Pediatric Emergencies In Prehospital Emergency Medicine Implications For Emergency Medical Qualification

In emergency medical services (EMS) systems, life-threatening pediatric emergencies comprise a rare indication but represent a particularly emotional and stressful situation for the personnel involved. This study aimed at evaluating the incidence of pediatric emergencies and the measures performed in ground-based and air-based German EMS systems and deriving the necessary skills and qualification of emergency physicians working within EMS systems.In a retrospective, multicenter study at three physician-staffed EMS systems with four ground based vehicles and one air-based EMS system the patient charts of patients over 18 years of age in 2005 and 2006 were analyzed regarding demography, the type and severity of emergency (NACA score), state of awareness (GCS) and emergency measures performed.Overall 20,386 patient charts were evaluated. Pediatric emergencies in the air-based EMS system comprised 11.5% of all missions, which is 2-3 fold higher compared to ground-based EMS system with 4.3%. The percentages of children with a NACA score of IV-VII or a GCS < 9 in air-based EMS services (55.4% and 13.9%, respectively) exceeded by far the corresponding figures observed in the ground-based EMS systems (20.4%, p < 0.01 and 5.8%, p < 0.01). Non-traumatic emergencies represented the majority of missions in children aged < 1 year and 1-5 years. However, with increasing age injuries had a rising impact in the type of rescue mission. Whereas the frequency of certain emergency measures rose in both systems with increasing age of the pediatric patients, others remained constant, intubation of the trachea (7%) and emergency anesthesia (7%), or even declined along with increasing age, CPR (4% vs. 0.3%) and intraosseous access (3% vs. 0.0%). In comparison to the ground-based EMS systems, in the air-based EMS system the ECG monitoring (77% vs 32%, p < 0.01), manual blood pressure measurement (80% vs. 51%, p < 0.01), pulsoxymetry (96% vs. 73%, p < 0.01)] and i.v. access (79% vs. 46%, p < 0.01) were used more often and oxygen (73% vs. 32%, p < 0.01) and drugs (80% vs. 49%, p < 0.01) were administered more often. Also the frequency of intubation of the trachea and emergency anesthesia (17% vs 2%, p < 0.01) was higher in air-based EMS systems than in ground-based EMS systems.Ground-based and air-based EMS systems differ significantly regarding the incidence and the type of pediatric emergency missions. Despite the lower incidence of certain life-saving invasive emergency measures in ground-based EMS systems, the data indicate the necessity for both air-based as well as ground-based emergency physicians to undergo comprehensive and repetitive training in pediatric advanced life support.