Children’s Ability to Call 911 in an Emergency: A Simulation Study

Participants were typically developing primary school–aged children from an urban school. Participants were recruited by using research information letters, and an in-person information session was held to answer parents’ questions. Ethical approval was obtained from St. Michael’s Hospital Research Ethics Board, and informed consent and assent were obtained. A parent questionnaire to collect participant demographic information including age, sex, previous emergency education, and experience with mobile devices was administered. Caregiver sociodemographic data were also collected, including education level and annual household income.

The study was explained to each child individually and each child assented to participating in a practice emergency simulation. The simulated scenario required them to recognize an emergency, dial 9-1-1, and report the emergency using a simulated 9-1-1 smartphone application designed for this study. During the simulation, an actor playing the role of a school helper engaged the child in an educational activity (ie, reading a book) in a school library. The actor received a call on his smartphone and then placed it on the table in front of the child, so it was visible and accessible. Subsequently, the actor, who was eating a snack, started to choke on his food and cough while clutching his neck (ie, universal choking sign) and then collapsed to the floor: a situation that requires calling 9-1-1. If the child dialed 9-1-1 correctly on the smartphone, a simulated 9-1-1 dispatcher answered the call from another room and asked for emergency information. Simulations were videoed by using a camera hidden from view. Using a 13-item task analysis checklist, 2 raters independently assessed each child’s ability to recognize the emergency and respond using the smartphone. Interrater reliability was excellent (κ = 0.975), disagreements were adjudicated by a third rater. A debrief followed each simulation to review the scenario with the child and reassure them it was simulated. Sociodemographic data and information on mobile phone use were gathered by using a parent survey.

Fifty children participated (mean age: 6.22 ± 1.63 years; range: 4–9 years; girls: n = 18 [36.0%]). Eighty percent (n = 40 of 50) of children in this study had regular mobile phone access; none had their own device. Twenty-four percent (n = 12 of 50) of households reported having no landline phone. Although half of parents (n = 25 of 50, 95% confidence interval [CI]: 35.5%–64.5%) reported to have spoken to their child about what to do in an emergency and how to dial 9-1-1, only 34% (n = 17 of 50, 95% CI: 21.2%–48.8%) had demonstrated using a smartphone. Sociodemographic and mobile phone usage data are outlined in Table 1.

Less than half of the children in kindergarten and grade 1 (n = 10 of 25, 95% CI: 21.1%–61.3%) recognized the simulation as an emergency. In contrast, 80.0% of children in grades 2 and 3 (n = 20 of 25, 95% CI: 59.3%–93.2%) recognized the emergency (Table 2). Of those who recognized the emergency compared with those who did not, there were no differences in the proportion of children having received 9-1-1 education from their parents (53.3% vs. 45.0%, P > .05). None of the children in kindergarten and grade 1 were able to complete the tasks of dialing 9-1-1 or reporting the emergency. Twenty percent of children in grades 2 and 3 (n = 5 of 25, 95% CI: 6.8%–40.7%) dialed 9-1-1 successfully; 2 had regular smartphone access, 2 were shown how to dial 9-1-1 on a smartphone, and 1 had both access and education. Only 16.0% of children in grades 2 and 3 (n = 4 of 25, 95% CI: 4.5%–36.1%) successfully reported the emergency to the simulated dispatcher.

Although mobile devices are ubiquitous in children’s lives today,⁶  in this study we found that most primary school–aged children, and particularly those in kindergarten and first grade, are not prepared to respond to an emergency using a smartphone to dial 9-1-1 and communicate the emergency to a dispatcher. Additionally, most children in kindergarten and first grade were unable to recognize an emergency. Elementary school emergency education is frequently offered through regional police school visits and typically involves didactic teaching without simulated practice or assessment,⁵  strategies known to enhance transfer of skills to real-life. Furthermore, instructional materials and curricula may not adequately reflect advancements in digital technology such as smartphones.⁵  In this study, we underscore the need to develop emergency skills education aimed at enhancing young children’s emergency preparedness in the digital era with a focus on developmentally appropriate strategies for building these skills in children as young as 4 to 6 years of age. We created a Canadian Institutes of Health Research award-winning knowledge translation education video outlining how to recognize an emergency and how and when to call 9-1-1, focusing on the steps required to call 9-1-1 on a smartphone.^7,8  A potential limitation of this study is that the majority of participants (62%) had household incomes close to or above the median annual household income in the United States, and 94% of primary caregivers had at least a college education. Therefore, the study population may not represent the full breadth of children from all sociodemographic backgrounds.⁹  Future research evaluating educational strategies using simulated practice with smartphone applications would help inform best practices.

We thank the Allan Waters Family Simulation Program for their assistance with the simulation portion of this study.

CI

confidence interval