Use of resuscitation skills by paramedics caring for critically injured children in Oregon.
OBJECTIVE
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



METHODS
Retrospective, database analysis of major trauma cases.


METHODS
1995 statewide trauma registry data for patients with EMT-P scene care.


METHODS
The database included patient demographics, field vital signs, field procedures [e.g., intravenous (i.v.) line placement, chest compressions, needle thoracostomy, endotracheal intubation], field medication, and vital signs at ED presentation.


METHODS
Patients aged < or = 12 years ("pediatric") were compared with those aged > 12 years ("older"). Analyses of patients with tachycardia, hypotension, and obtundation were performed using chi 2 analysis (alpha = 0.05).


RESULTS
Of 3,502 trauma patients managed by an EMT-P, only 297 (8%) were aged < or = 12 years. Fewer pediatric patients (18%) than adults (27%) had an injury severity scale score > or = 16, p < 0.005. The frequency of most resuscitation skills and the administration of medications were not statistically different between patient groups. However, i.v.s 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 i.v., 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. i.v.s 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.
Su
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E
Oregon Health Sciences University, School of Medicine, Portland, OR, USA. sue@ohsu.edu
Mann
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NC
McCall
M
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Hedges
J R
JR
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000379:methods; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009922:Oregon; D012151:Resuscitation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000628:therapy*