Implementation of a Child Maltreatment Screening Tool in the Prehospital Setting

Objectives: Emergency Medical Services (EMS) clinicians are in a unique position to screen for child maltreatment as they are often the first point of contact with the health care system and they may encounter children in their home environment. However, EMS training regarding the signs of child maltreatment is lacking. Although several child maltreatment screening tools have been developed for the primary care and Emergency Department (ED) settings, there appears to be no published literature describing or evaluating a prehospital screening aid. The objective of this study was to develop, implement, and examine the effectiveness and acceptability of a prehospital child maltreatment screening tool.

Methods: We completed a mixed methods qualitative and quantitative study, with data collection spanning June 2021-June 2022. We developed a child maltreatment screening tool "Shield" for the prehospital setting by adapting Pittsburgh Child Abuse Screening Tool (P-CAST), a screening tool developed at the University of Pittsburgh for use in the ED. Shield was integrated into the EMS electronic Patient Care Report (ePCR) for three participating fire agencies. Data, including demographics, ED evaluation, and outcomes, were collected for patients who underwent Shield evaluation. The EMS clinicians completed self-assessment surveys and participated in focus groups to provide feedback on their experience using Shield.

Results: Participating EMS agencies evaluated 1,054 eligible patients (children <15 years old) during the study period, June 2021-June 2022. Of these, Shield screenings were initiated on 948 patients and completed on 753. Among all patients for whom a Shield evaluation was started, 32 (3.4%) screened positive for findings and/or histories concerning for possible maltreatment. Of these, 20 patients were transported to the primary study institution; in the ED 10 patients underwent additional child maltreatment evaluation. Pre-implementation surveys suggested a majority (77.2%) of EMS clinicians desired a child abuse screening tool integrated into the ePCR and post-implementation focus group data demonstrated EMS clinicians found Shield to be well integrated into their ePCR.

Conclusions: Shield screens were initiated on nearly 90% of pediatric patients evaluated by EMS during the study period, suggesting that this tool has the potential to help standardize child maltreatment screening in the prehospital setting.