Vital signs as part of the prehospital assessment of the pediatric patient: A survey of paramedics

doi:10.1016/S0196-0644(05)81804-9

Annals of Emergency Medicine

Volume 19, Issue 2, February 1990, Pages 173-178

https://doi.org/10.1016/S0196-0644(05)81804-9 Get rights and content

Vital signs are an integral part of the field assessment of patients. A two-part study was undertaken to determine which vital signs are taken in the field assessment of pediatric patients and to determine whether the frequency of vital signs taken is influenced by base station contact, patient's severity of illness or injury, or paramedic demographic factors such as parenting and field experience. An initial pilot study of prehospital care records (run sheets) from two base hospitals in Los Angeles County revealed that there were significant differences between field vital sign assessment in pediatric and adult patients (P < .0001). A retrospective review of 6,756 pediatric run sheets from Los Angeles County showed that the frequency of vital sign assessment varied with the age of the pediatric patient (P < .05) (ie, the frequency of vital sign assessment increased correspondingly with the age of the patient). Base hospital contact occurred in 26% of the runs; when contact was made, vital signs were more likely to be taken in all age groups studied. Vital signs often were not assessed in children less than 2 years old, even if the patient's chief complaint suggested the possibility of a major illness or trauma. The second part of the study was a field assessment survey that was distributed to 1,253 active paramedics in Los Angeles County; the results showed that paramedics were less confident in their ability to assess vital signs in children less than 2 years old. Confidence increased with age of the patient. The number of runs a provider made during a 24-hour shift was the only demographic factor related to the level of provider confidence. Future emergency medical services research must link field vital sign assessment to outcome to determine the value of this type of field assessment in the pediatric age group.

References (4)

TsaiA et al.
Epidemiology of pediatric prehospital care
Ann Emerg Med
(1987)
SeidelJS
A needs assessment of advanced life support and emergency medical services in the pediatric patient: State of the art
Circulation
(1986)

There are more references available in the full text version of this article.

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: Funded in part by a grant from the US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Maternal and Child Health and Resources Development, through the California State Department of Health, Maternal Child Health Branch (Grant no. MCH-064001-01-3, Contract to the State of California no. 87-91857).

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Original contributionVital signs as part of the prehospital assessment of the pediatric patient: A survey of paramedics

Epidemiology of pediatric prehospital care

Ann Emerg Med

A needs assessment of advanced life support and emergency medical services in the pediatric patient: State of the art

Circulation

Original contribution
Vital signs as part of the prehospital assessment of the pediatric patient: A survey of paramedics