Despite high rates of prostaglandin E(1) adverse effects, elective intubation of infants for transport significantly increased the odds of a major transport complication. The risks of prophylactic intubation before the transport of otherwise stable infants on prostaglandin E(1) must be weighed carefully against possible benefits.
For pediatric weight estimation, the Broselow tape performed better overall than the Handtevy tape and more closely approximated actual weight. Lowe CG , Campwala RT , Ziv N , Wang VJ . The Broselow and Handtevy resuscitation tapes: a comparison of the performance of pediatric weight prediction. Prehosp Disaster Med. 2016;31(4):364-375.
Our aim was to determine whether starting inhaled nitric oxide (iNO) on critically ill neonates with severe hypoxemic respiratory failure and/or persistent pulmonary hypertension (PPH), at a referring hospital at the start of transport, decreases the need for extracorporeal membrane oxygenation (ECMO), lessens the number of hospital days and improves survival in comparison with those patients who were started on iNO only at the receiving facility. The study was a retrospective review of 94 charts of neonates that had iNO initiated by the transport team at a referring hospital or only at the tertiary neonatal intensive care unit (NICU) of the receiving hospital. Data collected included demographics, mode of transport, total number of hospital days, days on inhaled nitric oxide and ECMO use. Of the 94 patients, 88 were included. Of these, 60 were started on iNO at the referring facility (Field-iNO) and 28 were started at the receiving NICU (CHLA-iNO). All patients survived transport to the receiving NICU. Death rates and ECMO use were similar in both groups. Overall, patients who died were younger and had lower birth weights and Apgar scores. For all surviving patients who did not require ECMO, the length of total hospital stay (median days 22 versus 38, P = 0.018), and the length of the hospital stay at the receiving hospital (median days 18 versus 29, P = 0.006), were significantly shorter for the Field-iNO patients than for the CHLA-iNO patients, respectively. Earlier initiation of iNO may decrease length of hospital stay in surviving neonates with PPH not requiring ECMO.
The prehospital provider is met with unique challenges when responding to a call and finding a pediatric aged patient that requires evaluation, treatment, and transfer to a medical facility. Many mass causality incidents secondary to natural disaster, man-made disasters, or acts of terrorisms have exposed the vulnerabilities of prehospital emergency medical services personnel in the evaluation, treatment, and transport of the pediatric population. Many lessons learned from past events have been published with agendas to incorporate the needs of the transport of pediatric patients. This article will review the issues and recommendations of the prehospital personnel's role with expectations that pediatric aged victims are rendered optimal care.
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