Table 4 Major Themes from Qualitative Focus Groups with 47 EMS Providers and Example Quotes

1. Low number / lack of experience

We definitely don’t run a lot of pediatric calls [...] they’re very low frequency calls so you do start to feel a little bit rusty [...] there’s that lack of contacts with pediatric patients […] I definitely can see how it becomes one of those things that’s like...Oh my gosh, this is a pediatric call in the city!

2. Pediatric patients are fundamentally different / more stressful

Even with a baby with totally stable vitals there does seem to be an air of anxiety among the responders

3. Managing scene / more chaotic scene

When you have them it’s a little bit chaotic and rowdy there especially when you don’t necessarily know the others that are there; you never even worked with them and there could be some communication issues as far as who’s doing what, too many cooks in the kitchen.

4. Tendency to “grab and go”

They just want to grab the baby and throw him in the ambulance and just tell us to go. You know, there’s so many things we’ve got to do beforehand - get the parents ready, check out the baby, do all our assessment. But they just want to grab him and just be like, “All right you guys ready to go?”

1. Challenge of medication dosing

Not just what is the dose for this drug, but how are you going to draw it up, how is it formulated, what is the volume you draw up, what concentration, something a lot of people don’t really think about until it comes time to do it and they’re “oh, I totally forgot how much percent do I give?”

2. Communication with parents, caregivers, and patient

One of the more challenging things, or the added challenges, with kids is not only you have the patient, but you have at least two or three patients, which are the parents, the family. Which is often overwhelming, especially if they are emotional or trying not to give the child up. I feel like the environment is just very different. You often have more than one person to take care of. And I feel like if you’re not used to that or if people don’t know that environment, it might make it more challenging

3. Airway management

Anything airway, we don’t have as many tools to manage a baby’s airways like we do for an adult. With adults, I have a lot of things I can do for somebody; as for a kid? Not so many. That would be my biggest thing is give me more tools to manage a bad airway

1. Need for repetition, reinforcement, and feedback

In order to keep those skills proficient, there has to be a lot of frequent ongoing training.[…] That’s where I think a lot of the providers are deficient in their skills. They’re not as confident because there are not enough training hours to support this large volume of skills that you have to maintain.

2. Preference for hands-on and small group setting

You know right off the bat, I think having that hands on, holding something in your hand experience, really, really cements how things are supposed to go.

3. Desire for more interaction with physicians and hospital setting

What we need more frequently is building that relationship between pre-hospital, medics, firefighters, everyone out there. Bridging that gap between the actual hospital providers and the emergency room. Knowing what they require of us, what information they would want in certain situations.

4. Receptive to high fidelity simulation

For me it would definitely be a strong preference for simulation. Simulation, simulation, simulation! Muscle memory of just going through calls. Doing a PALS class once a year is just not…it’s so woefully not enough. Just having the monitor, having the mannequin set up, calculating drug doses, running codes is important to practice.

5. Suspicion for more training / desire for on-job training

I would put the emphasis on in-service training because most of us are family people, we have kids. […] So I’ve got a kid, school, work. If it’s outside my work [...] I’m probably not going to go to a training. I’m going to look and say, okay I’ve got this assignment, or I got this [...] That can try to get me on a day off, but I’m not going to do it