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Trauma and Children: Treating at the scene of a collision

Paramedics deal with collisions on a daily basis. Even more, collisions where children are involved. We take a look at the vulnerability of a child when it comes to collisions and ask ER24’s Vaal Branch Manager and ER24’s Trauma Coordinator if it’s more difficult to treat children than adults.  

The World Health Organization’s Global Status Report on Road Safety 2015 rated the African continent’s roads the world’s most dangerous. After pedestrian injuries, passenger injuries are the most lethal. Children have specific anatomical and physiological limitations that render them more vulnerable to serious injury. (Childsafe, 2017)

In 2017, 1 300 children were killed on South African roads. This is according to research conducted by Childsafe under its UNICEF-backed Prevention of Road Injuries Impacting Children in South Africa (PRICSA) programme.

Yolande Baker, Executive Director of Childsafe South Africa, furthermore states in an article titled ‘Safer Streets for Children Campaign Launches to Save Kids’ Lives’ that their research shows most of the children injured or killed on South African roads are passengers or pedestrians. “They are injured or killed as a direct result of reckless or negligent driving by drivers who drive too fast, who drive drunk or take risky decisions on the road,” she said.

“Over weekends we typically see collisions involving families, and during the week we see taxi collisions involving school children,” says John Ramcharan, ER24 Vaal Branch Manager.

According to John, in about half of the incidents they respond to the children sustain either serious or fatal injuries.

As first responders to the scene, paramedics are fully equipped to handle traumatic situations, but it can be a particularly challenging task where children are amongst the injured. “Most of the staff within the EMS are mothers or fathers themselves. When you see a little kid on the scene, you tend to think that this could have been my child. You are more emotionally involved, and while you provide treatment, you provide comfort too. We’ve been on scenes where we’ve had to hold and comfort babies anything between 8 months to a year old. Your parenting instinct kicks in,” said John.

Trauma and ways to treat children

A scene of a collision (or any type of incident) can be a terrifying and traumatic experience for anyone, but for a child even more so. Some patients might also compare the arrival of paramedics with a sense of relief, that help is at hand, but when the patient is a child, it can be a daunting and frightening experience.

John explains how he goes about treating children at a scene. “Most of the time when we get to a scene where children are involved they are usually scared or sad and ask for their parents. Their parents might not always be nearby, and you have to ensure that you provide the comfort they might need at that moment. There is a specific way you go about treating a child. It does come with years of experience within the service. Your mannerisms are different when you work with a child. You have to be soft-spoken and also choose words that a child will understand. Make them feel comfortable in an otherwise stressful situation.

“It is crucial to talk to the child and to talk to them continuously. Tell them what you are busy with now, even if you are taking their blood pressure or checking for any injuries. This is the only way you can gain their trust and help them to remain calm so that you can treat them.

“I’ve always maintained that when you treat a child, you always go down to their level. Kneel and treat the child. Look them in their eyes and introduce yourself before you even attempt to ask where they are hurting,” said John.

The communication part is essential to John. “I find that repeating a question is important. A child might be thinking of a million different things at the same time and might not open up immediately.”

This doesn’t just speak to the immediacy of the treatment provided at the scene, but also the lasting effects the traumatic ordeal can potentially have on the child.

At Grobler, ER24 Trauma Coordinator, explains further: “The reality is the perception of the child. The perception of his/her experience is on their level. A child will most likely remember the gentle person on the scene who spoke to him/her or asked if I was scared. Children are clever, they can read body language, and they can understand different tones of voices. Absolute honesty is required when speaking to children. If the child asks where his/her mother or father is, tell them she is being looked after in the ambulance, or he is still entrapped in the vehicle. If a scene is horrific, that is when you will keep a child away from it as that will be what they will remember for the rest of their lives. But, for the most part, be as honest as possible.”

Part of the training paramedics undergo is how to treat a child, but John explains that the classroom is very different than being on the road.

“In a classroom environment, you are told how to treat a child. With exposure and experience on the road, you learn the art of treating a child and how to gain their trust in order to treat them,” said John.

Although the training equips paramedics on how to handle different situations or scenes, some of the scenes also necessitate for At to be there.

“I usually get called to the scene when the impact is of such a nature that someone’s way of life will likely change for the rest of their lives. For example, at a suicide scene. Paramedics are equipped to heal someone or put them on a path of healing, but they are not equipped to offer therapy. We come in when it is no longer bodily injuries that need to be treated, but rather injuries pertaining to the heart or the soul,” said At.