Compassionate Options for Pediatric EMS (COPE): Addressing Communication Skills

Figures & data

Table 1. Principles of communication incorporated into the app

Theme:	Explanation:
1. Engage the Family	– Work quickly and explain what is being done and why
	– Assure them that you are doing everything you can to help
	– Allow the family to accompany the child if possible
	– If a child dies, give the family space to grieve
2. Divide Responsibilities	– If possible divide the team so that one provider can work exclusively with the family
	– Goals include information gathering and keeping the scene calm
	– Standing by the family members is a form of social support
	– Sometimes family members need help making phone calls
3. Provide Emotional Support	– Give reassurance that you are doing everything you can to help their child
	– Touch can also express caring
	– Answer questions as best you can
	– Express sadness and condolences if the child dies
4. Be Open and Attentive	– Listen clearly to the family, allow them to speak
	– If they are negative towards the first responders, don't take it personally
	– It is common for family members to be frustrated and angry about the situation
5. Don't Give False Hope	– Find the correct balance between hope and truthfulness
	– Say “we will do our best” if asked if the child will survive
	– Remain calm in the face of stress
	– Look for other calm family members who can help you
6. Maintain Professionalism	– Show respect to all family members
	– If there is suspected child maltreatment, suspend judgment
	– If the child dies under those circumstances, recognize that there are protocols preventing movement of the child, but take care to give the family some time with the child
	– Let the family know what is permissible.
7. Be Flexible	– In unexpected situations be ready and willing to reassess your approach
	– If a child has a DNR, all you may be asked to do is keep the child calm and comfortable
	– Respect the family's wishes in these situations
8. Follow Up With Families When Possible	– Family members cope better if EMS providers follow up with condolences
	– This can involve attending the visitation or simply sending card
	– Providing information about available support resources is also helpful

This table lists the principles of good prehospital communication incorporated into the app. Each theme is followed by an explanation expanding on the specific content. Additional app components addressing provider coping mechanisms are not explored in this paper.

Figure 1. Assessment structure of the study. This chart depicts the temporal relationship between the simulations, usage of the app, and learner assessments. Communication assessments were conducted by trained observers using the GKCSAF form. Intervention groups engaged with the app immediately after the initial simulation.

Table 2. Participant demographic characteristics

	Intervention Group	Control Group
	(N = 68)	(N = 80)	Significance
Gender (%)			p = 0.88
• Male:	74%	76%
• Female:	26%	24%
Ethnicity (%)			p = 0.69
• Caucasian:	91%	92%
• African-American:	5%	6%
• Hispanic:	2%	2%
• Mixed Race:	2%	2%
• Native American:	1%	0%
Training (%)			p = 0.12
• Emergency Medical Technician (EMT):	60%	75%
• Paramedic:	40%	25%
• Additional Fire-fighter Training:	65%	65%
Work Environment (%)			p = 0.22
• Urban/Suburban:	89%	90%
• Rural:	11%	10%
Experience (median, range)
• Years of Work Experience:	6–10 (<1–30)	6–10 (<1–30)	P = 0.44
• Number of Child Mortalities Encountered:	7 (0–50)	6 (0–50)	P = 0.70

This table displays the demographic characteristics of the subject groups. No significant differences were noted between intervention and control groups.

Figure 2. Comparison of communication scores at pre and post-test intervals. This figure depicts overall GCKSAF scores during the pre- and post-test intervals. Pre-test scores were not significantly different. Post-test scores showed a statistically significant difference (p < 0.001) by Mann-Whitney U. Effect size was moderate by r-value (0.69).

Figure 3. Comparison of gap analysis scores at pre and post-test intervals. This figure depicts gap analysis scores from the pre- and post-test intervals. Pre-test scores were not significantly different. Post-test scores showed a statistically significant difference (p = 0.013) by Mann-Whitney U. Effect size was moderate by r-value (0.41).

Table 3. Interventional group perceptions of the COPE app

Question	Mean (Standard Deviation)
App Quality
• I found the COPE app content to be displayed in an interesting manner	3.83/5 (0.892)
App Relevance
• I found the COPE app content to be relevant to my work when a pediatric death happens in an OOH setting	3.91/5 (0.996)
App Importance
• I found the COPE app content to be important	4.13/5 (0.741)
App Applicability
• I found the COPE app content to be applicable for my next pediatric case	3.98/5 (0.989)
• I found the COPE app content to be applicable for my next adult case	3.77/5 (1.2)
• I was able to apply the information from the COPE app in the second simulation.	4.02/5 (1.07)
• I believe that my performance on the second simulation was better than in the first simulation because of what I learned from the COPE app.	3.89/5 (1.07)
• Overall	3.92/5 (1.08)
Behavioral Intention to Apply Learning and Use App in Future
• I am likely to apply what I learned from the COPE app in future OOH pediatric death cases.	4.02/5 (1.02)
• I want a copy of the COPE app so that I can review the contents before my next pediatric case	3.28/5 (1.3)
App Helpfulness for adults
• I believe that the COPE app will also help me intervene with families whose adult loved one is dying.	3.73/5 (1.18)
Recommend the App
• Once the COPE app is available widely for EMS use, I will recommend it to my EMS colleagues.	3.68/5 (1.07)

This table shows the responses of intervention group subjects regarding usefulness and applicability of the app. Sixty-seven percent of participants indicated a desire for a copy of the app, and 90% indicated that they would recommend the app to colleagues.