Physician staffed emergency medical service for children: a retrospective population-based registry cohort study in Odense region, Southern Denmark

Abstract

ObjectivesThe aim of this study is to determine diagnostic patterns in the prehospital paediatric population, age distribution, the level of monitoring and the treatment initiated in the prehospital paediatric case. Hypothesis was that advanced prehospital interventions are rare in the paediatric patient population.SettingWe performed a retrospective population-based registry cohort study of children attended by a physician-staffed emergency medical service (EMS) unit (P-EMS), in the Odense area of Denmark during a 10-year study period.ParticipantsWe screened 44 882 EMS contacts and included 5043 children. Patient characteristics, monitoring and interventions performed by the P-EMS crews were determined.ResultsWe found that paediatric patients were a minority among patients attended by P-EMS units: 11.2% (10.9 to 11.5) (95% CI) of patients were children. The majority of the children were <5 years old; one-third being <2 years old. Respiratory problems, traffic accidents and febrile seizures were the three most common dispatch codes. Oxygen supplementation, intravenous access and application of a cervical collar were the three most common interventions. Oxygen saturation and heart rate were documented in more than half of the cases, but more than one-third of the children had no vital parameters documented. Only 22% of the children had respiratory rate, saturation, heart rate and blood pressure documented. Prehospital invasive procedures such as tracheal intubation (n=74), intraosseous access (n=22) and chest drainage (n=2) were infrequently performed.ConclusionPrehospital paediatric contacts are uncommon, more frequently involving smaller children. Monitoring or at least documentation of basic vital parameters is infrequent and may be an area for improvement. Advanced and potentially life-saving prehospital interventions provide a dilemma since these likely occur too infrequently to allow service providers to maintain their technical skills working solely in the prehospital environment.

Clinical Characteristics and Meteorological Factors Affecting the Use of Emergency Medical Services by Pediatric Emergency Patients: A Single-center Study (2005 – 2019)

“…The differences in the distributions of age and sex in the two groups might be due to the greater incidence of trauma among male adolescents than females and the more frequent suicide attempts among adolescents than younger children. Several previous studies have reported similar trends (18,19). There was a higher proportion of children younger than four years in the non-EMS group, which might be associated with their light body weight and mild symptoms caused by respiratory infection.…”

Prehospital Release of Patients After Treatment in an Anesthesiologist-Staffed Mobile Emergency Care Unit

“…The rates of nontransport of patients after contact with ambulances staffed by EMTs and paramedics vary from 3.7% to 93.7% in very selected cases. 22 , 23 , 24 In another Danish study from a different health region, 22 consultations between EMTs or paramedics and a physician at the emergency medical dispatch center resulted in the release of more patients with noncritical presentation at the scene with high patient satisfaction and without compromising patient safety.…”

Pediatric out-of-hospital cardiac arrest in Denmark

“…The national Emergency Medical Service (EMS) system is divided into five health care regions, using the same national prehospital electronic patient records [ 40 ]. In cases of suspected POHCA, an ambulance and an anesthesiologist-paramedic staffed mobile critical care unit are dispatched [ 41 ]. Most areas are accessible with response times below 20 min [ 39 ].…”