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

Published online by Cambridge University Press:  21 May 2015

Julie Richard ,
Martin H. Osmond ,
Lisa Nesbitt  and
Ian G. Stiell
Julie Richard
Affiliation:
Faculty of Medicine, University of Ottawa, Ottawa, Ont.
Martin H. Osmond*
Affiliation:
Department of Pediatrics, University of Ottawa, Ottawa, Ont. Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Lisa Nesbitt
Affiliation:
Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ont.
Ian G. Stiell
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ont.
*
Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa ON K1H 8L1

Abstract

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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.

Keywords

childrenemergency medical servicesadvanced life support interventionsbasic life support interventions
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 1 , January 2006 , pp. 6 - 12
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

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