Table 3 Examples of quotes supporting the major categories and subcategories
Challenges in providing medical care to pediatric trauma casualties in emergency departments daily routine and during mass casualty events | |
Subcategory | Examples of Quotes |
Lack of uniformity concerning the definition of a child | “I have a problem with any definition of what a child is... anyone over 50 kilogramsor over the age of 14 years is an adult as far as I am concerned.” “In certain hospitals the age limit for the definition of a child was changed because of perceptions, and for all sorts of reasons not related to anything medical. Someone wanted to increase capacity at a certain place or decrease it elsewhere and then suddenly a [person is a] child until the age of 18.” “There are places in which [the definition of a child] is until the age of 14, there are places 16, however it suits, it depends.” |
Medical Care management | “Sometimes, there is an ambiguity concerning who is responsible for managing the patient. Is it the (general) trauma surgeon, or the pediatric surgeon?” “Emergency medicine professionals do not understand anything about trauma.” |
Availability of human resources | “Experts in pediatrics can treat an injured child correctly right from the start ... the approach of a specialist, no matter how qualified he is in treating adults, is completely different when required to treat an injured child” “The problem lies entirely within the small surgical professions, such as in neurosurgery, ophthalmology, ear nose and throat that we do not always, or not at all, have on call.” |
Pediatric training and experience among physicians and nurses working in EDs. | “The problem is that a pediatric surgeon, by definition, almost never has training in pediatric trauma. The (general) trauma surgeon has experience in trauma but generally no experience with children.” “There may be a situation in which the majority of the medical teams have no previous experience in treating small children” “Who is assembling [training programs] for child care? Who is teaching trauma?” “I sent a nurse twice to an emergency medicine course but when I looked at the syllabus, I saw that the content she learnt was mostly irrelevant, so I felt that I was wasting the time of a very important resource [the nurse]” |
Variability in the healthcare system (that affects) the provision of medical care to pediatric trauma casualties in EDs | |
Subcategory | Examples of Quotes |
Different models for admitting and treating pediatric trauma casualties in EDs | “We do all the primary care [in pediatric ED]. An injured child arrives, whether it is an orthopedic injury or a head injury. We, the pediatric ED doctors respond… perform all the tests, and we call in a surgeon at some stage… we deal with the neurosurgeons if needed”. “The existing mode of operation is, at least here in Israel, that a child with severe trauma is treated in the adult trauma room”. |
The best setting for care of pediatric trauma casualties | |
Subcategory | Examples of Quotes |
The ED perceived as most suitable for pediatric casualties | “A child that is injured should be in a pediatric ED…similar to the way we treat a sick child, we should care for an injured child”. |
Centralizing the treatment of injured children | “I think that [severe] pediatric trauma, that is a severe but rare disease, should be cared for in a centralized manner, in only a few medical centers.” “The advantage of a central pediatric trauma care structure, i.e. treatment in a limited number of centers, is that each center acquires more experience and thus improves its capacity for providing the specific care it is expected to deliver.” |