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Allowing Parents To Ride In The Ambulance


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#21 Tim Hoffman

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Posted 30 April 2009 - 10:51 PM

We are the transport team for a large PICU with a busy referral system. (about 60 beds) I find that bringing a parent helps calm most children down considerably. Some kids get upset if the parent isn't walking in front of the stretcher where they can be seen at all times. Separation anxiety is real and profound depending upon the patient's age.
The decision should be a 'guideline' left to the crew to determine after assessing each situation. (This is assuming the laywers are letting them in the vehicle in the first place)
If the child is easier to assess and manage with the parent there, then they should go, and be in the compartment with the patient.
If the child is more upset with the parent there or if the parent is too emotional and not easy to control then they need to ride up front, or not at all.
Critically ill kids tend to be unconcious so their emotional state is not the concern. The issue becomes with what Eric mentioned; what if the child has a poor outcome? One train of thought says "Let the parent see it all so they can know and understand that the crew was competent and caring and all that could be done for their little one was done." This is a huge part of the grieving process. This may not be physically possible depending upon space and configuration of the vehicle. An advantage of ground transport is that we can stop and remove the parent from the area if need be. I don't fly much, but asking a parent to leave the helicpter may not go over well with the bosses.
Note: I have a lot of experience with this and I've found that talking very straight to the parents and setting ground rules prior to leaving the facility avoids many headaches down the road. A conversation may go like this. "You're little boy/girl is very sick. This transport carries a lot risks with it, but he/she needs resources that just aren't availble here. You may ride with us in the back of the ambulance, BUT, if your child becomes unstable during the trip, his/her life depends upon you staying out of our way and listening to every word we say. Do you understand this?" Then follow it up with something a bit more lighthearted if you feel the situation warrants it. You didn't catch the social worker part of the job description when you signed up, did you?

This is why crews need to be well trained and adapt to each patient and situation accordingly. I don't know if this helped answer your initial question.

One more note before I get even more long winded. Some kids out there have some exotic stuff going on. It's impossible to be an expert at everything. Parents know their kids better than anyone. Use them and their info.

P.S. DVD players are an absolute godsend in pediatric transport. Spend the money. It's well worth it! SpongeBob is better than benzos!

Regards,

Tim

We are 100% pediatric, and we try to take a parent along of at all possible on all 3 modes of Transport. On ground, we have hem ride up front almost all the time. We, too, have found that the patient becomes more calm more quickly when you separate them from the added emotional stress that the parent usually brings along. Baring physical or emotional limitations, I could not, however, understand why a program would not allow the parent along. On rotor, we take them if they can deal with it emotionally, can speak and understand English, and we have the capability to carry the added weight. On FW, the same applies.

On more than a couple of occasions, I have transferred care of the child to the receiving unit and the child has died soon after. How would you not allow the parent to be there for one last kiss or to say goodbye. Our program and health system is very focused on family centered care. This involves having the patient's primary caregiver around as much as possible.


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#22 BackcountryMedic

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Posted 30 April 2009 - 11:09 PM

P.S. DVD players are an absolute godsend in pediatric transport. Spend the money. It's well worth it! SpongeBob is better than benzos!


I must second this advise. When I worked ground, one of the AMB's I worked on had a DVD player. I carried my personal IPOD with some downloaded cartoons while in the other AMB's. I found the Star Wars cartoon to be worth 3mg morphine in most kids, even though I wanted to kill myself after the 10th viewing. If the kid was I awake I would start a movie before attempting an IV. The kids almost never even let out a cry. Distraction is powerful medicine in a kid. Tim is right on with his recommendation.

I've flown parents on a number of occasions. It is a pain in the ass for me, but it's not about me. As long as the entire crew agreed and the parent was manageable I would recommend it.
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#23 Simon Martin

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Posted 01 May 2009 - 11:54 PM

I've been flying for over 8 years now (mix of FW and RW), over 3000 flight hours and I can count on one hand the number of times we did NOT take a parent with us, and they were always because a parent was not available to go (comcomittant trauma, intoxication etc). I always talk to the parent first and assess their mental state and have rarely been concerned. They always manage to pull it together for the sake of their child.
I have NEVER had a parent "lose it" in the back and even the older literature from the AHA talks about having parents present during resucitation attempts, that I believe extrapolates to transport.
It is very beneficial to the child and the parent as well and and apparently reduces law-suits as the parents truly know you did all you could. More often than not it results in a "thank you" from the parent for accomodating them.
Since becoming a parent, I can not imagine someone trying to separate me or my wife from our child if they were ill/injured.
This also raises the issue of consent. If you remove the child from their parent, and their condition changes in any way, how can you obtain appropriate consent for that child?
I think that having a policy forbidding the transport of a parent with their child is at best narrow minded and short sighted and at worst cold and heartless...........
Just my 2 cents?
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#24 fire_911medic

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Posted 04 May 2009 - 01:49 PM

P.S. DVD players are an absolute godsend in pediatric transport. Spend the money. It's well worth it! SpongeBob is better than benzos!


I strongly second that - I noticed recently some hospitals - especially peds hospitals or those that have a large amount of pediatric cases are using IPhones or videos for kids to watch pre - op. They say it has reduced in many cases or even eliminated the need for pre-medicating the kids. Amazing what a little entertainment will do for the little ones. Haven't tried star wars yet though - I couldn't stand it the first time around don't know how you survived ten ! I'll take sponge bob and strawberry shortcake over Chewbaca anyday !
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#25 John9909

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Posted 12 October 2009 - 09:52 AM

We allow one parent by any mode (depending on the parent's behavior and size) to ride with us. We have quite vast transport distances and find that, logistically, a parent often assists in the transition of care to the receiving hospital. The entire team, including medical staff, drivers, and pilots help make the choice about suitability for riding along. There hasn't been a major incident with the policy of taking a parent.
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#26 JPatterson

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Posted 17 November 2009 - 07:55 PM

At my program it is completely up to the crew.
I used to be of the mindset that parents were a distraction and a possible hazard until I became a father. Now, I find myself advocating for parents to ride along as long as they are emotionally stable, sober, and are not a medical liability (I don't want 2 patients). The parents ride in the back seat of the quad cab to avoid driver distraction unless the child is not settling well or has autism etc that make the parents presence almost mandatory. If the parent rides in the back, we brief them about if something goes wrong, they will be asked to unbelt, walk to the cab, and belt in a designated seat. We assure them that we will keep them informed if this happens and explain that we do this to avoid distractions when we need to focus on their child. They also have a clear line of site to the back of the truck and can see what is going on and speak to the child if needed.
I have had a couple occasions that parents were not cooperative and attempted to interfere, but that is not the norm.
Nothing feels worse than having to tell a parent their child died 2 hours after denying them the chance to ride with you and knowing that the child died in a scary place surrounded by strangers. That is why I want parents with us if the child is critically ill.

Respectfully submitted,

Jeff NREMT-P CCT
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Jeff Patterson NREMT-P

#27 emsrn

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Posted 18 November 2009 - 03:46 AM

Does anyone have and research and or articles related to transporting Parents along with pediatric pts.... I am working on a ethics project for grad school.


I don't know of any studies relating to parent riders with HEMS, FW, or ground; but, there are some studies that address parents being in the room during coding of children and the benefits. I don't know if they would be any help to you if you are specifically looking for transport related material.
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#28 flightnursesarah

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Posted 21 November 2009 - 06:12 PM

We do RW and ground transports. For ground, we contract with a local ambulance service for their rig and crew. If we all agree the parent can go with us (room allows, the parent is emotionally stable, the child is not ready to arrest), the parent rides up front in the rig. We do not allow the parents to be in the back with us.

As far as RW, we do not have a concrete policy on parents riding with us. I have been there 7 years, though, and only know of once instance that any parent came along. The child had epiglottitis and the crew was worried about stressing the child any further.

The great majority of the children that we transport are critically ill and are sedated and intubated, so adding a parent to the mix would probably not have a great effect on the child. We are also worried about the safety aspect of throwing an anxious parent into the mix. The only seat available for the parent would be the co-pilot seat.

Most of us are parents and can only imagine what those parents are going through. We understand that the parents are very worried about their child and flying in the helicopter. We try to give reassurance the best we can, and phone them the minute that the helicopter lands at the hospital.
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#29 Macgyver

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Posted 21 November 2009 - 09:24 PM

I've been flying for over 8 years now (mix of FW and RW), over 3000 flight hours and I can count on one hand the number of times we did NOT take a parent with us, and they were always because a parent was not available to go (comcomittant trauma, intoxication etc). I always talk to the parent first and assess their mental state and have rarely been concerned. They always manage to pull it together for the sake of their child.
I have NEVER had a parent "lose it" in the back and even the older literature from the AHA talks about having parents present during resucitation attempts, that I believe extrapolates to transport.
It is very beneficial to the child and the parent as well and and apparently reduces law-suits as the parents truly know you did all you could. More often than not it results in a "thank you" from the parent for accomodating them.
Since becoming a parent, I can not imagine someone trying to separate me or my wife from our child if they were ill/injured.
This also raises the issue of consent. If you remove the child from their parent, and their condition changes in any way, how can you obtain appropriate consent for that child?
I think that having a policy forbidding the transport of a parent with their child is at best narrow minded and short sighted and at worst cold and heartless...........
Just my 2 cents?


Ditto - and agree fully. also as said earlier

Some kids out there have some exotic stuff going on. It's impossible to be an expert at everything. Parents know their kids better than anyone. Use them and their info.

P.S. DVD players are an absolute godsend in pediatric transport. Spend the money. It's well worth it! SpongeBob is better than benzos!


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Ken BHSc, RN, REMT-P

#30 ljwrn99

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Posted 21 April 2010 - 03:10 PM

we allow 1 parent or legal gaurdian to ride. they usally ride in back, unless we feel that theu might imped our care then they ride up front
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#31 Grouse

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Posted 14 February 2011 - 06:28 AM

A parent always goes but normally ride up front..... I have the parent fade out of sight before we place the child in the ambulance and ask them to keep their voice low while riding up front. Normally, within five minutes, they adjust and are fine..... Having parents ride in the back keeps them very "clingy" and less likely to accept your presence. Try this... I've done peds transport for a long time and it works like a charm......
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#32 CheetahBreath

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Posted 07 December 2011 - 04:51 AM

Our team usually takes one parent and we usually relegate the parent to the front. The parents are usually exhausted and tend to nap on the way to the hospital, and the kids almost always nod off as soon as we pop in the DVD. This is a team decision though. We have had a handful of parents ride in back; often parents of our well-known SMA population. They really bring so much to care of these kids. They will have a better history of our patient's current problem then anyone at the RH will, and they are better interpreters of their child's muffled voice than we are. We have also dealt with scary and out-of-control parents that are just kept off the truck entirely.
so, TL;DR We usually take one, in front, and it's a team decision.
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#33 Macgyver

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Posted 08 December 2011 - 11:00 PM

Recently heard of a program (FW) based in NM that flew single pilot with the parent in the co-pilot seat (with live controls) that had a VERY unfortunate incident where it is alleged that the mother dove the aircraft into the ground just after takeoff (probable shaken baby with dismal prognois)

If anyone has any FACTS they can share it would be a good case / NTSB report to read...
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#34 jmalia1

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Posted 23 December 2015 - 07:51 PM

We let one parent ride in the ambulance or helicopter. Our goal building a new ambulance is to build in a safe seat designated for the parent in the back and then anyone else can ride up front in the quad cab. Currently we just don't have the room for more than one parent.


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