[Pediatric emergency patients in the air rescue service. Mission reality with special consideration to "invasive" measures]

Abstract

Background: In Germany only 2-9% of rescue missions performed by emergency physicians are pediatric emergencies. Therefore, an emergency physician has to deal with a pediatric emergency on average every 1.1-1.3 months. There are only a few studies in the literature evaluating the frequency of "invasive" techniques and procedures (e.g. vascular access, endotracheal intubation, alternative airway techniques and insertion of chest tube) in pediatric patients in the prehospital setting performed by German emergency physicians. The purpose of this study was to evaluate the frequency of these kinds of procedures in pediatric emergencies in the field of the Helicopter Emergency Medical Service (HEMS).

Methods: Evaluation of pediatric emergencies (defined as <18 years of age) over a 4 year period at the Helicopter Emergency Medical Service (HEMS) was carried out retrospectively.

Results: During the study period 5,826 rescue missions (4,778 primary rescue missions, 571 inter-hospital transfers and 461 others) were completed. A total of 643 (11%) pediatric emergency patients were treated by the HEMS team. Out of this pediatric study group 16.3% had an initial Glasgow Coma Score (GCS) <9 and 59.3% were rated IV-VII on the National Advisory Committee of Aeronautics (NACA) scale. Within the pediatric study group children 1-5 years of age and children 14-17 years of age were predominant (29.2% and 25.8%, respectively). Regarding the whole pediatric study group trauma was predominant (57.9%). In children <1 year of age and children 1-4 years of age, non-traumatic emergencies were predominant (84.2% and 56.9%, respectively), whereas in children 6-9 years of age, 10-13 years of age and 14-17 years of age, traumatic injuries were predominant (64.2%, 74.8% and 72.3%, respectively). Non-invasive standard monitoring by ECG (electrocardiogram), blood pressure (RR) and pulse oximetry (S(p)O(2)) was established in more than 75% of the pediatric patients (ECG: 77.0%, RR: 81.5%, S(p)O(2): 96.7%) and the older the children the more monitoring was established (children <1 year of age: ECG: 47.4%, RR: 36.8%, S(p)O(2): 93.0% vs. children 14-17 years of age: ECG: 89.8%, RR: 98.2%, S(p)O(2): 100.0%). Regarding the whole pediatric study group, vascular access was established in 81.5% of the cases and in 2.5% of the cases as intraosseous infusion. Out of a total of 16 intraosseous infusions performed within the study period 14 (87.4%) were performed in children <6 years of age. In 20.7% of the cases an endotracheal intubation was performed and in 92.5% of these cases induction of anaesthesia was necessary. The insertion of a chest tube within the study period was only necessary in 1.2% of the cases.

Conclusions: Compared to the results of other studies the number of pediatric emergency patients with a NACA score IV-VII in this study is very high. Furthermore, the percentages of non-invasive monitoring procedures applied to the patients as well as invasive therapeutic procedures performed by the HEMS team were also high. Therefore, a special pediatric training course for emergency physicians seems to be necessary.