Training to Recognize Abuse & Neglect

Lurie Children’s recognizes that abuse and neglect are often hard to detect in our patients, and so we’ve developed training modalities to train our pre-hospital providers to recognize abuse.

Possible Signs

On a cool October evening, Chicago paramedic Maggie Coen-Murphy responded to a call for a child experiencing seizures and a very high fever. When she arrived, the child's grandmother handed her a naked, shivering 18-month-old boy wrapped in a towel. As Coen-Murphy assessed the child, several things raised red flags. The boy had no diaper bag, no bottle, no food or clothing. She also noticed bite marks in various stages of healing.

"Advocacy is not an afterthought in the emergency department," says Susan Fuchs, MD, Associate Division Head, Emergency Medicine. Fuchs leads the Emergency Medical Services team at Lurie Children's. "Anticipating children's needs helps us prevent injuries a way that we can't during brief encounters we have in the emergency room.”

Under her direction, Lurie Children's emergency department is reaching beyond the hospital walls to train pre-hospital providers — emergency medical technicians, paramedics, firefighters and police officers — how to recognize and respond to child abuse and neglect.

Not Status Quo

In 2003, Lurie Children's enhanced its capability of responding to patients arriving at the ER via the Chicago Fire Department. With the designation of Associate Hospital status granted by the Illinois Department of Public Health, the hospital joined only a handful of others that directly respond to calls from ambulances and paramedics in the field.

In the past, information on incoming patients was called in to Lurie Children’s through one of three intermediary resource hospitals. The new system eliminates the middleman. A dispatch center with a radio and telemetry system is staffed 24-hours a day and enables the hospital to answer calls directly from the field.

"Having Associate Hospital status elevates us in the EMS community," says Fuchs. "In addition to allowing us to provide direct medical advice to paramedics, we have a seat at regional meetings, ensuring that more pediatric expertise is part of the education for new pre-hospital care providers."

Paramedics — "Eyes & Ears"

Of the approximately 350 children evaluated for abuse and neglect each year at Lurie Children's, many of them are seen first by paramedics. Additionally, paramedics often observe potential cases of child abuse or neglect when they are called for medical needs of other family members. "Paramedics are the eyes and ears of the hospital," says child protective services team member Dana Wiltsek. "They can provide critical information from the home environment that's helpful in gathering a history." Furthermore, Wiltsek says, it's important for pre-hospital providers to feel confident in making a report to the  Illinois Department of Child and Family Services and navigating this system.

Fuchs, Wiltsek and Lurie Children’s emergency medical system coordinator Peter Lazzara, who conducts extensive training for pre-hospital providers on pediatric emergency care, felt that abuse and neglect were critical areas frequently overlooked in course material. In 1995 they received funding from the hospital's Office of Child Advocacy to launch the child maltreatment awareness project. Prior to developing a curriculum, they surveyed paramedics and found that even the most experienced felt uncertain about their responsibility when they confronted possibly abusive situations. "They told us that they didn't know they had the power to do anything about it," says Fuchs.

Vital Training & Practical Aids

Following the survey, they developed a two-hour training program that puts information and tools in the hands of paramedics, police, and firefighters who encounter abuse and neglect. "The training heightens their index of suspicion, raises red flags about who is at risk and defines the provider's role in the process," says Lazzara.

In addition to training approximately 1,200 Chicago Fire Department personnel, suburban fire department personnel, Chicago public school nurses and paramedic students, he has been asked to present the education program to audiences outside of Illinois. The child maltreatment courses can now be found online.

In an effort to not only report, but also support, families in crisis, the Child Maltreatment Awareness team developed a laminated reference card for paramedics with phone numbers for ancillary services such as domestic violence and elderly abuse hotlines and crime victims’ assistance programs. Paramedic Coen-Murphy appreciated having the Child Maltreatment Awareness training when she responded to the child experiencing seizures in October. "The course really heightened my awareness about what to do after the fact."

For their important work, both Fuchs and Lazzara received outstanding achievement awards from the Illinois Department of Health's Emergency Medical Services for Children program. Also, Prevent Child Abuse Illinois recognized the project with their Program Excellence Award.