Training pre-hospital providers to recognize abuse and neglect
On a cool October evening, Chicago paramedic Maggie Coen-Murphy responded to
a call for a child experiencing seizures and a very high fever. When she
arrived, the child's grandmother handed her a naked, shivering 18-month-old boy
wrapped in a towel. As Coen-Murphy assessed the child, several things raised red
flags. The boy had no diaper bag, no bottle, no food or clothing. She also
noticed bite marks in various stages of healing.
"Advocacy is not an afterthought in the emergency department," says Susan Fuchs, MD,
associate division head, emergency medicine. Fuchs leads
the Emergency Medical Services team at Children's Memorial. " Anticipating
children's needs helps us prevent injuries a way that we can't
during brief encounters we have in the emergencu room. Under her direction, Children's Memorial's
department is reaching beyond the hospital walls to train pre-hospital
providers — emergency medical technicians, paramedics, firefighters and
police officers — how to recognize and respond to child abuse and
neglect.
Not so status quo
In 2003, Children's Memorial greatly enhanced its capability of
responding to patients arriving at the ER via the Chicago Fire Department. With
the designation of Associate Hospital status, granted by the Illinois Department
of Public Health, the hospital joined only a handful of others that
directly respond to calls from ambulances and paramedics in the field.
In the past, information on incoming patients was called in to Children's
Memorial through one of three intermediary resource hospitals. The new system
eliminates the middleman. A dispatch center with a radio and telemetry
system is staffed 24 hours a day and enables the hospital to answer calls
directly from the field.
"Having Associate Hospital status elevates us in the EMS community," says
Fuchs. "In addition to allowing us to provide direct medical advice to
paramedics, we have a seat at regional meetings, ensuring that more pediatric
expertise is part of the education for new pre-hospital care
providers."
Paramedics are "eyes and ears"
Of the approximately 350 children evaluated for abuse and neglect each year
at Children's Memorial, many of them are first seen by paramedics. Additionally,
paramedics often observe potential cases of child abuse or neglect when they are
called for medical needs of other family members. "Paramedics are the eyes and
ears of the hospital," says child protective services team member Dana Wiltsek.
"They can provide critical information from the home environment that's helpful
in gathering a history." Furthermore, Wiltsek says it's important for
pre-hospital providers to feel confident in making a report to the Illinois
Department of Child and Family Services and navigating this system.
Fuchs, Wiltsek and Children's Memorial emergency medical system coordinator
Peter Lazzara, who conducts extensive training for pre-hospital providers on
pediatric emergency care, felt that abuse and neglect were critical areas
frequently overlooked in course material. In 1995 they received funding from the
hospital's Office of Child
Advocacy to launch the Child Maltreatment Awareness
Project for Pre-hospital Providers. Prior to developing a curriculum, they
surveyed paramedics and found that even the most experienced felt uncertain
about their responsibility when they confronted possibly abusive situations.
"They told us that they didn't know they had the power to do anything about it,"
says Fuchs.
More training and practical aids are vital
Following the survey, they developed a two-hour training program that puts
information and tools in the hands of paramedics, police, and firefighters who
encounter abuse and neglect. "The training heightens their index of suspicion,
raises red flags about who is at risk and defines the provider's role in the
process," says Lazzara. In addition to training approximately 1,200 Chicago Fire
Department personnel, suburban fire department personnel, Chicago public school
nurses and paramedic students, he has been asked to present the education
program to audiences outside of Illinois. The course is now available on CD-ROM
for state-wide distribution.
In an effort to not only report, but support families in crisis, the Child
Maltreatment Awareness team developed a laminated reference card for paramedics
with phone numbers for ancillary services such as domestic violence and elderly
abuse hotlines and crime victims assistance programs. Paramedic Coen-Murphy
appreciated having the Child Maltreatment Awareness training when she responded
to the child experiencing seizures in October. "The course really heightened my
awareness about what to do after the fact."
For their important work, both Fuchs and Lazzara received outstanding
achievement awards from the Illinois Department of Health's Emergency Medical
Services for Children program. Also, Prevent Child Abuse Illinois recognized the
project with their Program Excellence Award.