Paramedics, firefighters, physicians, nurses and psychologists recently met at APA headquarters to identify ways to help emergency medical personnel and rescue workers who care for severely ill and injured children address their psychological needs.

Pediatric emergency caregivers can experience myriad emotions and psychological problems--feelings of helplessness, post-traumatic stress disorder, substance abuse, marital problems, burnout, compassion fatigue and eating disorders.

For caregivers on the front lines, treating children can be more stressful than treating adults who are similarly afflicted with acute injuries or illness, says George Everly, PhD, a psychologist with the International Critical Incident Stress Foundation who participated in the meeting.

"The innocence of children, and their right to grow into adults is assumed to be part of a natural and just world," says Everly. "If the caregiver is unable to mitigate a child's suffering, or if a child dies, the caregiver feels that he or she has betrayed a trust given to those who care for children and has violated the fundamental right of children to be protected, nurtured and otherwise kept safe."

APA invited 20 health professionals from all over the United States to the October conference called, "Mental health needs of emergency medical services for children providers." A main concern among conference participants was the fact that many emergency rooms and police, fire and paramedic units have no formal or informal services to address the mental health needs of service providers. And scheduling debriefings or counseling sessions after stressful events is difficult, participants said.

Speaker Wayne Zygowicz, division chief of the Littleton Fire Department in Littleton, Colo., described the feelings of anger, distress and guilt that firefighters who worked during the Columbine High School shooting in April 1999 experienced after the incident. Underscoring the need for protocol in helping stressed staff, Zygowicz says he was unable to find comprehensive information on how to help his staff.

"We found that there were no road maps for what was going to happen [with people] down the line," he says. "No one could give us the answers."

The group concluded that emergency institutions and leaders need more information on ways to manage critical-incident stress and address the psychological needs among pediatric emergency staff. More research is needed on the efficacy of stress-reduction programs, who should provide interventions and offer debriefings, when debriefings should occur and whether interventions can make stress symptoms worse, they agreed.

The group also recommended that emergency caregivers and mental health professionals:

  • Establish courses and continuing-education programs on the stress involved in providing emergency care for children at professional schools and in emergency medical training programs.

  • Encourage leaders and supervisors in emergency care and medical settings to help erase the stigma often associated with seeking help for mental health problems by persuading emergency caregivers to use stress-reduction programs and individual counseling.

  • Build community partnerships among police, firefighters, paramedics, chaplains and psychologists to better prepare for community disasters such as the Columbine shootings.

The conference was held as part of an APA contract with the Emergency Medical Services for Children (EMSC) program--part of the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services and the National Highway Traffic Safety Administration. The meeting was the third conference on the topic of emergency medical services for children held at APA. The first conference, held in July 1997, explored ways to train EMSC staff in violence prevention, and the second conference, held in June 1999, addressed the mental health needs of children involved in the emergency medical system.

Further Reading

For more information on the EMSC project, contact APA's Public Interest Directorate at (202) 336-6046 or by e-mail.