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Study Objective: Child abuse and neglect is common in the United States, and victims often present to emergency departments (EDs) for care. Most US children who seek care in EDs are treated in general EDs without specialized pediatric services. We aim to explore general ED providers' experiences with screening and reporting of child abuse and neglect to identify barriers and facilitators to detection of child abuse and neglect in the ED setting., Methods: We conducted 29 semistructured interviews with medical providers at 3 general EDs, exploring experiences with child abuse and neglect. Consistent with grounded theory, researchers coded transcripts and then collectively refined codes and identified themes. Data collection and analysis continued until theoretical saturation was achieved., Results: Barriers to recognizing child abuse and neglect included providers' desire to believe the caregiver, failure to recognize that a child's presentation could be due to child abuse and neglect, challenges innate to working in an ED such as lack of ongoing contact with a family and provider biases. Barriers to reporting child abuse and neglect included factors associated with the reporting process, lack of follow-up of reported cases, and negative consequences of reporting such as testifying in court. Reported facilitators included real-time case discussion with peers or supervisors and the belief that it was better for the patient to report in the setting of suspicion. Finally, providers requested case-based education and child abuse and neglect consultation for unclear cases., Conclusion: Our interviews identified several approaches to improving detection of child abuse and neglect by general ED providers. These included providing education through case review, improving follow-up by Child Protective Services agencies, and increasing real-time assistance with patient care decisions., (Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Aims and Objectives: We explored perceptions about capnography for procedural sedation and barriers to use in a paediatric emergency department., Background: Capnography is a sensitive monitor of ventilation and is increasingly being studied in procedural sedation. While benefits have been found, it has not gained wide acceptance for monitoring of children during sedation., Design: A qualitative exploratory study was performed., Methods: Using a grounded theory approach, physicians and nurses from the paediatric emergency department participated in one-on-one interviews about their experiences with and opinions of capnography. An iterative process of data collection and analysis was used to inductively generate theories and themes until theoretical saturation was achieved., Results: Five physicians and 12 nurses were interviewed. Themes included: Experiences: Participants felt that procedural sedation is safe and adverse events are rare. Normal capnography readings reassured providers about the adequacy of ventilation. Knowledge: Despite experience with capnography, knowledge and comfort varied. Most participants requested additional education and training. Diffusion of Use: While participants expressed positive opinions about capnography, use for sedation was infrequent. Many participants felt that capnography use increased in other paediatric populations, such as patients with altered mental status, ingestions or head trauma. Barriers: Identified barriers to use included a lack of comfort with or knowledge about equipment, lack of availability of the monitor and cannulas, lack of inclusion of these supplies on a checklist for procedural sedation preparedness, and lack of a policy for use of capnography during sedation., Conclusion: Capnography use during sedation in the paediatric emergency department is limited despite positive experiences and opinions about this device. Addressing modifiable barriers such as instrument availability, continuing education, and inclusion on a checklist may increase use of capnography during sedation., Relevance to Clinical Practice: Despite the perceived benefits, a broad implementation plan is required to introduce capnography successfully to the paediatric emergency department., (© 2015 John Wiley & Sons Ltd.)

Background: In disasters, paramedics often triage victims, including children. Little is known about obstacles paramedics face when performing pediatric disaster triage., Objective: To determine obstacles to pediatric disaster triage performance for paramedics enrolled in a simulation-based disaster curriculum., Design: We conducted a qualitative evaluation of paramedics' self-reported obstacles to pediatric disaster triage performance. The paramedics were enrolled in a pediatric disaster triage curriculum at one of three study sites. An individually administered, semi-structured debriefing was created iteratively, and used after a 10-victim, multiple-family house fire simulation. The debriefings were audio-recorded, and transcribed. Two investigators independently analyzed the transcripts. Using grounded theory strategy, the data were analyzed via 1) immersion and coding of data, 2) clustering of codes to generate themes, and 3) theme-based generation of hypotheses. While analyzing the data, we employed peer debriefing to determine emerging codes, groups, and thematic saturation. Systematically applied data trustworthiness strategies included triangulation and member checking., Results: A total of 34 participants were debriefed, with prehospital care experience ranging from 1 to 25 years of experience. We identified several barriers to pediatric disaster triage: 1) lack of familiarity with children and their physiology, 2) challenges with triaging children with special health-care needs, 3) emotional reactions to triage situations, including a mother holding an injured/dead child, and 4) training limitations, including poor simulation fidelity., Conclusion: Paramedics report particular difficulty triaging multiple child disaster victims due to emotional obstacles, unfamiliarity with pediatric physiology, and struggles with triage rationale and efficiency.