1. Study of the level of comfort among Emergency Medical Services providers in pediatric patients care
Abdullah Almutairi

2. Outlines Introduction Objectives Methodology Result Discussion
Conclusion
References
Summary
Introduction:
Rational and literature review
Objectives:
Aim, primary and secondary objectives
Methodology:
Data collection method, Questionnaire
Sample size, sampling technique
Study design, area
Inclusion and exclusion criteria
Analysis plan
Result
Discussion Recommendation and limitation
Conclusion
Refences

3. Introduction EMS = pre-hospital care system, ambulance service
EMS providers:
EMT = diploma of 2 years
Paramedic = Bacholar degree of 5 years
EMS in Riyadh:
Hospital based EMS
Ground EMS
Helicopter EMS
Pediatric patient = 14 years or younger

4. Rational Pediatric account for 5-10% of EMS patients
EMS personnel perform urgent interventions1.
Pediatric are vulnerable to errors particularly in emergencies2
Low level of comfort can affect the level of care2
Reasons to assess the level of comfort
Infrequent exposure
No or minimal college education
No or minimal postgraduate education/courses

5. Literature
“Pediatric patients who are transported by EMS personnel are more prone to injury and acute medical problems more than any other transportation”3(Dawson, Brown, & Harwell, 2003)
“EMS personnel have very limited pediatric care training and comfort comparing with nurses” 4 (Jewkes, 2001)
(Dawson, Brown, & Harwell,
2003)

6. Aim
Aim:
To assess the level of comfort of pediatric patient care among pre-hospital care providers working in Emergency Medical Services Departments in Riyadh, Saudi Arabia.

7. Objectives Primary Secondary
To assess the relation between level of comfort and the level of training of the EMS personnel
(EMT VS Paramedic)
To assess the relationship between the level of comfort and the years of experiencing the field
Secondary
To identify the differences between Air, hospital and ground emergency medical services providers level of comfort
Mnn-whiteny U test= for #1 categorical vs numerical ( because its comparing categorical vs numerical in 2 groups)
Kruskal wallis test H= for #2 and #3 ( because its comparing categorical vs numerical in 2 groups)

8. Method: Study Design
This is a cross-sectional descriptive study using a questionnaire-based survey.
Developed and reviewed by four Pediatric Emergency Medicine consultants
Questionnaire language: English
Questionnaire distribution: Handed over
Corrected Item-Total Correlation ( )
More than 0.2

9. Questionnaire
The instrument is a questionnaire of 26 questions , which assesses two parts:
Respondents demographic data, 7 questions
Comfort level in pediatric patient care 19 questions
Likert-scale answers regarding comfort level:
Very Comfortable
Somewhat Comfortable
Neutral
Somewhat Uncomfortable
Very uncomfortable

10. Questionnaire: First part
age group, level of training
years experience in the field
frequency of providing care to pediatric patients?
type of EMS agency?
Continuous pediatric education, training?
Courses in the last two years?

11. Second part: Patient care
Pediatric patient care
Suspected poisoning
Suspected child abuse
Seizure
Respiratory emergency
Cardiac Emergencies
Trauma
Newborn Delivery
Pediatric care knowledge

12. Second part: Skills Performing LMA Orotracheal intubation
BVM ventilation
Intraosseous access
Vascular access
Pediatric assessment by age
Access to resources within your institute
Pediatric patient assessment skills
Technical skills

13. Study setting Riyadh Saudi Arabia: EMS in King Fahad Medical City
EMS in King Abdulaziz Medical City
EMS in King Khaled University hospital
EMS in Prince Mohammad bin Abdulaziz hospital
Four Main Saudi Red Crescent authority stations

14. Sample size
The sample size is the complete population which is 265 EMS personnel working at the designated centers
Inclusion criteria:
All healthcare providers working as EMS providers in the designated centers in Riyadh, Saudi Arabia.
Exclusion criteria:
EMS working as administrative EMS.

15. Data analysis All data collection sheets entered and coded in SPSS 21
The 19 questions of the 5 points Likert-scale regarding the level of comfort presented as frequency, percentage of the comfortable answers.
Five points Likert-scale score is used to calculate the mean score and to compare between groups
Very Comfortable= 5
Very Uncomfortable = 1
Minimum score of 19 and maximum of 95

16. Ethical consideration
IRB approval from KAIMRC
Protocol number SP R
KAIMRK informed consent for cross sectional survey

17. Questionnaire Reliability Statistics of 210 respondents
Cronbach's Alpha of Items = .940
Inter-Item correlation matrix, no –ve correlation
Corrected Item-Total Correlation ( )
Cronbach‘s Alpha if item deleted =
The least was .936

18. Results:
Two hundred and ten out of 265 have completed the questionnaire with a response rate 79%.
Calculating the comfort level score of all respondents with 1 (Very comfortable) to 5 (Very uncomfortable)
Mean score
59.9 SD
14.5
Minimum score 26
Maximum score 95

19. Result: Demographics Table 1 ALL (n=210) Table 1 ALL (n=210) Age 18-29
18-29
138 (66%)
30-41
59 (28%)
>=42
13 (6%)
Certification
EMT
119 (57%)
Paramedic
91 (43%)
Years in field
0-5
109 (52%)
>5-10
71 (34%)
>10
30 (14%)
How frequent do you provide care to pediatric patient?
0/month
40 (19%)
1-10/month
118 (56%)
>=11/month
51 (25%)
Table 1
ALL (n=210)
Pediatric medical education hours in the last year?
46 (22%)
Training in the last 2 years? No
107 (51%)
PALS
45 (21%)
APLS
8 (4%)
Other courses
50 (24)%
Type of EMS
HB-EMS
122 (58%)
G-EMS
63 (30%)
H-EMS
25 (12%)

20. Level of comfort in pediatric patient care
Comfortable and somehow comfortable
Likert-Scale Mean SD
Pediatric patient care
67 (32%)
3.1
1.08
Suspected poisoning
75 (36%)
1.04
Suspected child abuse
2.9
1.13
Seizure
73 (35%)
1.11
Respiratory emergency
  84 (40%)
3.3
0.99
Cardiac Emergencies
82 (39%)
1.14
Trauma
101 (48%)
3.4
1.15
Newborn Delivery
2.8
1.23
Pediatric care knowledge
65 (31%)
0.92
Computing the comfort level score of all respondents with 1 (Very comfortable) to 5 (Very uncomfortable)
The mean score is 59.9
SD 14.5,
minimum 26
maximum 95

21. Level of comfort in Skills and assessment
Comfortable and somehow comfortable
Likert-Scale mean SD
Performing LMA
65 (31%) 3
1.17
Orotracheal intubation
55 (26%)
2.8
1.27
BVM ventilation
126 (60%)
3.7
1.14
Intraosseous access
57 (27%)
2.7
1.33
Vascular access
71 (34%)
3.1
1.19
Pediatric assessment by age
3.2
1.01
Access to resources within your institute
58 (28%)
2.9
1.07
Pediatric patient assessment skills
89 (42%)
3.4
0.85
Technical skills
92 (44%)
3.3
0.91

22. Comparing the comfort level scores between level of training (EMT VS paramedic)
A Mann-Whitney test indicated that the score of the comfort level is greater for Paramedics (Mdn = 67) than for EMTs (Mdn = 56), p = .001.
Level of training
Number
Mean rank
EMT
120
86.48
Paramedics 90
130.86
Total
210
Mann-Whitney U
P Value
Level of training
Number
Median
EMT
120 56
Paramedic 90 67
Total
210 57

23. Comparing the comfort level scores between years of experience
There was a statistically insignificant difference between the level of comfort score (H(2) = , p = 0.003), with a mean rank of for experience of >10 years, for experience of >5 -10 years and for experience from 0 up to 5 years
Years of experience
Number
Mean rank
0-5 years
109
97.61
>5-10 71
104.07 30
137.55
Chi-Square SumScore
10.237
P Value

24. Comparing the comfort level scores between EMS types
There was a statistically significant difference between the level of comfort score (H(2) = , p = 0.003), with a mean rank of for Helicopter-EMS, 101 for Hospital-EMS and for Ground-EMS.
Type of EMS
Number
Mean rank
Hospital EMS
122
101
Ground EMS 63
98.60
HEMS 25
144.82
Chi-Square SumScore
11.964
P Value

25. Discussion
Fieschman et al, 2011 study has shown that EMS personnel has reported7
Highest comfort level in:
Airway management
Trauma pediatric patient care
Seizure care
Lowest comfort level in:
pediatric cardiac arrest
newborn resuscitation
Arrhythmia
medication calculation
(Fleischman et al., 2011).
Fieschman et al, 2011 study in Oregon EMS system in the united states have shown that

26. Conclusion
EMS providers in Riyadh, Saudi Arabia have reported limited training in pediatric patient care, infrequent exposure, and low level of comfort.
Paramedics have a statistically significant difference of a higher level of comfort score than EMTs

27. Recommendation Implement a pediatric course in EMS colleges
Adopt more pediatric course for EMS and CME personnel
Frequent assignment of EMS personnel in pediatric department as a rotation to gain enough exposure

28. Limitation
Hospital based EMS employee are not authorized to responded to emergencies which explains their infrequent exposure to pediatric patient
The result of the comparison between the type of EMS is affected by the facts that:
HEMS require courses in pediatrics for recruitment
95% of HEMS are paramedics (Bacholer degree)

29. References
Bair, A., Rose, J., Vance, C., Brown, E., & Kuppermann, N. (2008). Ultrasound- assisted peripheral venous access in young children: a randomized controlled trial and pilot feasibility study. The Western Journal of Emergency Medicine, 9(4), 219– 224.
Markenson D, Foltin GL. The New Emergency Medical Technician-Paramedic and Emergency Medical Technician-Intermediate Curricula: History, Changes, and Controversies. Clinical Pediatric Emergency Medicine. 1999; 1(1):
Seidel JS. Emergency Medical Services and the Pediatric Patient: Are the Needs Being Met? II. Training and Equipping Emergency Medical Services Providers for Pediatric Emergencies. Pediatrics. 1986; 78(5):
Cook RT. The Institute of Medicine Report on Emergency Medical Services for Children: Thoughts for Emergency Medical Technicians, Paramedics, and Emergency Physicians. Pediatrics. 1995; 96(1 II Suppl):

30. Summary & Questions