Interpersonal Factors in the Emergency Care of Injured Children and Youth with Special Healthcare Needs.

Objective: Children and youth with special healthcare needs (CYSHCN) are those who have one or more chronic conditions necessitating medical, educational, and/or social services use. Of the 15 million CYSHCN, a quarter report accessing emergency care annually, some of whom have physical injuries. This study examines the perspectives, challenges, and opportunities identified by prehospital and hospital clinicians delivering injury care to CYSHCN.

Methods: Qualitative interviews were conducted with 23 hospital and 13 prehospital clinicians in one geographic region. All interviews were recorded and transcribed; interviews were analyzed using multiple coders and rapid analysis procedures to identify themes.

Results: One intrapersonal theme pertaining to clinicians' prior experiences and six interpersonal themes capture the factors characterized by the participating EMS- and hospital-level clinicians. Identified interpersonal themes include: 1) how prior experiences of injured CYSHCN shape future encounters with emergency care, 2) communication challenges specific to CYSHCN, 3) parental expertise and guidance during care, 4) emotional support, 5) trust-building, and 6) the need to balance accommodations pertaining to the child's special healthcare need in the emergent care context.

Conclusions: In prehospital and hospital settings, injured CYSHCN may need care for both their physical injury and their special healthcare need. Prehospital and hospital clinicians, who likely have not previously provided care for the child, are mindful of the opportunities and challenges this situation presents. These results inform an understanding of how clinicians approach care of injured CYSHCN in the emergency setting and indicate opportunities for future exploration, such as how to effectively leverage family strengths in this context.