Published online January 2, 2007
PEDIATRICS Vol. 119 No. 1 January 2007, pp. e103-e108 (doi:10.1542/peds.2005-2121)
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ARTICLE

A National Assessment of Knowledge, Attitudes, and Confidence of Prehospital Providers in the Assessment and Management of Child Maltreatment

David Markenson, MDa,b, Michael Tunik, MDc, Arthur Cooper, MDd, Lenora Olson, PhD, MAe, Lawrence Cook, MState, Hedda Matza-Haughton, MSW, CSWf, Marsha Treiber, MPSc, William Brown, NREMT-Pg, Phil Dickinson, NREMT-Pg and George Foltin, MDc

a Pediatric Emergency Medicine Section, Department of Pediatrics
b Department of Emergency Medicine, Maria Fareri Children's Hospital/New York Medical College, Valhalla, New York
c Center for Pediatric Emergency Medicine, Department of Pediatrics and Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center, New York, New York
d Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/Harlem Hospital Center, New York, New York
e National Emergency Medical Services for Children Data Analysis and Research Center, Department of Pediatrics, University of Utah, Salt Lake City, Utah
f "For the Health of It" Consultation Services, New York, New York
g National Registry of Emergency Medical Technicians, Columbus, Ohio

OBJECTIVE. The goal was to assess the knowledge and confidence in recognition, management, documentation, and reporting of child maltreatment among a representative sample of emergency medical services personnel in the United States.

METHODS. A questionnaire was developed and pilot-tested, with the input of experts in emergency medical services and child maltreatment, to assess knowledge, attitudes, confidence, and training needs regarding assessment and treatment of child maltreatment. The questionnaire was distributed nationally to a random sample of prehospital providers by using a previously validated sampling plan.

RESULTS. Of 2863 surveys sent to prehospital providers, 1237 (43%) were returned. Most prehospital providers reported receiving ≤1 hour of continuing medical education regarding child maltreatment. Most (78%) asked for additional educational opportunities, with only 3% stating that they required no additional training. Participants lacked knowledge regarding the developmental abilities of children, management of families in which child maltreatment is suspected, key elements of the history that should be noted, and the degree of suspicion necessary for reporting.

CONCLUSIONS. Prehospital providers expressed confidence in their abilities to recognize and to manage cases of child abuse and neglect; however, significant deficiencies were reported in several critical knowledge areas, including identification of child maltreatment, interviewing techniques, and appropriate documentation.

Key Words: child protection • child maltreatment • child abuse and neglect • emergency medical services

Abbreviations: EMS—emergency medical services • EMT—emergency medical technician • CME—continuing medical education

Accepted Jul 31, 2006.