title: Pediatric Out-of-Hospital Critical Procedures in the United States.
abstract: OBJECTIVE
  Regular clinical application is important for maintenance of difficult resuscitation skills. Although emergency medical services must provide life-saving care for critically ill and injured children, the frequency with which these procedures are performed is unknown. We sought to characterize critical pediatric procedures performed by emergency medical service personnel in the United States.
  
  
  METHODS
  We performed a retrospective, descriptive study of emergency medical service responses.
  
  
  METHODS
  We included patients less than 18 years old in the 2011 National Emergency Medical Services Information Systems national data set. We identified emergency medical service cases receiving critical procedures, including intubation, cricothyroidotomy, cardiac pacing, cardioversion, defibrillation, needle decompression, pericardiocentesis, and intraosseous or central venous catheter placement.
  
  
  METHODS
  None.
  
  
  RESULTS
  We analyzed the data to determine the number and prevalence of procedures, success rates, and factors associated with success. Of the 14,371,941 emergency medical service responses, 865,591 (6.8%) involved children. Emergency medical service responses to pediatric patients most often involved traumatic injuries (35.7%) or respiratory complications (13.2%). Emergency medical service performed a total of 616,913 procedures on 246,016 pediatric cases. Critical procedures were infrequently performed (n = 11,026, 10 per 1,000 pediatric cases). The most common critical procedures performed were intubation (n = 3,599, 6.7 per 1,000 pediatric cases) and intraosseous access (n = 2,618, 5 per 1,000 pediatric cases). Overall, 81% of critical procedures were successful. Increasing age and interfacility transfers were associated with greater odds of procedural success (p < 0.01).
  
  
  CONCLUSIONS
  Despite the broad range of pediatric conditions seen in the prehospital setting, pediatric critical procedures are infrequently performed. These data highlight factors that are associated with successful completion of critical pediatric procedures.
authors.affiliation: 1Department of Emergency Medicine, Allegheny Health Network, Erie, PA. 2Department of Pediatrics, NEMSIS Technical Assistance Center, University of Utah School of Medicine, Salt Lake City, UT. 3Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Jestin N
authors.initials: JN
authors.lastname: Carlson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gannon
authors.forename: N Clay
authors.initials: NC
authors.lastname: Mann
authors.forename: Karen E
authors.initials: KE
authors.lastname: Jacobson
authors.forename: Mengtao
authors.initials: M
authors.lastname: Dai
authors.forename: Caroline
authors.initials: C
authors.lastname: Colleran
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044469:Racial Groups; D012111:Residence Characteristics; D012151:Resuscitation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States