Pädiatrischer Notfallpatient im Luftrettungsdienst

Preclinical Pediatric Care by Emergency Physicians: A Comparison of Trauma and Nontrauma Patients in a Population-Based Study in Austria

OBJECTIVES

Fewer than 10% of emergency medical system (EMS) calls concern children and adolescents younger than 18 years. Studies have shown that the preclinical care of children differs from that of adults regarding assessment, interventions, and monitoring. The aims of this study were to describe the preclinical care and emergency transport of pediatric patients in Vorarlberg, Austria and to compare trauma and nontrauma cases.

METHODS

This is a population-based study, analyzing medical records of EMS calls to children and adolescents. We received all patient records of EMS calls to children and adolescents younger than 18 years (n = 4390 in total) from the 2 local EMS providers, the Red Cross Vorarlberg and the Austrian Mountain Rescue Service (Christophorus 8 and Gallus 1) covering a study period of 7 years, from 2013 to 2019. The record data were extracted by automation with an in-house program and subsequently anonymized. Statistical analyses were performed with SPSS Statistics.

RESULTS

During the study period, 7.9% of all EMS calls concerned children and adolescents younger than 18 years. For our study, 3761 records were analyzed and 1270 trauma cases (33.8%) were identified. The most common injuries were injuries of the extremities and traumatic brain injury. The frequency of National Advisory Committee of Aeronautics Scores of 4 or higher was 17.7%, similar for all age groups and for trauma as well as nontrauma patients. Mean Glasgow Coma Scale scores were higher in the trauma group than in the nontrauma group (14.2 vs 11.2). In 62.9% of all patients, 1 or more vital parameters were documented. A majority of these values was in the pathologic range for the respective age group. The rate of pulsoxymetry monitoring during transport was low (42.1% in trauma and 30.3% in nontrauma patients) and decreased significantly with patient age. Moreover, while the placing of intravenous lines and monitoring during transport were significantly more frequent in trauma patients, the administration of medication or oxygen was significantly more frequent in nontrauma patients.

CONCLUSIONS

The pediatric population lacks assessments and monitoring in preclinical care, especially the youngest children and nontrauma patients, although emergency severity scores are similar.

HEMS in Alpine Rescue for Pediatric Emergencies

OBJECTIVE

The objective of this study was to describe the pediatric emergencies encountered by the Christophorus-1 helicopter emergency medical service (HEMS) during a period of 2 years.

METHODS

Emergency treatment of pediatric casualties by HEMS was evaluated at a helicopter base. Children up to 14 years who were treated by HEMS emergency physicians from Christophorus-1 during primary missions in the alpine region were retrospectively enrolled.

RESULTS

Of the 1314 HEMS operations conducted during a 2-year investigation period, pediatric emergencies accounted for 114 (8.7%). Trauma was the most common emergency indication (91.3%) in alpine areas, and 77.5% of the indications were related to skiing and snowboarding; 11.3% of the prehospital pediatric emergencies were classified as life-threatening. Interventions on site were rendered in 46.3% of cases. Mean and SD intervals for approach were 11.0 ± 3.0 minutes; for treatment, 14.0 ± 6.0 minutes; and for transport, 8.0 ± 4.0 minutes. Intervals on site were significantly longer whenever it was necessary to search for an interim landing place (P < .001) or perform rope extrication (P < .001). Aggravating environmental conditions such as low temperature (78.8%), rocky terrain (18.8%), or precipitation (12.5%) were common.

CONCLUSIONS

Rapid procedures are preferred to sustained on-scene treatment, particularly when surrounding conditions are hostile. HEMS emergency physicians attempt to keep on-site intervals short and treatment and monitoring to the essential to minimize delay in rescue.

Evaluation of Dutch Helicopter Emergency Medical Services in transporting children

OBJECTIVE

In the Netherlands, helicopter emergency medical services (HEMS) function as an adjunct to paramedic ambulance service delivering hospital-level medical care to a prehospital location. The main goal of Dutch HEMS is to provide on-scene medical expertise and not primarily to serve as transport. The transportation of patients to specialized hospitals is sometimes mandatory, especially in cases of critically ill or wounded children. In the literature, no support can be found to support the safety of transportation by helicopter. We retrospectively evaluated the safety of this type of transportation and if any problems were encountered transporting children by helicopter.

METHODS

We reviewed our local HEMS database for all children (, 16 years) transported by helicopter to a level 1 trauma center between January 2007 and December 2012.

RESULTS

A total number of 430 patients were transported by helicopter to a hospital (0-87 years, mean 5 31.6 years). Of these patients, 83 (19%) were younger than 16 years (0-15.7 years, mean 5 6.6 years). Causes for HEMS transport in children varied, but the main groups were road traffic accidents (40%), cardiopulmonary arrests (15%), falls from height (12%), and horse riding accidents (7%). In the children group, 1 accidental extubation of the orotracheal tube was noted while lifting the patient (10 years old) into the helicopter. This was immediately noticed, and the patient was reintubated without complications. No further adverse events were encountered during transportation time. The accidental extubation is not a specific complication of helicopter transportation but is inextricably linked with moving severely injured and intubated patients/children.

CONCLUSION

We conclude that transporting children by helicopter is a safe method of transportation for critically ill children to adequately equipped medical centers.

[Intraosseous infusion in the German Air Rescue Service : Guideline recommendations versus mission reality]

BACKGROUND

In emergency medicine intraosseous access (IOA) has been established as an alternative to conventional intravenous access. Originally the use of IOA was strictly limited to children up to 6 years of age and to adults for cardiopulmonary resuscitation. These limitations have been relaxed and the indications for IOA have been expanded.

MATERIAL AND METHODS

A retrospective nationwide analysis of rescue missions by all helicopter emergency medical services of the German Automobile Club (ADAC) Air Rescue Service as well as the German Air Rescue (DRF) over a 7-year period was carried out.

RESULTS

A total of 466,813 patients were treated during the study period and an IOA was established in 1,498 (0.32 %) patients. There was a significant increase in using an IOA from 0.1-0.5 % (p < 0.05) from 2005 to 2011. Furthermore, there was an increase in using an IOA in elderly patients and in patients with lower degrees of severity according to the National Advisory Committee for Aeronautics (NACA) scales (2005-2011): decreased use of IOA in patients up to 6 years of age from 92.4 % to 19.7 % (p < 0.05) and in patients with NACA grades VII/VI from 74.4 % to 46.6 % (p < 0.05) and temporarily limited increase of non-indicated IOA use in patients with NACA grade III between 2008 and 2010. Furthermore, there was an increase in the number of the different drug groups used for intraosseous infusion over the study period.

CONCLUSION

The current guidelines and recommendations for the use of IOA in the prehospital setting are reflected more and more in mission reality for helicopter emergency medical services.

[Measurement of carbon dioxide in emergency medicine]

Expiratory carbon dioxide (CO(2)) monitoring is a valuable tool in the prehospital setting. Recent reports of misplaced endotracheal tubes in the prehospital setting make it important to ensure that tube placement is verified by CO(2) monitoring. The Euronorm 2007:1789 made provision of capnometry mandatory for all medical vehicles. However, the frequency of utilization of CO(2) monitoring after securing the airway and in patients with respiratory insufficiency is low. This article covers the terminology, physiology, technology and clinical applications of CO(2) monitoring. Monitoring of cardiac output and the efficiency of cardiopulmonary resuscitation are described and the article also highlights the importance of CO(2) monitoring in patients with severe head trauma as well as restrictive and obstructive pulmonary disorders.

Prehospital pediatric emergencies in Austrian helicopter emergency medical service - a nationwide, population-based cohort study

INTRODUCTION

Arguably, the most challenging emergencies encountered by emergency medical service crews involve children. Because only scant data exist about the epidemiology of pediatric emergencies in helicopter emergency medical service (HEMS) on a population level, we sought to determine the epidemiological characteristics stratified by responding area in a large nationwide sample.

METHODS

This was a retrospective cohort study including all pediatric patients (0-14 years of age) who were treated by HEMS in Austria from January 2006 to June 2007 (18 months).

RESULTS

Pediatric emergencies accounted for 2207 (8.2%) of a total of 26.850 helicopter rescue missions. Of those, 69.9% (n = 1543) were not involved in life-threatening emergencies. The rate of critical pediatric emergencies was higher in urban than in rural or alpine environment (45.2%, 38.2% and 20.3%, respectively). The most common chief complaint was trauma; the frequency of injuries ranged from 54.2% (582/1074) in rural area and 60.3% (44/73) in urban area to 91.4% (969/1060) in alpine environment. Fracture and head trauma (34.9%; 557/1595 and 26.3%; 419/1595, respectively) were the most common injuries. Advanced life support measures like tracheal intubation, cardiopulmonary resuscitation and intraosseous access were rarely performed (3.7%; n = 82, 1.9%; n = 42 and 0.9%; n = 19, respectively).

CONCLUSIONS

Pediatric emergencies in Austrian HEMS show different epidemiological characteristics in alpine, urban and rural operational environments. Because of challenges and infrequency of prehospital pediatric emergencies, HEMS crews need to maintain their skills in pediatric advanced life support and trauma care.