View from the door: Making pediatric transport decisions based on first impressions

Area of Science:

• Emergency Medicine
• Pediatric Care
• Prehospital Services

Background:

• The Pediatric Assessment Triangle (PAT) aims to standardize the "view from the door" assessment.
• Despite widespread teaching, the PAT's validity and practical application require further investigation.
• Understanding how experienced providers utilize prehospital assessment is crucial before validating the PAT.

Purpose of the Study:

• To determine if experienced prehospital providers can use "view from the door" information for pediatric transport decisions.
• To assess if the information used in the "view from the door" aligns with the Pediatric Assessment Triangle (PAT).

Main Methods:

• Ethnographic analysis was employed to identify emergent themes.
• A convenience sample of 12 EMTs observed videos of pediatric patients.
• Participants made transport decisions based on visual assessment of the patients.

Main Results:

• The average time to make a transport decision was 12.25 seconds.
• In 71% of cases, providers opted for immediate transport ("load and go").
• No correlation was found between CUPS status and transport decisions. Key decision factors included airway/breathing, consciousness, circulation, treatment plan, and anticipated outcomes.

Conclusions:

• Experienced prehospital providers utilize specific "view from the door" elements for pediatric transport decisions.
• These observed elements align with the principles of the Pediatric Assessment Triangle (PAT).
• The "view from the door" assessment is a time-efficient triage method in prehospital pediatric care.