This article was originally published in Kate's "StreetSmarts" column for the June, 2000 issue of EMS Magazine.

When I began my EMS career, one of the most dreadful stories I heard was of a father who ran to his child after the child had been hit by a car. He gathered the sobbing boy in his arms to provide comfort, and instead, finished the job on the boy's spinal cord, killing him.

Thankfully, decades later, some things have changed. Our public education efforts have taught people to resist moving those who have possible spinal cord injuries. But has the art of dealing with parents come as far?

In many cases, parents are a true problem (ask any teen). hen EMS is called to handle a pediatric case, it is natural to feel some anxiety. We dislike seeing children who are sick and injured. But perhaps another source of our anxiety is that we know where there is a child, there is often a parent or two. It might be time for us to recognize the parent as a secondary patient at pediatric scenes and plan to incorporate their needs into our care.

Working with Parents

As with any interpersonal communication challenge, when dealing with parents, the primary principle to keep in mind is that each situation is unique. Just because the last set of parents you encountered was out of control does not mean the next will be too. It's like keeping your balance on a ship in stormy seas—you know the going is rough, but all you can do is handle the wave that's here, now. Be flexible, avoid being patronizing and prepare a toolbox of communication methods to use.

The study of interpersonal relations at emergency scenes—particularly those beset by highly emotional and rightfully concerned parents who enmesh themselves in the situation—is a lifelong process. Here are some tips for communicating with parents at a pediatric emergency scene:

• Patents whose children are in pain an also in pain. Readers who are parents will understand how intense the parent-child bond can be. When my daughter slammed her fingers in the car door, I felt it. As hard as it is for you, the emergency provider, to witness an ill or injured child, it's harder for the parents. Be compassionate, and let that compassion show.

• Kids take their cues from their parents. The tricky part in writing about how to deal with pediatric situations is that each growth and development stage changes the rules. Generally, children pick up on the anxieties of those in authority—particularly their own parents. The calmer you can help a parent to be, the better your chance of keeping a child calm.

Additionally, there are family dynamics you cannot know. A child may be afraid that a parent will be angry at him for causing the disruption and chaos that surround an emergency. A child may see a parent cry for the first time. A child may witness explosive frustration as a parent reacts after stupidly leaving a pool gate unlocked. There are many subtle things to assess and watch out for regarding relationship dynamics between parents and children. Through good communication, you can offset or avoid many problems simply by noticing them and acting on those that become evident.

• Patents who have had to call for help an (or wet?) not in control. Often, following the first few minutes of your arrival, parents may react in various ways to the knowledge that they lost control. The parent may feel ashamed or silly or may over-respond and try to take back control by being overbearing and dominant. The parent may feel the need to answer all of your questions, when you are more interested in hearing what the child can tell you. (Hint: Kindly include them in the interview, but express your interest in hearing what the child has to say.)

The parent may try to reassert control in some way (or may need you to offer it back), so provide the opportunity, when possible, to do so: "Would you like to hold your baby while I examine her?" or "You can be a real help to us if you'll take charge of getting someone to watch your other children while we get your son into the ambulance, okay?" Use eye contact, and try to find ways for the parent to feel like an equal partner interrupting the emergency care). Think twice about letting a parent follow you to the hospital in the family car. Ask on-scene police to assess whether they are capable of driving safely, and be sure to instruct them not to keep up, if for some reason, the lights and siren go on.

• Don't let Parents (or other bystanders) say “Don't cry!" or “It won't hurt." Crying is a natural response to pain and fear. In time, it is drummed out of most of us. Kids are smart enough to know when to cry—so let them. If a parent starts telling a child not to cry, kindly overrule the message before the child adds the fear that "I'm being naughty because I can't stop crying" to his list of problems. A great message that often works is to give the child control over crying by saying, "Cry until you don't want to cry anymore." And (kindly) tell the parent that crying is allowed on your ambulance.

Regarding medical care that involves pain, such as shots or IVs, you have to develop trust and rapport with both the parents and child. Use the technique of verbalization to explain what you're going to do (before you do it), why it's important and what should happen as a result: "We're going to move your arm into this splint. It might be a little painful while we're straightening it, but afterwards, the splint should make it feel more comfortable than it is now." Be careful not to make false promises. (Hint: When starting an IV, show the needle port and tell the child and parents that you can put other shots through there and not into the skin—what a deal!)

• Be nonjudgmental of Parents. The grief a parent is feeling may be compounded by a sense of guilt. However, feeling guilty is not evidence of wrongdoing. Regardless of the circumstances of the call—even where child abuse or a preventable problem is evident—maintain your professional demeanor and avoid placing blame or making any judgments. You can, and should, remain as kind and supportive as possible.

Provide meaningful reassurance. In EMS, a dreadful phrase that should be eliminated is "Everything's going to be all right." It is meaningless. No one can predict how things will tum out for a family. Yes, maybe the child's injuries are minor, but maybe they missed a plane for an important family reunion. Maybe the illness will pass, but the child will nonetheless miss playing the lead in the school play. To be meaningful, reassurance should express your ability to provide appropriate assistance, that you believe the parents and child can and will cope and that you understand how difficult the situation is. Reassurance is a great and powerful skill to have in your communications toolbox.

Conclusion

Parents are truly "secondary" patients. They may not be the ones who are sick or injured, but they still need your capable guidance on how to behave and what to expect during the bewildering experience of a pediatric emergency situation. Treat them well.

Reference

1. Dernocoeur K. Streetsense: Communication, Safety and Control (3rd ed). Redmond, WA: Laing Research Services, pp. 75-77, 1996.