PALS Provider: Course
Effective Communication in Pediatric Emergencies
Communication failures are a leading cause of medical errors during pediatric resuscitations. In high-stress situations, clear, structured, and assertive communication is essential to ensure team coordination, timely interventions, and optimal patient outcomes.
Key Objectives
- Ensure that instructions are clearly understood and executed.
- Minimize errors caused by miscommunication.
- Promote collaboration and mutual respect among team members.
- Facilitate real-time adjustments to treatment plans.
Common Communication Barriers
- High-stress environment and time pressure
- Unclear role assignments
- Distractions and simultaneous conversations
- Failure to confirm orders
- Intimidation or fear of speaking up
Closed-Loop Communication (CLC)
Closed-loop communication ensures that instructions are clearly received, understood, and executed:
| Step | Example |
|---|---|
| Team Leader Gives a Clear Order | “Give Epinephrine 0.01 mg/kg IV now.” |
| Team Member Repeats Back | “Epinephrine 0.01 mg/kg IV, on its way.” |
| Leader Confirms Execution | “Thank you. Let me know when it’s in.” |
Effective Language Usage
Use clear and concise language to reduce ambiguity:
| Ineffective | Effective |
|---|---|
| “We need epinephrine!” | “Give 0.01 mg/kg epinephrine IV now.” |
| “Start compressions.” | “Begin chest compressions at 100–120 per minute.” |
| “What’s going on?” | “Heart rate is 50 bpm; prepare for atropine.” |
Real-Time Callouts
Call out significant findings so the team can respond quickly:
- “Heart rate is 60 bpm after the last dose of epinephrine.”
- “We are 2 minutes into CPR; prepare for rhythm check.”
- “Blood pressure is dropping; begin vasopressor support.”
Structured Handoffs (SBAR)
| Step | Example |
|---|---|
| S = Situation | “We have a 4-year-old in cardiac arrest for 6 minutes.” |
| B = Background | “Previously healthy, collapsed suddenly.” |
| A = Assessment | “Received 2 doses of epinephrine, HR now 80 bpm.” |
| R = Recommendation | “Continue monitoring and initiate post-ROSC care.” |
Post-Event Debriefing
- What went well during the event?
- Were there any communication issues?
- Did everyone feel heard and comfortable speaking up?
- What can we do differently next time?
Fostering a Culture of Communication
- Encourage open dialogue: Junior staff should feel safe speaking up.
- Use a calm, confident tone: Helps maintain team focus.
- Assign roles early: Clarifies expectations and streamlines teamwork.
Common Pitfalls and How to Avoid Them
| Error | Consequence | Solution |
|---|---|---|
| Vague commands | Delayed or incorrect care | Use specific, direct language |
| Unconfirmed orders | Missed or duplicated treatments | Use closed-loop communication |
| Quiet or hesitant speech | Missed instructions | Speak clearly and confidently |
| Ignoring junior team input | Missed critical information | Encourage inclusive communication |
| No debriefing | Missed opportunity to improve | Always review post-event |
Final Takeaways
- Closed-loop communication ensures clarity and reduces errors.
- Clear, direct instructions are vital in high-stress environments.
- Routine callouts and structured handoffs improve team response.
- Debriefing builds better teams and improves future performance.
Takeaway: Skilled resuscitation teams succeed not just with knowledge, but with communication. Precision, clarity, and teamwork save lives.