Safe Ground Transport of Pediatric Patients: A Qualitative Assessment of Best Practice Guidelines Implementation

Abstract

Objective

The National Highway Traffic Safety Administration issued guidelines on the safe transport of pediatric patients to lessen the chance of injury during ambulance transport. However, adherence to these standards have been slow to take hold. The objective of this quality improvement study is to evaluate barriers and facilitators of safe transport at the individual, organizational, and societal levels and identify improvement opportunities in the safe transport of pediatric patients.

Methods

This study was designed using an implementation science framework. Six focus groups were held with EMS clinicians to assess knowledge, behaviors, barriers, and facilitators of safe pediatric transport. Four interviews were conducted with EMS leadership to characterize organizational safe transport practices and policies. Detailed notes were taken during focus groups; interviews were recorded and transcribed. Qualitative data were analyzed using a thematic content analysis approach where team members reviewed transcripts using an established framework and identified major and minor themes related to safe pediatric transport.

Results

Three focus groups were conducted in a hospital setting and three were conducted at EMS base stations. Interview participants included two paramedic leaders, an ambulance service chief executive officer, and an ambulance service clinical coordinator. Recurring themes included the belief that children were inherently difficult to transport, the sentiment that training in pediatric transport is lacking, and the acknowledgement that familiarity with pediatric transport guidelines is low. Additionally, a major theme was that situational practicality can take precedence over adherence to best practice recommendations. Participants reported the presence of organizational and external barriers that made it more difficult for EMS personnel to follow safety guidelines. This included equipment unavailability, lack of clear policies, low pediatric patient volume, manufacturer design preferences, and prevailing EMS culture/norms.

Conclusion

EMS clinicians need hands-on training and knowledge reinforcement in safe pediatric ground ambulance transport. EMS agencies should ensure that their crews have proper equipment, training, and protocols in place. Regulators and manufacturers can be catalysts for the implementation of these recommendations. Substantial change at the individual, organizational, and societal levels are needed to improve the safety of pediatric patients being transported via ground ambulance.

Disclosure statement

The authors report no competing interests to declare.

Additional information

Funding

Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award Number KL2 TR001413-07. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additionally, this work was supported by the Niagara Frontier Kiwanis Clubs and the Children’s Hospital of Buffalo Foundation.