With over half the Auckland HEMS team coming from a hospital that serves age 15 and up (and therefore not dealing with children on a daily basis), prehospital management of paediatric patients is a field to which we must pay considerable attention in our training. Simulation exercises have included paediatric scenarios on several occasions – our thanks to Mike Shepherd and Trish Wood from Starship Hospital for their assistance!

Below are some useful resources regarding prehospital care of paediatric trauma patients:

Podcasts from Dr Jeffrey Guy, Medical Director of PHTLS (right-click to download)

• Paediatric Trauma 1: the child as a trauma patient
• Paediatric Trauma 2: what kills kids
• Paediatric Trauma 3: airway and breathing
• Paediatric Trauma 4: circulation
• Paediatric Trauma 5: traumatic brain injury

(he has also produced other PHTLS podcasts – found here)

A 2012 review of prehospital paediatric trauma from the Harbourview Medical Centre in Seattle can be found here. Take-home messages:

• falls and MVA are the most common causes of paediatric trauma morbidity
• despite a lot of research and intervention paediatric trauma patients are under-resuscitated on arrival compared to their adult counterparts
• children have very different airways anatomically to adults; with full cervical spine immobilisation airway view can be improved with a towel under the shoulders to bring the neck into a neutral position
• with a higher surface area/size ration children are more prone to hypothermia
• due to their smaller blood volume a small amount of blood lost can represent a large percentage of their blood volume
• contrary to traditional teaching, cuffed ETT are increasingly used at half a size smaller than the appropriate uncuffed ETT