Children in the ambulance: how do paramedics go about psychosocial care?

“The beer they gave Casper in the ambulance, calmed him down” she says.

The presenter is recounting the story of a boy who broke his leg in a swimming pool accident.

What? Is alcohol the latest innovation in professional care for children?

It keeps the audience in suspense for a while. Until it turns out presenter meant to say (teddy) ‘bear’, not ‘beer’. That presenter was me by the way 🙂 we had a good laugh about it.

Ambulance staff are often the first at the scene when a child is seriously injured. What do they know about children’s stress reactions? Have they had any training in psychological first aid? And how confident are they about providing it?

Those questions guided our latest project on emergency professionals’ care for injured children. It just came out in the European Journal of Psychotraumatology.

Our previous study focused on how Emergency Department nurses and doctors support children around the world. We found a strong need for education. This time, we conducted a survey among 812 ambulance staff, mostly working in the USA, Canada, and Australia.

These were our key findings:

1) Quite a few basic facts about child traumatic stress were unknown. For example, only a third of the respondents recognized that toddlers can develop long-term stress reactions. And only a fifth knew that more than 50% (actually, as much as 80%) of children may develop at least one symptom of acute stress post-trauma.

2) Similar to the ED staff, only a handful of paramedics had received any training regarding traumatic stress, while a large majority wanted to receive training. To be honest, we knew this already from our earlier interviews and conversations with staff; our surveys were secretly meant to provide a solid argument for anyone who wants to barrack for more education.

3) Overall, ambulance staff felt moderately confident about providing psychosocial care (a 3 on a scale from 1 – not at all, to 4 – very). On the one hand, that’s a good thing considering the pressure that paramedics are under when working with children:

“If there is any time that you want to do everything absolutely right, it’s when you have a small child” (Ambulance Nurse in Nordén et al. 2014, p. 77).

On the other hand, having confidence despite a lack of knowledge can be dangerous.

What now?

The surveys established that many emergency care providers want to learn about children and traumatic stress. Good materials can be found via the Health Care Toolbox,  AfterTheInjury, Psychological First Aid online training, and Recover. In addition, several teams are busy developing specific online training packages for healthcare providers.

Considering the time pressure that ambulance staff are under, it may be useful to establish priority elements of psychosocial care with them; what should a training package definitely include? If anyone is interested in such a project, do get in touch 🙂


Alisic, Tyler, Giummarra, Kassam-Adams, Gouweloos, Landolt, & Kassam-Adams (2017). Trauma-informed care for children in the ambulance: international survey among pre-hospital providers. European journal of psychotraumatology, 8 PMID: 28326162

Nordén, Hult, & Engström (2014). Ambulance nurses’ experiences of nursing critically ill and injured children: A difficult aspect of ambulance nursing care. International emergency nursing, 22, 75-80 PMID: 23711561

*Probably needless to say but for good measure: the picture, the name, and the story are not related to each other.

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