Transporting children with toxicological emergencies.
OBJECTIVE
Each year, the Newborn and Paediatric Emergency Transport Service (NETS) receives over 3600 calls from health professionals regarding the management and transportation of critically ill children across New South Wales, with toxicological emergencies making up 1.5% of these calls. The aim of the present study is to describe the characteristics of patients transported for toxicological emergencies and their retrieval management.


METHODS
A retrospective review of patients referred for management of a toxicological emergency between 2007 and 2011. Extracted data included patient demographics, substances involved, consultation with toxicological expertise, interventions performed and major adverse outcomes.


RESULTS
Two hundred and thirty patients, with 307 toxicological exposures, were referred to NETS, of whom 169 (73.5%) were subsequently transported. Pharmaceutical poisonings (223, 72.6%) were the most common, followed by non-pharmaceutical poisonings (61, 19.9%) and envenomation (23, 7.5%). Psychotropics, analgesics and chemicals were the most frequently ingested substances. The most common source of accidentally ingested pharmaceuticals was a family member. The most frequently given therapies were specific antidotes, in particular naloxone and N-acetylcysteine. Nearly half (43.2%) of transported children required only non-invasive monitoring. There was one death during the retrieval process.


CONCLUSIONS
Many children with toxicological emergencies require only non-invasive monitoring, which could be provided by trained ambulance crews in select scenarios. Involvement of a toxicologist in the initial consultation to identify these patients might reduce retrieval numbers and costs. Children on regular medication and those living with family members on psychotropic or cardiac drugs were identified as high-risk groups that should be targeted for medication safety education.
Newborn and Paediatric Emergency Transport Service, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.
Danielle
D
Blake
Sarah
S
Dalton
Naren
N
Gunja
D000293:Adolescent; D017677:Age Distribution; D000552:Ambulances / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D010360:Patient Transfer / Q000706:statistics & numerical data*; D004364:Pharmaceutical Preparations; D011041:Poisoning / Q000453:epidemiology*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies
D004364:Pharmaceutical Preparations
child; critical care; poisoning; transportation