Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system

Abstract

Objectives: There is uncertainty around the types of interventions that are provided by emergency medical services (EMS) to children during prehospital transport. We describe the patient characteristics, events, interventions provided and outcomes of a cohort of children transported by EMS. Methods: This prospective cohort study was conducted in a city of 750 000 people with a 2-tiered EMS system. All children <16 years of age who were attended by EMS during a 6-month period were enrolled. Data were extracted from ambulance call reports and hospital charts, and analyzed using descriptive statistics. Results: During the study period there were 1377 pediatric EMS calls. Mean age was 8.2 years (standard deviation 5.4), and the most common diagnoses were trauma (44.9%), seizure (11.8%) and respiratory distress (8.8%). The ambulance return code was Urgent in 7%, Prompt in 57%, Deferrable in 8% and Not Transported in 28%. Fifty-six percent received either an Advanced Life Support or Basic Life Support prehospital intervention. Common procedures included cardiac monitoring (20.0%), oxygen administration (19.8%), blood glucose monitoring (16.3%), spine board (12.2%), limb immobilization (11.1%) and cervical collar (10.0%). Uncommon procedures included administering medications intravenously (IV) (1.4%), bag-valve-mask ventilation (0.3%) and endotracheal intubation (0.1%). Seventy-eight percent of attempted IV lines were successful. Only 9.0% of EMS-transported children were admitted to hospital, and 2.2% were admitted to the intensive care unit. Conclusions: This first study of Canadian pediatric prehospital interventions shows a high rate of non-transport, and a low rate of Urgent transports and hospital admissions for children. Very few children receive prehospital airway management, ventilation or IV medications; consequently EMS personnel have little opportunity to maintain these pediatric skills in the field.

Kindernotfälle in der Luftrettung – eine epidemiologische Studie zur Versorgung in Österreich

“…Similar rates were reported by Nagele et al [6] in Austrian ground-based EMS, whereas a higher frequency was found in European HEMS [2,4,13,14]. In contrast, previous studies from US/ Canadian EMS showed that the frequency of tracheal intubation as well as CPR by paramedics is lower than 1% in pediatric emergencies [10,21,22]. Our average rate of pediatric tracheal intubation performed by individual HEMS emergency physician was in line with the literature, clearly indicating that some teams go without a pediatric airway in several years [23,24].…”

Accuracy of Paramedic Broselow Tape Use in the Prehospital Setting

“…12 The distribution of patient ages was assumed to be equal among the nine weighted categories, based on an examination of previously published data. 13 In the numerical simulations, we assumed varying rates of disagreement between the two assessments, ranging from 0% to 50% disagreement. Under each assumed rate of disagreement, we simulated 1,000 trials, each with simulated patients, and calculated the resulting unweighted kappa coefficient that would be obtained.…”

Pediatric Prehospital Seizure Management

“…In these seizure calls, EMS providers checked the patient's blood glucose by glucometry 70% of the time. 35 A study by Kumar showed that capillary blood glucose values measured by glucometer best approximate venous blood glucose values from the laboratory and can be used effectively to guide clinical decisions in the field. 36 A review article on pediatric seizures by Friedman recommends rapid, point of care glucometry in all actively seizing pediatric patients.…”