Help!! EMS Question that I NEED answered

[New Medic]

Hey Guys,

I'm sorry for this question as I find it to be quite obvious. However, a friend and I are both EMR's and have been for the past year. We are going to school for our EMT but we both disagree on the answer to this following question.

It was brought up that if a Trauma patient (seriously injured or not) that needed to be taken to the hospital via ambulance and they had a child, should the child be allowed to be taken to the hospital with their father in the Ambulance? Does it matter if the father would allow it?

I had the opinion that weather the father/ patient would have allowed the daughter to ride in the ambulance with him or not that the child should not be allowed to be taken with the patient. I believe that it would be to traumatic for the child emotionally and could even be physically dangerous. As the child would take up more room in the ambulance which could possibly take away from patient care and could cause emotions to be high and if anything were to happen now the medic has neglect of the patient and the patients child to worry about.

However, my friend disagrees. she also brought up the good point of what are you supposed to do if it was just the patient and the young child and no one is there to look after the child. What would you do in that circumstance? call for back-up? or allow the child to be transported with the patient?

Your Help Would be much appreciated as this is probably a very common issue and we are bound to experience something like this eventually and I would like to be prepared for a situation like this!!

[Just Plain Ruff]

What a kettle of fish you bring up

many schools of thought but you didn't say how old. But let's go down this rabbit hole with a 10 year old say we 

1.  10 year old is old enough to ride in front seat - I would let them if and only if there was no one to come get the child.  

2.  If there is someone to come get the child the child stays with the police and that said someone comes to get them. 

For less than 10 - a stickier situation

CAR SEATS CAR SEATS CAR SEATS

1.  Does your agency have car seats available? 

2.  How badly injured is dad?  Will you need all hands on deck for dad's treatment and will there be room for this kid in the back?

3.  If no room for kiddo, then sorry kid stays with police on scene with a car seat until Police can bring child to hospital because more than likely police are coming to hospital anyway. 

4.  is there someone to come get said child?  If so then all points are MOOT!!!

5.  If no one to come get child, then all points 1,2, 3 apply

If child is an infant - see points 1,2,3, 4 and 5

If your agency has a policy about NO non patient riders in the ambulance (which is a freaking stupid policy IMHO) that's a entirely different thread altogether, then we can go down that rabbit hole and follow it where it leads but I never followed the two services who said no riders, I erred on the side of pt care not policy and never got in trouble for it.  Your mileage on this might vary. 

 

So when in doubt, this is my opinion, if it is safe for both the patient and the child to take the child along, then do so, but if at any time you believe it isn't safe to bring the kid along, leave the child with the police along with a car seat and have them transport the child to the same hospital you transported the father to.  You will find that most police departments will be most accomodating in this regard.  You will also find that most children will have at least someone that can come and get them at some point in the process.  

 

Any other questions?

[New Medic]

If the child was 6 years old lets say and there are seat belts in the back if the father is not badly injured then I take it that it would be alright to bring the child along?

But if the child is 6 years old and the father is in critical condition and all hands on deck is in fact needed I realize that you would not be able to bring the child along. But what would you do if EMS was first on scene, Police have not arrived yet, there is no one to stay with the child and police have not arrived yet. What should be done in a situation like this? Obviously your partner etc could not stay and wait with the child because they are needed and you cannot delay emergency care especially in a critical situation. I realize that this specific and very difficult situation may be very rare, but it does happen and I would have no idea what to do in a situation like this because at this point EMS would be responsible for both the patient and the child under neglect and possibly abandonment. Correct? 

[Just Plain Ruff]

Sticky, but here is what I'm going to do and let the powers that be kick my ass

I'm going to put the child in a seat belt at the far end of the bench seat, and transport both of them.  But the chances of your scenario happening with you being the only one on scene is going to be very rare but it could happen. 

It's really a non-issue.  You do what you have to do, you work with what you have and you either transport the child if there is absolutely NO one to take custody of them or you give them to someone in a position of authority.  Simple as that.  

[Arctickat]

Our vehicles have a swivel airway seat. I'd flip it all the way around so it faces forward and have the kid ride there. He may turn his head around to see what's going on with dad and that's fine. Face it, if dad is really in that bad shape that the child may be traumatised, the damage is already done. He was with dad, alone, waiting for you to arrive. If he's going to be, the child has already been damaged by what he witnessed. I would think it might be therapeutic for him in the long run to be able to witness dad's demise rather than be sheltered from it.

Here's a story, like you asked for in your intro thread.

I got called to a scene by a husband whose wife has been suffering from depression and is threatening suicide. As we pulled up and my partner walked to the house and the husband answered the door. He told my partner what's going on and so on and so forth. Partner walked in and as I entered the room the husband lost his mind. He started screaming at me and yelling to "GET THE F___ OUT!!!" , "I HATE YOU!!! GET OUT!!!!" He's perfectly fine with my partner, it's me he's enraged with and I couldn't fathom why. My partner and I both left to discuss what's going on when the husband came outside. He's incredibly distraught and very remorseful for his conduct, and that's when I recognised him.

Two years earlier I responded to a different house for what was eventually diagnosed as a SIDS baby. THEIR baby. My partner went in to talk to mom and I talked to dad. This was the first time I had seen him since they lost their daughter, and as we sat on the front step of their house, he shared what happened over the past couple years. When his wife couldn't wake their daughter he called for an ambulance. When we arrived I swooped in, grabbed his lifeless daughter away from his wife, and rushed out the door. The next time he saw his little girl she was dead. (Remember, it doesn't matter how dead someone is, when we leave the house actively working on a body, the family holds out some hope for survival.) I took away his chance for reconciliation. For years he harboured the envy that I got to spend his daughter's last moments with her and he did not, and he was jealous that I had taken that away from him. Even though she was long dead. His wife got depressed from the loss of their only child, their marriage began to suffer, their love life was non-existent, they became withdrawn, had to move in hopes of burying the memories and continued to spiral. Eventually she became suicidal and when I was called in, it was her third attempt.

I was stunned, I didn't know what I should do. Here I was, a young EMT with only a few years under my belt and this guy is pouring his most private and intimate life details out for me. I hadn't learned the coping mechanisms that I have now. I had no advice I could give him. He was older and wiser than I, what could I do that could console him and start their healing. I tried to apologise, I tried to explain my point of view when we were called to his daughter. I didn't have the experience to be able to empathise with his pain. 6 months later they both committed suicide.

30 years ago there was a mantra, work every dead body, even if it's useless, it gives the family hope and time to prepare to grieve. After this call I changed my entire outlook when it comes to dealing properly with loved ones. I am entirely open, honest, and forthright regarding the care they are receiving. I would take a free moment during a cardiac arrest while my partners continued CPR and speak with the family about what we are doing and what to expect. I also invite family to come with us if we are transporting, regardless of how gruesome the call is. They don't see the blood and gore...they see their little girl or little boy. Just as your scenario, the child sees daddy, not daddy's intestines on the floor or blood squirting from an arterial bleed.

Regardless the choice you make, the child will likely need some form of therapy, but the current thinking in many sectors is that being shut away from a family member in this way usually does more harm than good.

[scubanurse]

Regardless the choice you make, the child will likely need some form of therapy, but the current thinking in many sectors is that being shut away from a family member in this way usually does more harm than good.

This.  My ER handles a lot of critical patients being a trauma center.  We almost always incorporate the family in critical patients, letting them stand with the chaplain and watch us work on their loved one does a lot of good in the long run.  But, this is in a large trauma bay with adequate staff to monitor the family.

In an ideal world, you would have the room to have someone sit with the kiddo in the ambulance and explain things to them, but we don't live in ideal worlds and truth is sometimes in EMS it isn't possible to bring family members along.  If possible and dad was critical, I would have PD bring them following right behind so they can be at the hospital where they have resources to handle these things.