MR BUMP STUDY
Research type
Research Study
Full title
Emergency Response—Children’s Traumatic Brain Injury Management and Triage in the Prehospital Setting: A Qualitative Study
IRAS ID
329465
Contact name
Richard Body
Contact email
Sponsor organisation
University of Manchester
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Research Summary:
Traumatic Brain Injury (TBI) is a frequent reason for paediatric emergency medical services (EMS) transport. Paramedics' approach to paediatric TBI cases can vary depending on service policies. Some require paramedics to transport children under two years old, regardless of injury severity. The paramedics' role is to assess injury severity, triage, and transfer patients to the appropriate facility to prevent further brain damage. However, paramedics lack a formal system to evaluate paediatric TBI in different age groups, making decisions challenging. Several factors influence their decisions, including parental presence and concern, and the child's unfamiliarity with emergencies, making the situation more distressing for them. Decision-making is complex, especially in prehospital settings, and the paediatric context adds to the difficulty.
This study aims to understand the challenges paramedics face when dealing with paediatric TBI in prehospital settings and explore potential solutions. It consists of three main components:
1. Evaluating existing guidelines for managing paediatric head injuries in the UK prehospital environment.
2. Exploring paramedics' experiences, obstacles, and decision-making processes in managing paediatric TBI cases.
3. Gathering perspectives from patients and their parents through interviews to understand their views on the care provided.By using a qualitative approach, this study seeks to provide comprehensive insights and develop a new pathway to enhance paramedics' decision-making when triaging children with head injuries in prehospital situations.
Summary of Results:
Head injuries in children are common, and many families call emergency services when they happen. We noticed that most children with a mild head injury were taken to hospital by ambulance, even though many of them did not need hospital treatment. This puts extra pressure on emergency services and can be stressful for families.
We wanted to understand why this happens. To do that, we spoke with:
Paramedics, who assess and treat children before they reach hospital Parents, who decide to call for help Children, who experienced the head injury We asked about their views and experiences of care before reaching hospital. We were especially interested in their thoughts about “non-conveyance,” which means choosing not to take a child to hospital when it is safe to care for them at home.
What we found:
Paramedics often choose to transport children because paediatric cases feel high-pressure and challenging, and because current protocols usually default to taking children to hospital.
Parents are understandably worried about brain injuries and often want a hospital check for reassurance, even when the injury is minor.
Children told us they felt safe and reassured when paramedics arrived, and many trusted their judgement.
Using these insights, we developed a new care pathway to help paramedics assess mild head injuries in children more consistently. The pathway also supports shared decision-making with parents, giving them clear information on what symptoms to look out for and when hospital care is genuinely needed.
Our aim is to reduce unnecessary ambulance journeys and hospital visits while keeping children safe and giving families confidence in care provided at home.REC name
West Midlands - Black Country Research Ethics Committee
REC reference
23/WM/0261
Date of REC Opinion
15 Mar 2024
REC opinion
Further Information Favourable Opinion