title: Characteristics of out-of-hospital paediatric emergencies attended by ambulance- and helicopter-based emergency physicians.
abstract: BACKGROUND
  In Germany, as in many other countries, for the vast majority of cases, critical out-of-hospital (OOH) paediatric emergencies are attended by non-specialised emergency physicians (EPs). As it is assumed that this may lead to deficient service we aimed to gather robust data on the characteristics of OOH paediatric emergencies.
  
  
  METHODS
  We retrospectively evaluated all OOH paediatric emergencies (0-14 years) within a 9-year period and attended by physician-staffed ground- or helicopter-based emergency medical service (EMS or HEMS) teams from our centre.
  
  
  RESULTS
  We identified 2271 paediatric emergencies, making up 6.3% of all cases (HEMS 8.5%). NACA scores IV-VII were assigned in 27.3% (HEMS 32.0%). The leading diagnosis groups were age dependent: respiratory disorders (infants 34.5%, toddlers 21.8%, school children 15.0%), convulsions (17.2%, 43.2%, and 16.0%, respectively), and trauma (16.0%, 19.5%, and 44.4%, respectively). Endotracheal intubation was performed in 4.2% (HEMS 7.6%) and intraosseous canulation in 0.7% (HEMS 1.0%) of children. Cardiopulmonary resuscitation (CPR) was commenced in 2.3% (HEMS 3.4%). Thoracocentesis, chest drain insertion and defibrillation were rarities. HEMS physicians attended a particularly high fraction of drowning (80.0%), head injury (73.9%) and SIDS (60.0%) cases, whereas 75.6% of all respiratory emergencies were attended by ground-based EPs.
  
  
  CONCLUSIONS
  Our data suggest that EPs need to be particularly confident with the care of children suffering respiratory disorders, convulsions, and trauma. The incidence of severe paediatric OOH emergencies requiring advanced interventions is higher in HEMS-attended cases. However, well-developed skills in airway management, CPR, and intraosseous canulation in children are essential for all EPs.
authors.affiliation: Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Medical Centre Göttingen, 37075 Gottingen, Germany. ceich@med.uni-goettingen.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Eich
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: Russo
authors.forename: Jan F
authors.initials: JF
authors.lastname: Heuer
authors.forename: Arnd
authors.initials: A
authors.lastname: Timmermann
authors.forename: Uta
authors.initials: U
authors.lastname: Gentkow
authors.forename: Michael
authors.initials: M
authors.lastname: Quintel
authors.forename: Markus
authors.initials: M
authors.lastname: Roessler
mesh_terms: D000293:Adolescent; D000552:Ambulances; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004630:Emergencies / Q000145:classification*; D005858:Germany; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010045:Outpatients; D010820:Physicians / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014218:Triage / Q000379:methods; D000078329:Workforce