Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service.
BACKGROUND
To determine the advanced life support procedures provided by an Emergency Medical Service (EMS) and a Helicopter Emergency Medical Service (HEMS) for vitally compromised children. Incidence and success rate of several procedures were studied, with a distinction made between procedures restricted to the HEMS-physician and procedures for which the HEMS is more experienced than the EMS.


METHODS
Prospective study of a consecutive group of children examined and treated by the HEMS of the eastern region of the Netherlands. Data regarding type of emergency, physiological parameters, NACA scores, treatment, and 24-hour survival were collected and subsequently analysed.


RESULTS
Of the 558 children examined and treated by the HEMS on scene, 79% had a NACA score of IV-VII. 65% of the children had one or more advanced life support procedures restricted to the HEMS and 78% of the children had one or more procedures for which the HEMS is more experienced than the EMS. The HEMS intubated 38% of all children, and 23% of the children intubated and ventilated by the EMS needed emergency correction because of potentially lethal complications. The HEMS provided the greater part of intraosseous access, as the EMS paramedics almost exclusively reserved this procedure for children in cardiopulmonary resuscitation. The EMS provided pain management only to children older than four years of age, but a larger group was in need of analgesia upon arrival of the HEMS, and was subsequently treated by the HEMS.


CONCLUSIONS
The Helicopter Emergency Medical Service of the eastern region of the Netherlands brings essential medical expertise in the field not provided by the emergency medical service. The Emergency Medical Service does not provide a significant quantity of procedures obviously needed by the paediatric patient.
Gerritse
Bastiaan M
BM
Department of Anaesthesiology, Amphia Hospital, Breda, the Netherlands. bgerritse@amphia.nl
Schalkwijk
Annelies
A
Pelzer
Ben J
BJ
Scheffer
Gert J
GJ
Draaisma
Jos M
JM
D000293:Adolescent; D017732:Air Ambulances / Q000706:statistics & numerical data*; D000488:Allied Health Personnel / Q000706:statistics & numerical data*; D000552:Ambulances / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004635:Emergency Medicine / Q000379:methods*; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008020:Life Support Care / Q000379:methods*; D009426:Netherlands; D011446:Prospective Studies; D011787:Quality of Health Care; D012720:Severity of Illness Index; D016019:Survival Analysis; D014187:Transportation of Patients / Q000379:methods