Els van Meijel

118 Chapter 7 | General discussion phase of medical treatment. In Chapter 3 of this thesis, the role of severe acute pain in the development of later PTSDwas confirmed. The findings emphasize the importance of the use of pain protocols for children. Measuring pain and intervening according to the pain protocol during the acute phase after an accident can make the difference for children in pain. Besides pain, factors such as severe anxiety, feeling out of control and physical arousal are also well known. The introduction of a child-friendly environment, patient-oriented communication and the availability of interpersonal social support are other examples of factors that can be addressed in medical care (Alisic et al., 2011; Cox, Kenardy, & Hendrikz, 2008; Hildenbrand et al., 2016; Kahana et al., 2006; Kassam- Adams & Butler, 2017). The National Child Traumatic Stress Network developedmaterial and tools for acute stress management by health care professionals (Stuber, Schneider, Kassam-Adams, Kazak, & Saxe, 2006). After considering the medical parameters A-B-C (Airway-Breathing-Circulation), the D-E-Fs (Distress-Emotional support-Family) should have the professional’s attention. Each of the three components contains practical guidelines. Examples are: “Actively assess and treat pain”, “Give a reassuring explanation about normal stress responses” (Distress); “Encourage expression of emotion, but do not force to talk” (Emotional support); “Promote to seek social support” (Family). The material is modified in a checklist “How to help: D-E-F” for the Dutch practice (Bronner, 2009) and is currently in use in the pediatric intensive care unit in the University Medical Centers location AMC in Amsterdam. The introduction of Trauma-Informed Care (TIC; traumasensitieve zorg in Dutch) offers a way to target medical care related risk factors. TIC is a multidisciplinary approach to reduce the risk of persistent posttraumatic stress and PTSD after injury (Marsac et al., 2016; Weiss et al., 2017), and can be used in all phases of the PMTS model. TIC uses psychotrauma related knowledge in medical practice. Knowledge of pediatric medical traumatic stress and TIC is necessary to understand the potential iatrogenic psychological consequences of medical care for children, and also how to mitigate these consequences (Kassam-Adams & Butler, 2017). Findings of a recent study on TIC in practice on hospital staff and patients (Moss et al., 2019) can be used to prepare implementation of TIC. The practice examples described in this study can be incorporated in staff training programs. International research among health care professionals such as ambulance staff and emergency department staff suggests that there is much variation in knowledge and practice of TIC. Almost all responding staff stated that they want to improve their knowledge and receive training on child