Use of resuscitation skills by paramedics caring for critically injured children in oregon

Abstract

Objectives. 1) To perform a statewide analysis of the frequency of major pediatric trauma cases and the use of resuscitation skills by paramedics (EMT-Ps). 2) To determine whether EMT-Ps use resuscitation skills less frequently for injured children than for older patients.

Methods. Study Design: Retrospective, database analysis of major trauma cases. Setting and Population: 1995 statewide trauma registry data for patients with EMT-P scene care.

Observations. The database included patient demographics, field vital signs, field procedures [e.g., intravenous (IV) line placement, chest compressions, needle thoracostomy, endotracheal intubation], field medication, and vital signs at ED presentation. Data Analysis: Patients aged ≤ 12 years (“pediatric”) were compared with those aged >12 years (“older”). Analyses of patients with tachycardia, hypotension, and obtundation were performed using χ² analysis (α = 0.05).

Results. Of 3,502 trauma patients managed by an EMT-P, only 297 (8%) were aged ≤ 12 years. Fewer pediatric patients (18%) than adults (27%) had an injury severity scale score ≤ 16, p < 0.005. The frequency of most resuscitation skills and the administration of medications were not statistically different between patient groups. However, IVs were four times more likely to be placed in adults (76%) than in pediatric patients (42%), p < 0.001. Subanalyses indicated fewer pediatric patients with tachycardia (p = 0.02) or hypotension (p = 0.02) received an IV, compared with adults who had similar physiologic parameters. Obtunded patients were equally likely to receive endotracheal intubation, although the procedure was rarely used (20%).

Conclusions. EMT-Ps infrequently manage seriously injured children. IVs are less frequently placed in pediatric trauma patients, even in the setting of physiologic abnormalities. The contributions of these field procedures to patient outcomes should be evaluated further.

Keywords:

• pediatric
• children
• emergency medical services
• EMS
• paramedic
• trauma
• skills, resuscitation
• training.