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Emergency medical services responders’ perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study
  1. Jeanne-Marie Guise1,2,3,4,
  2. Matthew Hansen2,
  3. Kerth O'Brien5,
  4. Caitlin Dickinson6,
  5. Garth Meckler1,7,
  6. Phil Engle8,
  7. William Lambert4,
  8. Jonathan Jui2
  1. 1Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
  2. 2Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon, USA
  3. 3Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
  4. 4Oregon Health and Science University-Portland State University School of Public Health and Preventive Medicine, Portland, Oregon, USA
  5. 5Department of Psychology, Portland State University, Portland, Oregon, USA
  6. 6Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland, Oregon, USA
  7. 7Department of Pediatrics and Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  8. 8Oregon Health Authority, Public Health Division, Portland, Oregon, USA
  1. Correspondence to Dr Jeanne-Marie Guise; guisej{at}ohsu.edu

Abstract

Objective Prehospital emergency medical services (EMS) providers report anxiety as the second most common contributor to paediatric patient safety events. The objective of this study was to understand how EMS providers perceive the effect of stress and anxiety on paediatric out-of-hospital patient safety.

Setting This was a nationwide study of EMS providers from 44 of 50 (88%) US states.

Participants A total of 753 eligible EMS professionals, including emergency medical technicians, emergency department physicians and nurses (general and paediatric), and respiratory therapists who participate in out-of-hospital transports.

Primary and secondary outcome measures Outcomes included responses to: (1) clinical situations where heightened stress or anxiety was likely to contribute to safety events, (2) aspects of these clinical situations that cause stress or anxiety and (3) how stress or anxiety may lead to paediatric safety events.

Results EMS providers reported that the clinical situations where stress and anxiety were more likely to contribute to paediatric patient safety events were trauma, respiratory distress and cardiac issues. Key themes were: (1) provider sympathy or identification with children, (2) difficulty seeing an innocent child hurt and the inherent value of children and (3) insufficient exposure to paediatric emergencies.

Conclusions Caring for paediatric emergencies creates unique stresses on providers that may affect patient safety. Many of the factors reported to cause provider stress and anxiety are inherent attributes of children and therefore not modifiable. Tools that support care during stressful conditions such as cognitive aids may help to mitigate anxiety in the prehospital care of children. Further research is needed to identify opportunities for and attributes of interventions.

  • ACCIDENT & EMERGENCY MEDICINE
  • PAEDIATRICS
  • Psychological Stress
  • Prehospital Emergency Care
  • Patient Safety
  • Emergency Medical Services

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors J-MG contributed to the conception and design of the study, development of survey tools, recruitment of participants and survey distribution, acquisition of the data, qualitative analysis and interpretation of the data, drafting and revising the article for important content and final approval of the submitted manuscript. MH contributed to interpretation and analysis of the data for the study, drafting and revising the article for important content, and final approval of the submitted manuscript. KOB contributed to the design of the study, development and validation of survey instruments, qualitative analysis of data and critical review of the manuscript. CD contributed to the development of data collection tools, collection, validation and qualitative analysis of data and provided critical review of the manuscript. GM, WL, PE and JJ contributed to the design of the study, development of survey instruments, recruitment of participants, validation, and analysis of data, and critical review of the manuscript.

  • Funding This work was supported by the National Institute of Child Health and Human Development grant ‘Epidemiology of Preventable Safety Events in Pre-hospital EMS of Children’. R01HD062478-04.

  • Disclaimer The content is solely the responsibility of the authors and does not represent the official views of the National Institute of Child Health and Human Development, or the National Institutes of Health.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Oregon Health and Science University Institutional Review Board (IRB# 6942).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Relevant anonymised data are available on reasonable request from the corresponding author.

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