Table 2

Emergency medical services responders' perspectives on the contributors to stress, anxiety and safety events in the out-of-hospital emergency care of children

Sympathy/identification with patient
  • “Sympathy for the patient can cloud judgement”

  • “For those of us that are parents, it is stressful to think about the possibility of being one of our own children, making one have a heightened level of stress”

  • “If we are parents, we also may have a tremendous sense of identification fear/familiarity that can add to the anxiety level”

  • “Because of the emotional components: people see their children as being the patient/family on scene causing stress we don't normally have”

  • “The ‘what if that was my kid’ questions causes distraction during care”

  • “Fear of similar injuries in own children is probably the largest factor. The apparent fragility of children and the potential harm that traumatic injuries can impose might also be a large factor”

Innocence of children/perceived value of children
  • “Children are different than adults in the simple fact that they are children who are innocent and still have their whole lives ahead of them”

  • “Innocent life being damaged through no fault of their own, lack of experience with pediatrics/fear of making mistakes, cultural: children are more ‘valuable’ than ‘old’ people in some people's eyes”

  • “Most people have a deeper emotional response to injured children”

  • “Everyone can handle adult trauma because as we get older, we are expected to get hurt and sick, but not our children”

  • “Fear or ruining someone's WHOLE life, before they have had a chance to live it”

Experience/exposure
  • “Due to rarity of peds trauma and the fragility of children workers are often shocked with this”

  • “Lack of experience or confidence”

  • “Small percentage of our patients”

  • “Anxiety of not feeling proficient or experienced enough”

  • “Infrequent exposure to pediatric clinical cases making the clinician feel insecure”

Family emotional response
  • “Bystanders and parents watching make doing your job difficult. EMS providers are already stressed and then you add a screaming mother, father or sibling”

  • “Family on scene causing stress we don't normally have”

  • “Family presence can also increase the stress level as expectations become very high when dealing with people's children”

Child's emotional response
  • “Crying! It's so difficult to calm an injured child, or ignore the distraction of an upset child”

  • “Children's fears can exacerbate their perception of the severity of injury and this excites the parents”

  • “Kids cry more in general and it may be due to fear as well as pain”

Rapid decompensation
  • “Need to act quickly paralyses decision choices”

  • “Underestimation of non-visible blood loss since kids compensate so well (vital signs not as sensitive as in adults)”

  • “Children can have minimal symptoms from a trauma and then crash quickly causing a constant stress during treatment and transport”