Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study

Oulasvirta, Jelena; Harve‐Rytsälä, Heini; Lääperi, Mitja; Kuisma, Markku; Salmi, Heli

doi:10.1186/s13049-020-00816-8

Cited by 3 publications

(4 citation statements)

References 32 publications

(56 reference statements)

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“…Our findings reflect that the educational initiatives for this project were centred around the clinical examination of infants and small toddlers. The extent of individual vital sign registration within our service is acceptable for infants and toddlers if the results are compared to other prehospital systems in the Nordic countries [ 6 , 18 ]: respiratory rate 34–51% (77% in our service), heart rate 59–66% (72% in our service), SpO 2 56–69% (69% in our service) and level of consciousness 29–83% (78% in our service). In United States EMS, registration rates of respiratory rate (81–89%) and heart rate (57–91%) appear to be higher [ 15 , 36 , 37 ].…”

Section: Discussionmentioning

confidence: 84%

“…Every tenth patient cared for by the Danish emergency medical services (EMS) is a paediatric patient, most often teenagers or infants and toddlers aged two years or younger [ 1 , 2 ]. Life-threatening events are infrequent among children [ 3 – 6 ]. Nonetheless, clinical examination of children with acute illnesses or injuries can be challenging for health care professionals who do not treat children on a daily basis and may be stressful in emergency settings [ 7 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Prehospital vital sign monitoring in paediatric patients: an interregional study of educational interventions

Nielsen

Søvsø

Kløjgård

et al. 2023

Scand J Trauma Resusc Emerg Med

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Background Prehospital vital sign documentation in paediatric patients is incomplete, especially in patients ≤ 2 years. The aim of the study was to increase vital sign registration in paediatric patients through specific educational initiatives. Methods Prospective quasi-experimental study with interrupted time-series design in the North Denmark and South Denmark regions. The study consecutively included all children aged < 18 years attended by the emergency medical service (EMS) from 1 July 2019 to 31 December 2021. Specific educational initiatives were conducted only in the North Denmark EMS and included video learning and classroom training based on the European Paediatric Advanced Life Support principles. The primary outcome was the proportion of patients who had their respiratory rate, peripheral capillary oxygen saturation, heart rate and level of consciousness recorded at least twice. We used a binomial regression model stratified by age groups to compare proportions of the primary outcome in the pre- and post-intervention periods in each region. Results In North Denmark, 7551 patients were included, while 15,585 patients from South Denmark were used as a reference. Virtually all of the North Denmark EMS providers completed the video learning (98.7%). The total study population involved patients aged ≤ 2 months (5.5%), 3–11 months (7.4%), 1–2 years (18.8%), 3–7 years (16.2%) and ≥ 8 years (52.1%). In the intervention region, the primary outcome increased from the pre- to the post-intervention period from 35.3% to 40.5% [95% CI for difference 3.0;7.4]. There were large variations in between age groups with increases from 18.8% to 27.4% [95% CI for difference 5.3;12.0] among patients aged ≤ 2 years, from 33.5% to 43.7% [95% CI for difference 4.9;15.5] among patients aged 3–7 years and an insignificant increase among patients aged ≥ 8 years (from 46.4% to 47.9% [95% CI for difference − 1.7;4.7]). In the region without the specific educational interventions, proportions were steady for all age groups throughout the entire study period. Conclusions Mandatory educational initiatives for EMS providers were associated with an increase in the extent of vital sign registration in paediatric patients ≤ 7 years. Incomplete vital registration was associated with, but not limited to non-urgent cases.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Prehospital vital sign monitoring in paediatric patients: an interregional study of educational interventions

Nielsen

Søvsø

Kløjgård

et al. 2023

Scand J Trauma Resusc Emerg Med

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“…Based on paramedics' own perceptions, such emotions traditionally seem to be commonly related to experiences involving acutely sick children and lonely elderly. Although these clearly differ from each other, a potentially common denominator between such experiences might be paramedics' sense of helplessness; paediatric patients are generally rare in EMS and often elicit stronger emotions in healthcare personnel [56], here buoyed by feelings of fear and, perhaps, uncertainty [57]. Meanwhile, daily occurring EMS assignments involving patients with complex pathologies or social distress, such as elderly loneliness, isolation, long-term substance abuse or chronic conditions, are not easily managed and treated before arriving at the hospital.…”

Section: Discussionmentioning

confidence: 99%

Paramedics’ perceptions of job demands and resources in Finnish emergency medical services: a qualitative study

Ericsson

Lindström

Rudman

et al. 2022

BMC Health Serv Res

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Background Paramedics’ fatigue is rising. Stress factors show increased risk for burnout, fatigue, leaving the profession, decreased performance and risk for patient safety. Meanwhile, paramedics’ strong community of practice, autonomy and a sense of professional respect are important factors in forming psychological resilience. We aimed to explore Finnish paramedics’ perceptions of job demands and resources. Methods Our study design was descriptive, inductive with a constructivist approach. Using reflexive thematic analysis, we analyse open-ended questions, from a web-based survey and essays written by Finnish paramedic masters-degree students. The study followed the SRQR checklist. Results We identified paramedics’ job demands as stress from a high workload, environmental factors and emotional burden. Performance expectations and a sense of inadequacy were further noted, as well as an organizational culture of hardiness, presenting lack of support and sense of inequality. Paramedics’ job resources were pressure management strategies, which were expressed as positive coping mechanisms, agency to affect workload and professional self-actualization, expressed as psychologically safe work community, professional pride and internal drive to professional development. Conclusions Finnish paramedics exhibit resources and demands related to uncertainty and emotional burden as well as cultural hardiness and psychological safety in communities. Patient or public contribution This study was done based on survey data collected and analysed by the authors. No patient or public contribution was utilized for this study.

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“…As younger children are more challenging for EMS clinicians to assess, 13,14 we separately evaluated the performance of these cut points among infants. Analyses were performed using the rms (v6.7‐0) 15 and cutpointr (v1.1.2) 16 packages in R, version 4.3.1 (R Foundation for Statistical Computing).…”

Section: Methodsmentioning

confidence: 99%

Establishing outcome‐driven vital signs ranges for children in the prehospital setting

Ramgopal,

Horvat,

Macy

et al. 2023

Academic Emergency Medicine

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Background:Vital signs are frequently used in pediatric prehospital assessments and guide protocol utilization. Common pediatric vital sign classification criteria identify >80% of children in the prehospital setting as having abnormal vital signs, though few receive lifesaving interventions. We sought to identify data‐driven thresholds for abnormal vital signs by evaluating their association with prehospital lifesaving interventions.Methods:We evaluated prehospital care records for children (<18 years) transported to the hospital during 2022 from a large, national repository of EMS patient encounters. Predictors of interest were heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP) and pulse oximetry. HR, RR, and SBP were converted to Z‐scores derived from age‐based distributional models. Our outcome was potentially lifesaving interventions, defined as performance of selected respiratory procedures, resuscitative interventions, or medication administrations. Using cut point analysis, we identified higher specificity (maximal specificity with a minimum of 25% sensitivity) and higher sensitivity (maximal sensitivity with a minimum of 25% specificity) ranges for each vital sign and evaluated measures of diagnostic accuracy.Results.We included 987,515 children (median age 10 years; IQR 2‐15 years). A lifesaving intervention occurred in 4.3% (2.1% with respiratory procedures, 1.2% with resuscitative interventions, and 2.0% with medication administration). HR, RR, and SBP demonstrated a U‐shaped association with lifesaving interventions. Specificities ranged from 84.1 to 93.7% for higher specificity criteria, with RR demonstrating the best performance (sensitivity 84.6%, specificity 27.0% Sensitives ranged from 62.3 to 84.4% for higher sensitivity criteria.Conclusions:Cut points for pediatric vital signs were associated with lifesaving interventions, and specific age‐adjusted ranges can identify children at higher‐ and lower‐risk for receipt of lifesaving intervention. These ranges may be combined with other objective measures to improve the assessment of children in the prehospital setting, assist in optimizing protocol utilization, improve transport decision‐making, and guide destination selection.

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Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study

Cited by 3 publications

References 32 publications

Prehospital vital sign monitoring in paediatric patients: an interregional study of educational interventions

Prehospital vital sign monitoring in paediatric patients: an interregional study of educational interventions

Paramedics’ perceptions of job demands and resources in Finnish emergency medical services: a qualitative study

Establishing outcome‐driven vital signs ranges for children in the prehospital setting

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