Tag Archives: paediatric

Paediatric prehospital trauma care resources

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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)

(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

 

 

 

Errors in prehospital paediatric resuscitation

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When compared to adult resuscitation, paediatric resuscitation has anatomical, pharmacological, procedural, social, and emotional differences that may make it more difficult and therefore more prone to error.

The authors of this study (full text pdf – NOT hosted on this site) used a simulated paediatric emergency (infant with altered mental status, seizures, and respiratory arrest) to look at errors in paediatric resuscitation by two person EMS teams.

What emerged were issues regarding equipment familiarity/use/misuse, failure to check BSL, and drug errors. Calculations of drug doses were difficult under stress. Failure rates in some of these domains exceeded 50%.

This study, coupled with our low incidence of significant paediatric resuscitation, suggests that we must have ongoing training in paediatric emergencies (simulation and otherwise) to mitigate these risks, and consider new ways of avoiding error. Given the high rate of smartphone use by HEMS personnel, this app is possibly a good start!