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Epidemiology of pediatric prehospital care
Insights
Few studies address pediatric prehospital emergencies. This review of 3,184 cases highlights trauma as the main issue for adolescents and medical conditions for younger children, with no survivors from prehospital cardiac arrest.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Prehospital Services
Background:
- Limited research exists on prehospital care for pediatric emergencies.
- New initiatives like Pediatric Advanced Life Support (PALS) and Advanced Pediatric Life Support (APLS) highlight the need for data on pediatric prehospital care.
- Understanding the scope and outcomes of pediatric emergencies is crucial for improving care.
Purpose of the Study:
- To analyze the types of pediatric emergencies encountered in prehospital settings.
- To determine the outcomes of these emergencies.
- To identify patterns in the utilization of emergency medical services (EMS) for pediatric patients.
Main Methods:
- Retrospective review of 3,184 prehospital assessment forms for patients under 19 years old over a 12-month period (starting August 1, 1983).
- Analysis of patient demographics, chief complaints, interventions, and outcomes.
- Comparison of pediatric EMS utilization with the overall population demographics.
Main Results:
- Pediatric patients represented 10% of ambulance runs but 32% of the population, with highest utilization by the youngest and oldest pediatric age groups.
- Trauma accounted for 54.4% of cases, with motor vehicle accidents being the most common among adolescents. Medical disorders were primary in younger children.
- Emergency medical services demand peaked during summer months, weekends, and afternoons (1 PM - 9 PM).
- Advanced life support had low use and success rates in younger children, associated with prolonged on-scene times (mean 18.3 minutes).
- No survivors to hospital discharge were recorded in 23 cases of pediatric prehospital arrest.
Conclusions:
- Prehospital pediatric emergencies are underrepresented in research despite significant population proportion.
- Trauma and medical conditions present distinct patterns based on age within the pediatric population.
- Current prehospital advanced life support protocols may require re-evaluation for efficacy in pediatric populations, particularly regarding on-scene time and resuscitation outcomes.
Abstract:
Very few studies about prehospital care of pediatric emergencies have been published. With new interest in emergency care of the pediatric population demonstrated by the development of Pediatric Advanced Life Support and Advanced Pediatric Life Support, it is imperative to have data that define the different types of problems encountered in the prehospital care setting and their outcomes. Prehospital assessment forms were reviewed retrospectively over a consecutive 12-month period beginning August 1, 1983. Patients under 19 years of age were studied in a service area with a population of 557,700. A total of 3,184 forms were analyzed, representing approximately 10% of all ambulance runs. This contrasts sharply with the fact that the pediatric age group represents 32% of the population. The major users were the youngest and the oldest of the pediatric population. Of the cases, 54.4% were in the trauma category. The largest trauma group was motor vehicle accidents in the adolescent age group. Male patients predominated in the trauma cases. Medical disorders were the major reason for prehospital care in the very young. The demand for emergency medical services (EMS) occurred mainly during the summer months and on weekends. More than 50 percent of all EMS pediatric cases occurred during the hours of 1:00 PM to 9:00 PM. Advanced life support was associated with prolonged on-scene time and had a relatively low use and success rate in the younger pediatric population. Resuscitation of 23 cases of pediatric prehospital arrest resulted in no survivors to hospital discharge. The appropriateness of prolonged time spent on scene (mean of 18.3 minutes in 1,196 cases) for prehospital pediatric emergencies requires further evaluation.