References
Factors that influence child conveyance decisions made by prehospital clinicians
Abstract
Introduction:
The decision to convey children to emergency departments is complex. This study aimed to identify barriers and enablers to making appropriate decisions, along with areas of disparity in this decision-making process by ambulance clinicians.
Methods:
A rapid evidence review was conducted. MEDLINE, CINAHL and PubMed were searched from 2012 to July 2023. Critical appraisal and thematic synthesis were performed.
Results:
Three studies were identified, which highlights the lack of research in this area. Five themes were identified: provision of care; equipment and protocols; exposure, experience and confidence; emotional and social circumstances; and education or skill set.
Findings:
Enhanced paediatric education is required before and after registration to ensure appropriate conveyance and address clinicians' lack of exposure, experience and confidence. Protocols and guidelines should be drawn up to support decision-making for lower-acuity child patients. Specialist paediatric roles are required in ambulance services to support clinicians and provide advanced patient-centred care.
Conclusions:
The findings of this review provide a basis for discussion and clinical practice improvement. Research to determine the clinical and cost effectiveness of implementing prehospital specialist paediatric roles is required.
As the first responders to cases of child trauma or acute illness, prehospital clinicians must have an appropriate knowledge base and the skills and confidence to provide effective and appropriate management (Fowler et al, 2017). Previous studies have noted that ‘management of the prehospital paediatric patient is inherently stressful’ (Fowler et al, 2017), with pre-arrival preparation for such individuals causing ‘extreme anxiety and discomfort for ambulance personnel’ (Houston and Pearson, 2010).
Strict conveyance protocols (Hetherington and Jones, 2021) conflict with both the ambulance services' growing autonomy and the current discourse of hospital avoidance (Hetherington and Jones, 2021), and often result in the unnecessary and avoidable transportation of children.
A cohort study discovered that a significant 15–80% of children visiting accident and emergency departments between 2007 and 2017 presented with conditions that were appropriate for primary care and were discharged with no treatment given (Ruzangi et al, 2020). Nonetheless, it has been recognised that discharging patients at scene is a complex process for prehospital clinicians to undertake and one that is seldom used (O'Hara et al, 2014; O'Cathain et al, 2018).
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