A management model for admission and treatment of pediatric trauma cases

Background Pediatric trauma, particularly major trauma cases, are often treated in less than optimal facilities by providers who lack training and experience in treating severely injured children. We aimed to develop a management model for admission and treatment of pediatric trauma using the Theory of Constraints (TOC). Methods We conducted interviews with 17 highly experienced policy makers, senior nursing managers and medical managers in pediatrics and trauma. The interviews were analyzed by qualitative methods. The TOC was utilized to identify undesirable effects (UDEs) and core challenges, and to design a focused current reality tree (CRT). Subsequently, a management model for optimal admission and treatment of pediatric trauma was constructed. Results The CRT was illustrated according to 4 identified UDEs focusing on lack of: (1) clear definitions of case manager in pediatric trauma; (2) uniform criteria regarding the appropriate site for admitting pediatric trauma, (3) standard guidelines and protocols for treatment of trauma cases and for training of trauma medical teams; and (4) standard guidelines for evacuating pediatric trauma patients. The management model for treatment and admission of pediatric trauma is based on 3 major elements: human resources, hospital policy concerning the appropriate emergency department (ED) for pediatric trauma patients and clear definitions regarding children and trauma levels. Each of the elements contains components that should be clearly defined in order for a medical center to be designated for admitting and treating pediatric trauma patients. Conclusions Our analysis suggests that the optimal ED for pediatric trauma cases is one with available operating rooms, intensive care beds, an imaging unit, laboratories and equipment suitable for treating children as well as with staff trained to treat children with trauma. To achieve optimal outcomes, medical centers in Israel should be classified according to their trauma treatment capabilities and their ability to treat varied severities of pediatric trauma cases.

The Politicised Child During the Seventeenth-Century British Civil Wars: An Historical Perspective on Representations of Children and Trauma During Conflict

The seventeenth-century British Civil Wars had a scale and impact to rival modern conflicts and its effects extended to children as well as adults. What might be today termed “child soldiers” were found in the armies in combat and supporting roles. Many more were witnesses to the conflict or had their lives changed by its consequences. This article is an historical case study of socio-cultural constructions of children, childhood and warfare. It aims to highlight the diverse nature of both historic and modern child experiences of warfare, and the plethora of ways that these experiences were and are understood and represented by adults. It argues that the evidence from the Civil Wars supports the scholarship of child psychologists such as Derek Summerfield that children in conflict should not always be regarded as victims but could display agency, whilst also acknowledging social, cultural, economic and political pressures. Although children in the Civil Wars may have experienced trauma, the evidence is insufficient to prove this and evidence for a contemporary concept of the psychologically damaged child as a result of conflict is ambiguous. However, what the evidence does uncover is the ways in which adults used representations of children to express their own anxieties about the Civil Wars.