Pre-hospital providers have little opportunity to use even basic paediatric critical-care skills ▸

This Canadian prospective cohort study explored the types of interventions given to children by pre-hospital emergency medical services (EMS). It recruited a contiguous group of 1377 children under 16 years of age (mean 8.2 years) attended by EMS during a 6 month period. The most common presenting conditions were trauma (44.9%), seizure (11.8%) and respiratory distress (8.8%). The study showed that, despite EMS providers having a major role in treating these conditions, lifesaving interventions, particularly airway management skills, were rarely used. These included intravenous drug administration (1.4%), bag valve mask ventilation (0.3%) and endotracheal intubation (0.1%). This may be explained by the high rate of patients (28%) not transported and a low rate of urgent transports (7%) for admission to hospital. However, it demonstrates that EMS providers have very little opportunity to maintain their paediatric skills. The study found most pre-hospital practitioners would not have the opportunity to ventilate a single child in one year. This has important implications for pre-hospital education. While …