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. 2023 Nov;182(11):5057-5065.
doi: 10.1007/s00431-023-05178-8. Epub 2023 Sep 1.

Prevalence and severity of pediatric emergencies in a German helicopter emergency service: implications for training and service configuration

Stefan Mockler  1 , Camilla Metelmann  2 , Bibiana Metelmann  2 , Karl Christian Thies  3
Affiliations

Prevalence and severity of pediatric emergencies in a German helicopter emergency service: implications for training and service configuration

Stefan Mockler et al. Eur J Pediatr. 2023 Nov.

Abstract

This study primarily aims to determine the frequency of life-threatening conditions among pediatric patients served by the DRF, a German helicopter emergency service (HEMS) provider. It also seeks to explore the necessity of invasive procedures in this population, discussing the implications for HEMS crew training and service configuration based on current literature. We analyzed the mission registry from 31 DRF helicopter bases in Germany, focusing on 7954 children aged 10 or younger over a 5-year period (2014-2018). Out of 7954 identified children (6.2% of all primary missions), 2081 (26.2%) had critical conditions. Endotracheal intubation was needed in 6.5% of cases, while alternative airway management methods were rare (n = 14). Half of the children required intravenous access, and 3.6% needed intraosseous access. Thoracostomy thoracentesis and sonography were only performed in isolated cases. Conclusions: Critically ill or injured children are infrequent in German HEMS operations. Our findings suggest that the likelihood of HEMS teams encountering such cases is remarkably low. Besides endotracheal intubation, life-saving invasive procedures are seldom necessary. Consequently, we conclude that on-the-job training and mission experience alone are insufficient for acquiring and maintaining the competencies needed to care for critically ill or injured children. What is Known: • Pediatric emergencies are relatively rare in the prehospital setting, but their incidence is higher in helicopter emergency medical services (HEMS) compared to ground-based emergency services. What is New: • On average, HEMS doctors in Germany encounter a critically ill or injured child approximately every 1.5 years in their practice, establish an IV or IO access in infants or toddlers every 2 years, and intubate an infant every 46 years. • This low frequency highlights the insufficiency of on-the-job training alone to develop and maintain pediatric skills among HEMS crews. Specific interdisciplinary training for HEMS crews is needed to ensure effective care for critically unwell pediatric patients.

Keywords: Emergency medical service; Epidemiology of pediatric emergencies; Pediatric airway management; Pediatric emergency medicine; Pediatric emergency treatment.

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Conflict of interest statement

All authors state that they are currently working or have been working as emergency physicians with DRF Luftrettung. There are no other financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

Figures

Fig. 1
Fig. 1
NACA score for non-trauma and trauma patients
Fig. 2
Fig. 2
Mechanism of injury
See this image and copyright information in PMC

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