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The Practice of Pediatric Out-of-Hospital Care in the United States Elizabeth Gannon, DO, MPH AHN - Saint Vincent Hospital – Erie, PA
Conflicts of Interest Disclosure • Elizabeth Gannon, DO, MPH – none • Jestin N. Carlson, MD, MSc – none • N. Clay Mann, PhD, MS – none • Karen E. Jacobson, BA, NREMT-P – none • Mengtao Dai, MS – none • Caroline Colleran, DO – none • Henry E. Wang, MD, MS – none
Introduction • Emergency medical services (EMS) must provide care for patients of all ages in the out-of-hospital setting • Critically ill pediatric patients present to acute care settings less frequently than adults and opportunities to perform critical procedures are rarely available
Introduction • There are limited data on the frequency of critical procedures performed in the pediatric population • Given the complications associated with infrequently performed critical procedures in the adult population, it is essential to examine the pediatric population
Objective • Characterize procedural performance in out-of-hospital pediatric patients in the United States
Methods • Retrospective study • 2011 National Emergency Medical Services Information Systems (NEMSIS) database • NEMSIS • Collects information on 83 required “national variables” from EMS offices in each participating state • Data includes all EMS responses in patients age <18 years old(1/1/11-12/31/11)
Methods • Demographics • Determine the frequency of procedures that directly involve the patient • Identify critical procedures that may be required during advanced cardiac life support (ACLS) or pediatric advanced life support (PALS)
Methods • Critical Care Procedures • Airway-Intubation • CPR • Venous Access – IO • Venous Access – Central Line • Defibrillation-Manual • Defibrillation-Automated (AED) • Chest Decompression • Chest Tube Placement
Methods • Critical care procedure success and complications • Analysis • Descriptive statistics • Frequency of procedures performed per 1000 pediatric EMS responses
Results • There were 14,371,941 total responses in the 2011 NEMSIS database • 865,591 (6%) responses were in patients less than 18 years old
Results • Provider impression • Most common • Traumatic injuries • Respiratory complications • Seizures • Respiratory (0.4%) and cardiac (0.6%) arrests were rare
Results • There was a total of 616,913 procedures were performed in 246,016 pediatric patients • There were 0.7 procedures performed per each pediatric patient • There were 13.3 critical care procedures performed per 1000 pediatric EMS responses
Complications • The most common complication was esophageal intubation
Limitations • Study design • Retrospective study • Confounding • Reporter bias • Missing data • Voluntary database
Discussion • Critical procedures were performed in only 1.3% of all pediatric EMS responses • Intubation was performed in only 4.4 per 1000 total EMS responses • The overall critical care procedure success rate was 81.4% • Success rates ranged from 73-100%
Discussion • Inexperience with pediatric medical management could lead to adverse patient outcomes • Complications have been linked to poor outcomes in adult patients • Evaluation of EMS protocols
Conclusion • Pediatric patients represent a small percentage of total EMS responses nationwide • Few critical care procedures are performed during EMS responses • Procedures involving the airway have the most complications
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Acknowledgements • Jestin N. Carlson, MD, MSc • N. Clay Mann, PhD, MS • Karen E. Jacobson, BA, NREMT-P • Mengtao Dai, MS • Caroline Colleran, DO • Henry E. Wang, MD, MS