RESUMO
Pediatric behavioral health emergencies (BHE) are increasing in prevalence, yet there are no evidence-based guidelines or protocols for prehospital management. The primary objective of this scoping review is to identify prehospital-specific pediatric BHE research and publicly available emergency medical services (EMS) protocols for pediatric BHE. Secondary objectives include identifying the next priorities for research and EMS protocol considerations for children with neurodevelopmental conditions. This is a scoping review comprised of a research literature search for publications from 2012-2022 and an internet search for publicly available EMS protocols from the United States. Included publications contain data on the epidemiology of pediatric BHE or describe prehospital management of pediatric BHE. EMS protocols were included if they had advisements specific to pediatric BHE. A total of 50 research publications and EMS protocols from 43 states were screened. Seven publications and four protocols were included in this study. Research studies indicated an increase in pediatric BHE over the last decade, but few papers discuss current prehospital management (n=4). Two EMS protocols were specific to pediatric BHE or pediatric agitation, and the other two EMS protocols focused on adult populations with integrated pediatric recommendations. All four EMS protocols encouraged nonpharmaceutical interventions prior to the use of pharmacologic restraints. Although there is a substantial rise in pediatric BHE, there is sparse research data and clinical EMS protocols to support best practices for prehospital pediatric BHE management. This scoping review identifies important future research aims to inform best practices for the prehospital management of pediatric BHE.
RESUMO
Small-scale fisheries underpin the aquatic food supply, and are facing acute challenges in the wake of the COVID-19 pandemic. The study aimed to examine how small-scale fishing households, including fishers and fish traders, are responding to COVID-19 and associated movement restrictions around Lake Victoria, Kenya. We conducted phone interviews with 88 households in three riparian communities around Lake Victoria to examine shifts in fish consumption, fishing activities, price changes, and coping strategies. We found that households are consuming less fish, perceiving high fish prices, and coping by more often selling than eating fish. Most fishers and traders reported spending less time fishing and trading, and concern about being infected with COVID-19 was high. Our findings suggest movement restrictions and COVID-19 concern, along with high lake levels in the region, may limit fishing activities and fish access. Controlling COVID-19 and supporting opportunities for fishers and traders to safely return to their livelihood activities will be paramount to the recovery of small-scale fishing communities today. Our findings can also support planning to mitigate the impacts of future crises on small-scale fishing communities.
