Abstract. Objective: To determine the value of paramedic judgment in determining the need for trauma team activation (TTA) for pediatric blunt trauma patients. Methods: A prospective, observational study was conducted a t the ED of Children's Hospital Medical Center of Akron between July 12, 1996, and February 28,1997, in cooperation with Akron Fire Department emergency medical technician-paramedics (EMT-Ps). The ED provides on-line and off-line medical control for pediatric transports. Patients with minor or no identifiable injuries are released a t the scene with the instructions to see a physician. The remainder are transported to the ED. The decision for TTA is based on ED trauma protocols as well as emergency physician judgment of injury severity in combination with the judgment of the treating paramedic. During the study, EMT-Ps were asked (before physician input) whether, based solely on their judgment, a patient needed TTA. Patients 0-14 years old who were involved in motor vehicle crashes, bike crashes, or falls from a height of 210 feet were included in the study. TTA was defined as necessary if the patient was admitted to the intensive care unit (ICU) or operating room (OR) for nonorthopedic surgical procedures. Out-of-hospital, ED, and hospital records were reviewed. Coroners' records as well as medical records of all trauma admissions during the study period were reviewed to ensure that the patients released a t the scene were not mistriaged. Results: One hundred ninety-two patients met study criteria. Eighty-five patients (44%) were transported to the ED, of whom 12 had TTA. EMT-Ps requested TTA for 10 of these patients, and 2 patients had TTA per ED trauma protocol. Two of the patients who were judged by EMT-Ps to need TTA were admitted to the ICU/OR, and neither of the patients identified by ED trauma protocol to require TTA were admitted to the ICU/OR. Two initially stable patients who did not have ITA deteriorated after arrival to the ED.Both were admitted to the ICU. The sensitivity and specificity of paramedic judgment of the need for " A for pediatric blunt trauma patients were 50% (95% CI 9.2-90.8) and 87.7% (95% CI 78.0-93.6), respectively. The positive and negative predictive values were 16.7% (95% CI 2.9-49.1) and 97.3% (95% CI 89.6-99.5). None of the patients released at the scene was mistriaged based on the review of the coroners' and trauma admission records. Conclusion: Results of this investigation indicate that a small percentage of pediatric blunt trauma patients require TTA. EMT-P judgment alone of the need for TTA for pediatric blunt trauma patients is not sufficiently sensitive to be of clinical use. The low sensitivity is explained by the deterioration in the clinical condition of 2 initially stable patients. The paramedic disposition decisions from the scene were always accurate. Nontransport by emergency medical services (EMS) may be acceptable in some uninjured pediatric trauma patients. Injured pediatric trauma patients who appear to be stable may deteriorate shortly aft...

Corneal endothelial polymegathism and pleomorphism can decrease with properly prescribed and monitored overnight corneal reshaping lenses over some standard contact lenses.

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An uncontrolled prospective observational study was conducted to record the interaction of Emergency Department physicians in cases of trauma and possible Sudden Infant Death Syndrome (SIDS) deaths, to determine whether the manner of death influences whether physicians immediately deliver news of a child’s death to the parents or whether the physician first asks questions of the parents. Physicians immediately delivered news of the child’s death in three-quarters of the cases at our centre. The presence of other professionals appeared to influence physician behaviour. The sample size limits the conclusions to be drawn, but room for improvement is noted. Chaplains are in a position to teach other staff.