EMS for pediatrics: Optimum treatment of unnecessary delay?

Abstract

Prehospital Emergency Medical Service (EMS) is an accepted method of care for the patient suffereing a catastrophic, emergent, or urgent medical problem. Pediatric EMS is a concept which has yet to be evaluated. The purpose of the present study was to evaluate a pediatric EMS system in a moderatesized city where all entrants into the system could be tracked from initial dispatch to arrival at a definitive care facility. The following questions were asked: What was the impact of pediatric emergencies on an EMS system? What types of pediatric emergencies entered the system? What was the length of time spent awaiting the first responder at the scene? What was the length of time spent in-the-field? What was the transport time to the hospital? Finally, as most pediatric patients are easily transportable without a special vehicle, is the "scoop and run" concept appropriate for this age group of patients? A detailed review of all paramedic run-sheets was carried out in Mobile, Alabama for a 1-year period. 6.6 percent (60/919) of the cases involved pediatric patients. This included 13% of all trauma cases. In 47% of all pediatric cases, advanced life-support skills were used in the field. The ambulance records and paramedic time sheets were carefully reviewed to determine: (1) the response time, (2) the time spent in-the-field, and (3) transit time to the hospital. Twenty-three of the 60 cases required emergency treatment; 19 of these had reliable time records. The mean response time was 6.3±2.3 minutes. The average time spent in the field was 17±6.7 minutes, and the mean transit time was 4.9±2.8 minutes. The longest time period in the prehospital phase was the time spent in-the-field. Although advanced life-support skills were not overused in the pediatric age group, when the transit time to the hospital was less than 5 minutes, and 16.8 minutes were spent in-the-field, the patient's ultimate outcome may have been jeopar-dized. Another major problem in this series was the response time coupled with a false alarm rate of 80.4%. A high false-alarm rate could significantly prolong the response time of the paramedic vehicle. It was apparent that time lost awaiting the onset of treatment may have had a detrimental effect on outcome in as many as 17% of patients. Therefore, solutions to this time-loss dilemma might include: (1) changing the location of ambulance/paramedic bases to be better dispersed throughout the city, (2) placing greater emphasis on public education to teach rapid, safe transport of the injured pediatric patients by the lay public, and (3) to decrease the false alarm rate. This study further showed that 6.6% of patients accessing the EMS system were in the pediatric age group. Trauma was the most common reason (56%) for the pediatric patient to access the system. When advanced life-support skills were required, they were used more discriminately in pediatrics than in adults.