Emergency Medical Services (EMS) Clinician Perspectives on the Pediatric Observation Priority Score (POPS)

Approximately 50% of children assessed by emergency medical services (EMS) in the United States (U.S.) have no emergent needs. The lack of validated triage tools to identify children at low risk of deterioration without transport is one reason that children have not been included in most alternative disposition programs. The Pediatric Observation Priority Score (POPS) is a triage tool incorporating vital signs and clinical observations. British prehospital studies show the POPS accurately identifies low-acuity children. The POPS has not been assessed in the U.S. Our objective was to determine whether U.S. EMS clinicians find the POPS acceptable, appropriate, and feasible.

We conducted a mixed methods study with EMS clinicians. Participants were provided with an overview of the POPS then completed a survey using the validated Acceptability, Appropriateness, and Feasibility of Implementation Measures (12 Likert-scale questions [1 = strongly disagree to 5 = strongly agree]). We calculated mean question scores. A PhD-trained facilitator conducted cognitive interviews with a subset of participants to explore their perception of the POPS. Multiple investigators coded transcripts until we reached thematic saturation.

We recruited 100 participants (51% paramedics, 48% emergency medical technician (EMTs)) with a median (IQR) of 5 years (3, 9) clinical experience. Individual question mean scores across all domains ranged from 4.4-4.6. Paramedic and EMT responses were similar. 10 participants completed interviews and agreed the POPS was acceptable, appropriate, and feasible. Positive themes from analysis included: (1) ease of use and (2) helpful additional tool. Facilitators to implementation included (1) embedding the POPS in documentation systems (2) with a force function, (3) positive messaging, and (4) incorporating the POPS in protocols. Implementation barriers included (1) resistance to mandatory documentation, (2) undermining professional standing, (3) impaired rapport with patients, (4) uncertainty about integration with protocols, (5) and concern about legal liability. Participants suggested changes in wording and question order to improve usability.

Prehospital clinicians in the U.S. find the POPS acceptable, appropriate, and feasible for implementation with minor modifications. Further research is needed to determine whether EMS clinicians can accurately apply the POPS in controlled and field settings before implementation.