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Epidemiology of Pediatric Transports and First Aid in a German Municipal Emergency Medical Services (EMS) System: A
Katharina Garrelfs1, Benjamin Kuehne1, Jochen Hinkelbein2
1Department of Pediatrics, Division of Neonatology and Pediatric Intensive Care, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Insights
Pediatric emergency care rarely involves invasive procedures like tracheal intubation. Training should focus on airway management and vascular access, with improved documentation to enhance care for critically ill children.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
Background:
- Pediatric emergencies present significant challenges for prehospital care.
- Analysis of invasive measures and medications in pediatric prehospital care is crucial for quality improvement.
Purpose of the Study:
- To retrospectively analyze invasive procedures and medications administered during prehospital care for pediatric patients.
- To identify areas for improvement in pediatric emergency medical services and invasive techniques.
Main Methods:
- Retrospective analysis of emergency protocols, including Glasgow Coma Scale (GCS) and National Advisory Committee for Aeronautics (NACA) scores.
- Categorization of pediatric patients (1 month to 12 years) based on diagnosis, medication, and invasive techniques.
- Evaluation of data from patients admitted to the Emergency Department (ED) and Pediatric Intensive Care Unit (PICU) from 01/2015 to 05/2020.
Main Results:
- Invasive procedures like tracheal intubation were infrequent in both ED (5.8%) and PICU (9.5%) settings.
- Peripheral venous access was more common in the ED (51.2%) than PICU (33.7%); central venous access was rare.
- Mortality was significantly higher in the PICU group (19 deaths) compared to the ED group (1 death).
Conclusions:
- Invasive procedures are rarely performed in pediatric prehospital care, highlighting a need for enhanced training.
- Medical documentation gaps were identified, emphasizing the need for improved record-keeping.
- Training should prioritize airway management (e.g., supraglottic airway devices), thoracic drainage, and vascular access (e.g., peripheral intravenous, intraosseous).
Abstract:
Background: Pediatric emergencies remain a significant challenge for emergency services. The study aimed to retrospectively analyze invasive measures and medication administered during prehospital care. The analysis focused on invasive procedures (e.g., tracheal intubation and vascular access) performed on pediatric patients (aged 1 month to 12 years) admitted via the Central Emergency Department (ED) or directly to the University Pediatric Intensive Care Unit (PICU) of the University Hospital of Cologne. These findings provide insights into quality assurance and improvement of prehospital care and invasive emergency techniques in pediatrics. Methods: Emergency protocols were evaluated, including parameters such as the Glasgow Coma Scale (GCS) and National Advisory Committee for Aeronautics (NACA) score. Patients were categorized based on diagnosis, medication administration, and invasive emergency techniques. Results: A total of 373 patients were admitted to the ED, and 237 patients were admitted to the PICU between 01/2015 and 05/2020. Sedation was at similar in both groups, while catecholamines were more frequently used in the PICU group. Invasive procedures, such as tracheal intubation, were rare (PICU: 9.5%; ED: 5.8%; p=0.093). Peripheral venous access was performed in 33.7% of PICU cases and 51.2% of ED cases, whereas central venous access was almost never performed. 19 children admitted to the PICU died compared to one in the ED (p < 0.001). Conclusion: Invasive procedures are rarely performed during prehospital care for pediatric patients. Trauma cases predominated in the ED group (99.2%), whereas the PICU group exhibited greater diagnostic variability, including trauma and internal emergencies. This study identified significant gaps in medical documentation. Training for paramedics and emergency health workers should prioritize airway management, including supraglottic airway (SGA) devices, thoracic drainage, and vascular access techniques such as peripheral intravenous (PIV) and intraosseous (IO) access. Additionally, efforts to improve medical documentation should be emphasized to enhance pediatric emergency care.
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