John Magee: A lot of people ask, how is it different, taking care of a child on a call John Magee: as opposed to an adult- is a child just a little adult? And the answer there is no. John Magee: Their systems are different. Assessing them as a patient is different. John Magee: Vital signs are different. Treatments are different. Michael Lopez: Whereas you or I would start having our pulse rate go up, we’d start complaining about not feeling well Michael Lopez: same scenario with a kid, they’re fine, they’re boom-boom-boom Michael Lopez: and then all of a sudden they drop. And when they drop they drop precipitously. Rebekah Miner: How do you get history? How do you get what’s going on Rebekah Miner: out of an eighteen month old who can’t talk, who can’t describe symptoms? Rebekah Miner: You have to use parents, use diagnostic tools, use your exam, other things Rebekah Miner: that you can see on the outside to try and figure out what’s going on with them. T.J. Bishop: Ten percent of the total patient load that you see in a year, will probably T.J. Bishop: be between the ages of birth and, maybe, thirteen, fourteen years old. And then, T.J. Bishop: ten percent of those will be what we consider to be sick or critical kids. T.J. Bishop: So, for some people, you might be talking, zero to one critical kid a year. John Magee: We know those are, what we call, low frequency, high risk patients. We don’t John Magee: see them very often because kids generally aren’t as sick as adults are. Dave Nice: One of the problems with pediatrics is that Dave Nice: it’s really not something that we deal with a lot. Consequently Dave Nice: we have to continually train and practice on it. T.J. Bishop: We really should be capitalizing on practicing those skills that you do T.J. Bishop: very, very infrequently, so that when you do have to do them, T.J. Bishop: it makes a huge difference. John Magee: What do I think when I go on a call for a kid? Is that everybody’s John Magee: gonna be a little more hyped up, everybody’s gonna be a little more nervous. John Magee: I think, in general, everybody feels a little bit more for a kid. Dave Nice: I’ve been doing it for thirty years and still would not say I’m proficient. T.J. Bishop: Probably the biggest thing that’s really making a sweeping change T.J. Bishop: in healthcare is medication errors and, like, what we call a culture of safety. T.J. Bishop: Almost all the interventions that we do for pediatrics are weight based. T.J. Bishop: So it’s math in a very chaotic situation. We don’t randomly pull up T.J. Bishop: medication or calculate things in your head. We always look it up. Michael Lopez: There are tools out there that allow EMS providers to make more rapid decisions Michael Lopez: in terms of medications, dosages, and those kinds of things. John Magee: You’re using different meds and concentrations that you’re not really used to. John Magee: So everybody’s a little nervous. And you’ve got to deal with the parents John Magee: and so it’s- the dynamic’s very different. T.J. Bishop: Probably the other largest difference between treating pediatrics and adults is T.J. Bishop: the necessity to involve the family in the decision making process, Geoff Richardson: in what we call family centered care. T.J. Bishop: They’re primary sources of patient history and information and being able to T.J. Bishop: rely on that information when the patients aren’t able to speak on their own behalf. T.J. Bishop: And they obviously know their children better than anybody else on the planet. Rebekah Miner: To see these beautiful little people when they’re young and be able to Rebekah Miner: keep them healthy and give a good start to life, I mean it doesn’t- Rebekah Miner: I think that’s one of the highest callings you can have in medicine. Rebekah Miner: I don’t think it gets better than that. John Magee: So a few years back I had a pediatric person, a six year old little girl, John Magee: whose brother was helping her do tricks on her bicycle. John Magee: So she was standing on the seat, John Magee: holding onto the handlebars, riding. She fell off and fractured her trachea. John Magee: So her windpipe was essentially crushed. John Magee: I know for a fact that without our intervention that day John Magee: she wouldn’t have made it. John Magee: We made a huge difference that day, we were able to keep mom calm, John Magee: the whole call went pretty well, and she came back two weeks later John Magee: and visited us at the station. John Magee: Mom was happy. She was happy. So that’s what makes it all worthwhile. John Magee: You get a couple of those in twenty seven years and you’re okay.