Patient safety events in out-of-hospital paediatric airway management: a medical record review by the CSI-EMS.
To describe the frequency and characterise the nature of patient safety events in paediatric out-of-hospital airway management.



We conducted a retrospective cross-sectional medical record review of all 'lights and sirens' emergency medicine services transports from 2008 to 2011 in patients <18 years of age in the Portland Oregon metropolitan area. A chart review tool (see online supplementary appendix) was adapted from landmark patient safety studies and revised after pilot testing. Expert panels of physicians and paramedics performed blinded reviews of each chart, identified safety events and described their nature. The primary outcomes were presence and severity of patient safety events related to airway management including oxygen administration, bag-valve-mask ventilation (BVM), airway adjuncts and endotracheal intubation (ETI).DC1SM110.1136/bmjopen-2016-012259.supp1supplementary appendix RESULTS: From the 11 328 paediatric transports during the study period, there were 497 'lights and sirens' (code 3) transports (4.4%). 7 transports were excluded due to missing data. Of the 490 transports included in the analysis, 329 had a total of 338 airway management procedures (some had more than 1 procedure): 61.6% were treated with oxygen, 15.3% with BVM, 8.6% with ETI and 2% with airway adjuncts. The frequency of errors was: 21% (71/338) related to oxygen use, 9.8% (33/338) related to BVM, 9.5% (32/338) related to intubation and 0.9% (3/338) related to airway adjunct use. 58% of intubations required 3 or more attempts or failed altogether. Cardiac arrest was associated with higher odds of a severe error.



Errors in paediatric out-of-hospital airway management are common, especially in the context of intubations and during cardiac arrest.
Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Matthew
M
Hansen
Division of Pediatric Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Garth
G
Meckler
Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA.
William
W
Lambert
Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
Caitlin
C
Dickinson
Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
Kathryn
K
Dickinson
Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.
Joshua
J
Van Otterloo
Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA.|Department of Public Health & Preventive Medicine, Oregon Health & Science University, Portland, Oregon, USA.|Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA.|Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA.
Jeanne-Marie
0000-0002-8961-488X
JM
Guise
D000293:Adolescent; D058109:Airway Management / Q000009:adverse effects* / Q000379:methods; D000552:Ambulances; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D008485:Medical Audit; D019300:Medical Errors / Q000706:statistics & numerical data; D009922:Oregon; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010100:Oxygen; D061214:Patient Safety; D010372:Pediatrics; D012121:Respiration, Artificial / Q000009:adverse effects; D012189:Retrospective Studies
D010100:Oxygen
ACCIDENT & EMERGENCY MEDICINE