The physiological and psychological differences between children and adults need not be stressed to a group of pediatricians, although I will take this opportunity to do so anyway. Careful consideration of the following differences is of critical importance during the emergency treatment of a pediatric patient.
- Children have smaller airways than adults, which are more easily obstructed by edema, secretions, foreign bodies or positioning.
- Children maintain blood pressure in the face of hypovolemia much longer than adults until a life-threatening volume loss is reached.
- Equipment, such as ETTs, oxygen masks, IV supplies, must be readily available in a variety of sizes.
- Medications must be calculated based on weight rather than the standard unit dosing used for adults.
- Children have different psychosocial needs and responses than adults, frequently fearing and resisting strangers and emergency interventions.
- Children cannot give accurate or often any information on their symptoms, history or pain so parents/caretakers are typically the source of such information.
Add to this, the sheer volume of pediatric ER visits, approximately 30 million per year or nearly 25% of all visits to US emergency rooms, as well as mounting evidence of poor outcomes of children receiving emergency medical treatment. This all led, starting in the late 1970s, to increasing public attention being paid to the inadequacies of the EMS system with regard to the pediatric population.