JEMS.com Editor's Note: Pediatric trauma calls are some of the most difficult EMS providers encounter. Does your system handle these exceptionally well? Read this article and comment below.
This month I'll wind up my brief literature review of pediatric prehospital care looking at papers on Mechanism of injury and outcomes.
Mechanism of injury
Researchers looked at mechanism of injury as a predictor in pediatric patient outcomes in their study,"Evaluation of the relationship between mechanism of injury and outcome in pediatric trauma."The study, published in the April 2007 issue of Journal of Trauma,analyzed several mechanisms of injury. Among these mechanisms, researchers reported a significant variability in the outcome and resources, as well as need for inpatient rehabilitation after discharge. Such mechanisms as firearms were more likely to be severe and require significant trauma center resources. Others, including falls related to stairs, were more likely to result in injuries that were less severe and required relatively few resources.
They concluded, "Mechanism of injury is associated with the need for trauma center care but this association is highly dependent on the measure used to determine appropriateness of triage."
So the idea is that certain mechanisms seem to be predictors, but how this is determined is relative to the protocol for measuring the mechanism.
Pediatric patient outcomes
In the paper"Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system",the authors researched almost 1,400 pediatric patients treated and transported by prehospital providers. The first study of Canadian pediatric prehospital, this study's conclusion shows a high rate of non-transport of children, with a low rate of urgent transports and hospital admissions for this population. It states, "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."
This study underscores some of the topics we've recently discussed in this column, such as the variance between treatment of adult and pediatric patients. (For more on this topic, read the last two installments of this column:"Small Expectations"and"More Pediatric Trauma Planning.") Certainly this points out a need to conduct further studies to determine methods for increasing prehospital provider confidence in assessing and treating pediatric patients.
Paramedic protocols to allow for non-transport of patients is a frequent subject of discussion when prehospital care is included in the continuum of healthcare. In"Paramedic initiated non-transport of pediatric patients", researchers study paramedic initiated non transport of pediatric patients. Published in the April-June 2006 issue of Prehospital Emergency Care, this paper specifically looked at protocol-driven, paramedic-initiated non-transport of pediatric patients. Patients were designated non-transport after an initial clinical assessment that was driven by EMS protocol and complaint-specific. This assessment was done in conjunction with medical oversight affirmation.
During the study period, 5,336 EMS requests were done. Of these, 704 were designated non-transport. Just 13 (2.4%) were admitted to the hospital after EMS initiated non-transport designation. Admissions after non-transport had trends toward younger age (p = 0.002) and medical etiology (p = 0.006). No PICU admissions or deaths were reported.
The authors concluded, "Our EMS system provides an alternative to traditional protocols, allowing EMS initiated non-transport of pediatric patients, resulting in effective resource utilization with a high level of patient safety and family satisfaction."
Although most of these studies have pointed out difficulties in assessing and treating pediatric patients in the field, this last one at least offers hope that training and protocols can produce good outcomes when we spend the time on developing the process.Well, that's it for my pediatric study review. I'm working on next month's column that looks at synthetic blood replacements. See you next month.