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Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States
Kerry McCans1, Selina Varma2, Sriram Ramgopal2
1From the University of Pittsburgh, Pittsburgh, PA.
Insights
State emergency medical services protocols show consistency in treating pediatric respiratory distress with albuterol for wheezing and epinephrine for anaphylaxis. However, significant variability exists in other treatments, highlighting a need for evidence-based protocol development.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Prehospital Care
Background:
- Pediatric respiratory distress is a common emergency.
- Standardized management protocols are crucial for effective prehospital care.
- Variability in existing protocols may impact patient outcomes.
Purpose of the Study:
- To compare statewide emergency medical services (EMS) protocols for pediatric respiratory distress management.
- To identify consistencies and variations in treatment recommendations across different states.
Main Methods:
- A descriptive study analyzed EMS protocols from 34 US states.
- Protocols for managing pediatric respiratory distress were compared.
- Medication and intervention recommendations for specific conditions were evaluated.
Main Results:
- All 34 states had protocols for pediatric respiratory distress.
- High agreement on albuterol for bronchospasm and epinephrine for anaphylaxis.
- Significant variability noted in epinephrine use for croup/epiglottitis, steroid administration, and continuous positive airway pressure (CPAP) use.
Conclusions:
- While some pediatric respiratory distress treatments are consistent, others show wide variability.
- Findings underscore the need for evidence-based updates to EMS protocols.
- Standardization of prehospital pediatric respiratory distress management is recommended.
Objective:
This study aimed to compare statewide emergency medical services protocols for the management of pediatric respiratory distress.
Methods:
We performed a descriptive study of emergency medical services protocols for the management of pediatric respiratory distress in the United States, excluding those without model or mandatory protocols. We compared medication recommendations for specific disease processes, including asthma, croup, epiglottitis, anaphylaxis, generalized respiratory distress, intubation, and drug assisted intubation.
Results:
Thirty-four state protocols were included. All had protocols to address the management of pediatric respiratory distress. There was high agreement in albuterol use for bronchospasm and epinephrine use in anaphylaxis. Epinephrine was recommended in all anaphylaxis protocols, 27 croup protocols (79%), and 3 epiglottitis protocols (9%). Six states (18%) called for albuterol in patients with generalized respiratory distress. Steroid recommendations and indications had variance among states; 26 states (76%) allowed steroid use in patients with asthma, 19 states (56%) recommended steroid use in anaphylaxis, and 11 (32%) recommended steroid use in croup protocols. The route for steroid administration also varied among protocols. Five states (15%) allowed continuous positive airway pressure application in pediatric patients, whereas endotracheal intubation and rapid sequence intubations had varying requirements as well as recommendations for use. Twelve (35%) listed impending or current respiratory failure as an indication, whereas other states had specific markers, such as Glasgow Coma Scale or oxygen saturation, as indications.
Conclusions:
All included states had specific recommendations for the management of pediatric respiratory distress. There was consistency in recommendations for albuterol use for wheezing and epinephrine use for anaphylaxis. However, there was wide variability in other uses for epinephrine, steroid administration, continuous positive airway pressure use, and specific treatments for croup and epiglottitis. The findings of this study provide a base for important future evidence-based protocol developments and changes in prehospital pediatric respiratory distress treatment.
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