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Pediatric Emergencies in Helicopter Emergency Medical Services: A National Population-Based Cohort Study From Denmark
Vibe M L Nielsen1, Niels H Bruun2, Morten B Søvsø3
1Center for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.
Insights
Physician-staffed helicopter emergency medical services (HEMS) provided critical care to many children, with nearly one-fifth requiring intensive care and 6.2% experiencing 30-day mortality. This study highlights the vital role of HEMS in pediatric emergencies.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Pre-hospital Care
Background:
- Physician-staffed helicopter emergency medical services (HEMS) play a crucial role in managing critically ill or injured patients.
- Understanding the specific needs and outcomes of pediatric patients treated by HEMS is essential for optimizing care.
Purpose of the Study:
- To analyze the diagnostic patterns, severity of illness/injuries, and mortality rates in pediatric patients receiving care from physician-staffed HEMS.
- To evaluate the impact and effectiveness of HEMS interventions in pediatric emergencies.
Main Methods:
- A population-based cohort study of pediatric patients (<16 years) treated by Danish national HEMS between 2014 and 2018.
- Data collection included diagnoses from medical records, on-scene severity assessment, advanced out-of-hospital interventions, and hospital intensive care needs and mortality.
- Severity was assessed using on-scene scores, advanced interventions, and intensive care unit admission.
Main Results:
- 651 HEMS missions involved pediatric patients, with critical emergencies in 29.6%.
- 20.1% received advanced out-of-hospital interventions (e.g., intubation, blood transfusion).
- Injuries (32.2%), burns (11.2%), and respiratory diseases (7.8%) were common diagnoses; 18.1% required intensive care within 24 hours, and 30-day mortality was 6.2%.
Conclusions:
- Physician-staffed HEMS missions frequently involve pediatric patients requiring advanced out-of-hospital care.
- A significant proportion of hospitalized pediatric HEMS patients need immediate intensive care, underscoring the severity of their conditions.
- The study indicates a 6.2% 30-day mortality rate among pediatric patients treated by HEMS, emphasizing the critical nature of these interventions.
Study Objective:
To examine the diagnostic pattern, level of severity of illness or injuries, and mortality among children for whom a physician-staffed helicopter emergency medical service (HEMS) was dispatched.
Methods:
Population-based cohort study including patients aged less than 16 years treated by the Danish national HEMS from October 1, 2014, to September 30, 2018. Diagnoses were retrieved from inhospital medical records, and the severity of illness or injuries was assessed by a severity score on scene, administration of advanced out-of-hospital care, need for intensive care in a hospital, and mortality.
Results:
In total, 651 HEMS missions included pediatric patients aged less than 1 year (9.2%), 1 to 2 years (29.0%), 3 to 7 years (28.3%), and 8 to 15 years (33.5%). A third of the patients had critical emergencies (29.6%), and for 20.1% of the patients, 1 or more out-of-hospital interventions were performed: intubation, mechanical chest compressions, intraosseous vascular access, blood transfusion, chest tube insertion, and/or ultrasound examination. Among the 525 patients with hospital follow-up, the most frequent hospital diagnoses were injuries (32.2%), burns (11.2%), and respiratory diseases (7.8%). Within 24 hours of the mission, 18.1% of patients required intensive care. Twenty-nine patients (5.1%, 95% confidence interval [CI] 3.6 to 7.3) died either on or within 1 day of the mission, and the cumulative 30-day mortality was 35 of 565 (6.2%, 95% CI 4.5 to 8.5) (N=565 first-time missions).
Conclusion:
On Danish physician-staffed HEMS missions, 1 in 5 pediatric patients required advanced out-of-hospital care. Among hospitalized patients, nearly one-fifth of the patients required immediate intensive care and 6.2% died within 30 days of the mission.
