Trauma-informed care for children in the ambulance: international survey among pre-hospital providers

Figures & data

Table 1. Pre-hospital providers’ knowledge of traumatic stress in children.

Knowledge item	N (%) responding correctly
All injury severities are at risk for traumatic stress	386 (47.5)
All age groups are at risk for traumatic stress	223 (27.5)
The child, parents, and siblings are at risk for traumatic stress	625 (77.0)
Various behaviours (e.g. calm, frantic) can precede traumatic stress	197 (24.3)
Subjective life threat is a risk factor	474 (58.4)
Pain experience is a risk factor	268 (33.0)
> 50% of children report stress symptoms in 1st month post-injury	21 (2.6)

N = 812.

Table 2. Respondents’ total knowledge score in relation to their characteristics: initial and final multiple regression.

Initial model	B	SE B	β	p value	95% CI for B	Univariate total scores per group/correlations^a
Constant	2.086	.136		<.001	1.819 to 2.354	Coded ‘0’	M (SD)/r	Coded ‘1’	M (SD)
Gender	.748	.123	.221	<.001	.507 to .989	Male	2.50 (1.56)	Female	3.16 (1.54)
Parent	.267	.112	.085	.017	.047 to .487	No	2.64 (1.59)	Yes	2.78 (1.58)
Profession	−.103	.138	−.026	.457	−.374 to .169	Paramedic	2.72 (1.57)	EMT	2.62 (1.62)
Experience (in years)^b	.013	.006	.077	.033	.001 to .025		.011
Child patients	.361	.135	.094	.008	.096 to .626	< 10%	2.64 (1.58)	≥ 10%	2.93 (1.59)
Recent training	.372	.213	.061	.082	−.047 to .790	No	2.67 (1.58)	Yes	3.14 (1.56)
Final model	B	SE B	β	P Value	95% CI for B
Constant	2.302	.091		<.001	2.123 to 2.481
Gender	.712	.118	.210	<.001	.480 to .945
Parent	.248	.111	.078	.026	.030 to .465
Child patients	.314	.133	.081	.018	.053 to .574

N = 780 for the initial model and 808 for the final model; these sample sizes differ due to a greater degree of missing data for ‘Profession’. ‘Profession’ distinguishes between (senior) paramedics and (advanced) Emergency Medical Technicians. ‘Child patients’ refers to the proportion of children among the participants’ patients (< 10% vs. ≥ 10%). ‘Recent training’ refers to training in psychosocial care for injured children in the past five years. ^aFor the univariate descriptives, we used all information available; N was 812 for all variables, except for ‘Gender’ (808) and ‘Profession’ (784). ^bNo longer significant when ‘Profession’ and ‘Recent training’ were removed from the model. Adjusted R² of the final model = .05, F(3,804) = 14.48, p < .001.

Table 3. Elements of psychosocial care perceived as part of the job.

Aspect of psychosocial care	‘not my job’ N (%)
Respond calmly and without judgment to a child’s or family’s strong emotional distress	9 (1.1)
Talk with children in age appropriate language	8 (1.0)
Tailor your approach according to a family’s cultural background	10 (1.2)
Assess and manage pain in children	9 (1.1)
Explain procedures to children and parents	8 (1.0)
Inform a child about an injured/deceased family member	22 (2.7)
Help a child/parent who is anxious to calm down by teaching relaxation (e.g. breathing) techniques	11 (1.4)
Assess a child’s or family’s distress, emotional needs, and support systems	13 (1.6)
Elicit trauma details from a child or family without them being exposed to more distress	8 (1.0)
Respond to a child’s (or parent’s) question about whether the child will die	14 (1.7)
Liaise with staff who can provide practical assistance to a family (e.g. Social Work)	29 (3.6)
Take action to get someone close (a parent, family member or friend) available to the child	11 (1.4)
Encourage parents to make use of their own social support system (family, friends, spiritual community, etc.)	21 (2.6)
Educate children and families about common traumatic stress reactions	43 (5.3)
Teach parents or children specific ways to cope with procedures	64 (7.9)
Provide information to parents about emotional or behavioural reactions that indicate that the child may need help (when back at home)	75 (9.2)
Educate parents or children about how to access mental health services if needed	55 (6.8)
Manage your own emotional responses to children’s pain and trauma	7 (0.9)

N = 812. The three aspects of psychosocial care that had the highest percentages, are highlighted.

Table 4. Respondents’ level of confidence regarding aspects of psychosocial care.

Aspect of psychosocial care	Mean score^a (SD)
Respond calmly and without judgment to a child’s or family’s strong emotional distress	3.70 (0.53)
Talk with children in age appropriate language	3.66 (0.56)
Tailor your approach according to a family’s cultural background	3.19 (0.69)
Assess and manage pain in children	3.40 (0.69)
Explain procedures to children and parents	3.78 (0.46)
Inform a child about an injured/deceased family member	2.92 (0.87)
Help a child/parent who is anxious to calm down by teaching relaxation (e.g. breathing) techniques	3.37 (0.71)
Assess a child’s or family’s distress, emotional needs, and support systems	3.21 (0.73)
Elicit trauma details from a child or family without them being exposed to more distress	2.98 (0.77)
Respond to a child’s (or parent’s) question about whether the child will die	3.09 (0.79)
Liaise with staff who can provide practical assistance to a family (e.g. Social Work)	3.24 (0.84)
Take action to get someone close (a parent, family member or friend) available to the child	3.53 (0.67)
Encourage parents to make use of their own social support system (family, friends, spiritual community, etc.)	3.37 (0.72)
Educate children and families about common traumatic stress reactions	2.71 (0.88)
Teach parents or children specific ways to cope with procedures	2.66 (0.88)
Provide information to parents about emotional or behavioural reactions that indicate that the child may need help (when back at home)	2.55 (0.94)
Educate parents or children about how to access mental health services if needed	2.80 (0.91)
Manage your own emotional responses to children’s pain and trauma	3.28 (0.74)

N = 737–805. The three aspects of psychosocial care that had the lowest mean scores, are highlighted. ^aAnswer options to indicate confidence regarding each element of psychosocial care were (1) not at all; (2) a little; (3) moderately; (4) very.

Table 5. Respondents’ average confidence score in relation to their characteristics: initial and final multiple regression.

Initial model	B	SE B	β	p value	95% CI for B	Univariate total scores per group/correlations^a
Constant	3.016	.039		<.001	2.939 to 3.093	Coded ‘0’	M (SD)/r	Coded ‘1’	M (SD)
Gender	.106	.035	.110	.003	.037 to .176	Male	3.18 (0.45)	Female	3.25 (0.45)
Parent	.057	.032	.064	.076	−.006 to .121	No	3.18 (0.47)	Yes	3.23 (0.43)
Profession	.036	.040	.032	.364	−.042 to .114	Paramedic	3.19 (0.44)	EMT	3.22 (0.48)
Experience (in years)^b	.005	.002	.112	.002	.002 to .009		.096
Child patients	.125	.039	.113	.001	.048 to .201	< 10%	3.18 (0.47)	≥ 10%	3.29 (0.40)
Recent training	.223	.062	.127	<.001	.102 to .344	No	3.18 (0.45)	Yes	3.43 (0.41)
Final model	B	SE B	β	p value	95% CI for B
Constant	3.047	.034		<.001	2.980 to 3.113
Gender	.103	.034	.107	.003	.036 to .171
Experience (in years)	.006	.002	.119	.001	.002 to .009
Child patients	.122	.038	.111	.001	.047 to .197
Recent training	.229	.061	.130	<.001	.109 to .348

N = 774 for the initial model and 801 for the final model. ‘Profession’ distinguishes between (senior) paramedics and (advanced) Emergency Medical Technicians. ‘Child patients’ refers to the proportion of children among the participants’ patients (< 10% vs. ≥ 10%). ‘Recent training’ refers to training in psychosocial care for injured children in the past five years. ^aFor the univariate descriptives, we used all information available; N was 805 for all variables, except for ‘Gender’ (801) and ‘Profession’ (778). Adjusted R² of the final model = .044, F(4,796) = 10.20, p < .001.

Table 6. Respondents’ preferences regarding training format.

	1^st preference N (%)	2^nd preference N (%)
Book	49 (6.0)	84 (10.3)
Static website	71 (8.7)	97 (11.9)
Interactive website	200 (24.6)	129 (15.9)
Mentoring by paramedic	66 (8.1)	66 (8.1)
Mentoring by MH clinician	89 (11.0)	74 (9.1)
One-off group training	168 (20.7)	135 (16.6)
Multi-session group training	82 (10.1)	114 (14.0)

N = 728 respondents interested in training regarding psychosocial care. MH = mental health.