title: Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system.
abstract: OBJECTIVE
  There is uncertainty around the types of interventions that are provided by emergency medical services (EMS) to children during prehospital transport. We describe the patient characteristics, events, interventions provided and outcomes of a cohort of children transported by EMS.
  
  
  METHODS
  This prospective cohort study was conducted in a city of 750 000 people with a 2-tiered EMS system. All children <16 years of age who were attended by EMS during a 6-month period were enrolled. Data were extracted from ambulance call reports and hospital charts, and analyzed using descriptive statistics.
  
  
  RESULTS
  During the study period there were 1377 pediatric EMS calls. Mean age was 8.2 years (standard deviation 5.4), and the most Common diagnoses were trauma (44.9%), seizure (11.8%) and respiratory distress (8.8%). The ambulance return code was Urgent in 7%, Prompt in 57%, Deferrable in 8% and Not Transported in 28%. Fifty-six percent received either an Advanced Life Support or Basic Life Support prehospital intervention. Common procedures included cardiac monitoring (20.0%), oxygen administration (19.8%), blood glucose monitoring (16.3%), spine board (12.2%), limb immobilization (11.1%) and cervical collar (10.0%). Uncommon procedures included administering medications intravenously (IV) (1.4%), bag-valve-mask ventilation (0.3%) and endotracheal intubation (0.1%). Seventy-eight percent of attempted IV lines were successful. Only 9.0% of EMS-transported children were admitted to hospital, and 2.2% were admitted to the intensive care unit.
  
  
  CONCLUSIONS
  This first study of Canadian pediatric prehospital interventions shows a high rate of non-transport, and a low rate of Urgent transports and hospital admissions for children. Very few children receive prehospital airway management, ventilation or IV medications; consequently EMS personnel have little opportunity to maintain these pediatric skills in the field.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa, ON.
authors.forename: Julie
authors.initials: J
authors.lastname: Richard
authors.forename: Martin H
authors.initials: MH
authors.lastname: Osmond
authors.forename: Lisa
authors.initials: L
authors.lastname: Nesbitt
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
mesh_terms: D022561:Advanced Cardiac Life Support / Q000706:statistics & numerical data; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002170:Canada / Q000453:epidemiology; D002574:Cervical Vertebrae / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D005260:Female; D006339:Heart Rate; D006801:Humans; D007103:Immobilization / Q000295:instrumentation; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000008:administration & dosage; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000295:instrumentation / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000453:epidemiology; D012640:Seizures / Q000453:epidemiology; D013396:Suction / Q000706:statistics & numerical data; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D010100:Oxygen