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BMC Emergency Medicine

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Open Access 01-12-2010 | Research article

Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service

Authors: Bastiaan M Gerritse, Annelies Schalkwijk, Ben J Pelzer, Gert J Scheffer, Jos M Draaisma

Published in: BMC Emergency Medicine | Issue 1/2010

Abstract

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.

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Ummenhofer W, Scheidegger D: Role of the physician in prehospital management of trauma: European perspective. Current Opinion in Critical Care. 2002, 8: 559-65. 10.1097/00075198-200212000-00013.CrossRefPubMed

Veldman A, Fischer D, Brand J, Racky S, Klug P, Diefenbach M: Proposal for a new scoring system in international interhospital air transport. J Travel Med. 2001, 8: 154-157. (Table 1, page 154)CrossRefPubMed

Lackner CK, Schlechtriemen T, Burghofer K, Stolpe E, Altemeyer KH: The Munich NACA score: Modification of the NACA score for preclinical emergency medicine. Notfall und Rettungsmedizin. 2005, 8 (2): 109-111. 10.1007/s10049-005-0719-5.CrossRef

Gerritse BM, Draaisma JMT, Schalkwijk A, van Grunsven PM, Scheffer GJ: Should EMS-paramedics perform paediatric tracheal intubation in the field?. Resuscitation. 2008, 79: 225-229. 10.1016/j.resuscitation.2008.05.016.CrossRefPubMed

Timmermann A, Russo SG, Hollmann MW: Paramedic versus emergency physician emergency medical service: role of the anaesthesiologist and the European versus the Anglo-American concept. Curr Opin Anaesthesiol. 2008, 21: 222-227. 10.1097/ACO.0b013e3282f5f4f7.CrossRefPubMed

Eich C, Russo SG, Heuer JF, Timmermann A, Gentkow U, Quintel M, Roessler M: Characteristics of out-of-hospital paediatric emergencies attended by ambulance- and helicopter-based emergency physicians. Resuscitation. 2009, 80: 888-892. 10.1016/j.resuscitation.2009.05.008.CrossRefPubMed

Zautcke JL, Lee RW, Ethington NA: Paramedic skill decay. Journ Emerg Med. 1987, 5: 505-512. 10.1016/0736-4679(87)90214-9.CrossRef

Boswell WC, McElveen N, Sharp M, Boyd CR, Frantz EI: Analysis of prehospital pediatric and adult intubation. Air Med J. 1995, 14: 125-128. 10.1016/1067-991X(95)90513-8.CrossRefPubMed

Pepe PE, Copass MK, Joyce H: Prehospital endotracheal intubation: rationale for training emergency medical personnel. Ann Emergency Medicine. 1985, 14 (11): 1085-1092. 10.1016/S0196-0644(85)80927-6.CrossRef

10.

Cooper A, DiScala C, Foltin G, Tunik M, Markenson D, Welborn C: Prehospital endotracheal intubation for severe head injury in children: a reappraisal. Sem in Pediatric Surgery. 2001, 10 (1): 3-6. 10.1053/spsu.2001.19379.CrossRef

11.

Gausche M, Lewis RJ, Stratton SJ, Haynes BE, Gunter CS, Goodrich SM, Poore PD, McCollough MD, Henderson DP, Pratt FD, Seidel JS: Effect of Out-of-hospital pediatric endotracheal intubation on survival and neurological outcome. JAMA. 2000, 283: 783-790. 10.1001/jama.283.6.783.CrossRefPubMed

12.

Glaeser PW, Helmich TR, Szewczuga D, Losek JD, Smith DS: Five-year experience in prehospital intraosseous infusions in children and adults. Ann Emerg Med. 1993, 22: 1119-24. 10.1016/S0196-0644(05)80975-8.CrossRefPubMed

13.

Helm M, Hauke J, Bippus N, Lampl L: Die intraossäre Punction in der präklinischen Notfallmedicin. Der Anaesthesist. 2007, 56: 18-24. 10.1007/s00101-006-1124-2.CrossRefPubMed

14.

Curran A, Sen A: Best evidence topic report. Bone injection gun placement of intraosseous needles. Emerg Med J. 2005, 22 (5): 366-10.1136/emj.2005.024406. Review.CrossRefPubMedPubMedCentral

15.

Calkins MD, Fitzgerald GF, Bentley TB, Burris D: Intraosseous infusion devices: a comparison for potential use in special operations. J Trauma. 2000, 48: 1068-74. 10.1097/00005373-200006000-00012.CrossRefPubMed

16.

Gerritse BM, Scheffer GJ, Draaisma JMT: Prehospital intraosseous access with the bone injection gun by a Helicopter Emergency Medical Service. J Trauma. 2009, 66: 1739-41. 10.1097/TA.0b013e3181a3930b.CrossRefPubMed

17.

Bredmose PP, Lockey DJ, Grier G, Watts B, Davies G: Pre-hospital use of ketamine for analgesia and procedural sedation. Emerg Med J. 2009, 26: 62-4. 10.1136/emj.2007.052753.CrossRefPubMed

18.

Thomas SH, Shewakramani S: Prehospital trauma analgesia. Journal of Emerg Med. 2008, 35: 45-57.

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-227X/10/6/prepub

Title: Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service
Authors: Bastiaan M Gerritse
Annelies Schalkwijk
Ben J Pelzer
Gert J Scheffer
Jos M Draaisma
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: BMC Emergency Medicine / Issue 1/2010
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/1471-227X-10-6

At a glance: The STEP trials

Springer Medicine

Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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