "It is hard to know what is normal in pediatric patients if you don’t have kids of your own, and if you don’t know what normal looks like it is hard to tell what is abnormal." | ||
| "People are hesitant to treat kids aggressively if they have to because, while we do get PALS and stuff like that, our pediatric airway, and especially our pediatric phlebotomy is very limited." | ||
| "We have adult phlebotomy rotations in the paramedic class where that’s what you do, you just go around and do IV’s and blood draws and stuff like that. But they don’t have one like that for pediatrics." |