Abstract
BackgroundAs pediatric patients are typically rare among helicopter emergency medical systems (HEMS), children might be at risk for oligo-analgesia due to the rescuer’s lack of experience and the fear of side effects.MethodsIn this retrospective analysis, data was obtained from the ÖAMTC HEMS digital database including 14 physician staffed helicopter bases in Austria over a 12-year timeframe. Primary missions involving pediatric trauma patients (< 15 years) not mechanically ventilated on-site were included. Analgesia was assessed and compared between the age groups 0–5, 6–10 and 11–14 years.ResultsOf all flight missions, 8.2% were dedicated to children < 15 years. Analgetic drugs were administered in 31.4% of all primary missions (3874 of 12,324), wherefrom 2885 were injured and non-ventilated (0–5 yrs.: n = 443; 6–10 yrs.: n = 902; 11–14 yrs.: n = 1540). The majority of these patients (> 75%) suffered moderate to severe pain, justifying immediate analgesia. HEMS physicians typically chose a monotherapy with an opioid (n = 1277; 44.3%) or Esketamine (n = 1187; 41.1%) followed by the combination of both (n = 324; 11.2%). Opioid use increased (37.2% to 63.4%) and Esketamine use decreased (66.1% to 48.3%) in children < 6 vs. > 10 years. Esketamine was more often administered in extremity (57.3%) than in head (41.5%) or spine injuries (32.3%). An intravenous access was less often established in children < 6 years (74.3% vs. 90.8%; p < 0.001). Despite the use of potent analgesics, 396 missions (13.7%) were performed without technical monitoring. Particularly regarding patient data at handover in hospital, merely < 10% of all missions featured complete documentation. Therefore, sufficient evaluation of the efficacy of pain relief was not possible. Yet, by means of respiratory measures required during transport, severe side effects such as respiratory insufficiency, were barely noted.ConclusionsIn the physician-staffed HEMS setting, pediatric trauma patients liberally receive opioids and Esketamine for analgesia. With regard to severe respiratory insufficiency during transport, the application of these potent analgesics seems safe.
Highlights
Immediate pain relief in emergency critical care is more than an ethical obligation and of major importance to prevent adverse physiological and emotional side-effects [1,2,3]
Data obtained from this digital database included date, time, sex, age in groups, location of the helicopter base, type of helicopter emergency medical systems (HEMS) operation, emergency classifications, required medical disciplines, injury patterns, medications administered, and interventions performed by the emergency team
Demographics and general findings In the 12-year time frame, HEMS responded to 176,056 patients including 14,425 (8.2%) children younger than 15 years (Fig. 3)
Summary
Immediate pain relief in emergency critical care is more than an ethical obligation and of major importance to prevent adverse physiological and emotional side-effects [1,2,3]. Rugg et al Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2021) 29:161 typically driven by the fear of possible severe side effects of pain killers such as respiratory or circulatory depression or agitation [4, 5]. In this regard, children present a special challenge for most health care providers. As pediatric patients are typically rare among helicopter emergency medical systems (HEMS), children might be at risk for oligo-analgesia due to the rescuer’s lack of experience and the fear of side effects
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