A response from a lurker...
At 16.51 15.10.96, Razack Saleem wrote:
>what should be attempted in the field?
Our EMS system currently struggles with pediatric needle cricothyrotomy,
and seeks guidance/outcome information.
>One study cited 30-50% field success rate with pediatric intubation in the
>field vs 80-90% in adults.
While 1) below doesn't address success rates, it describes a very
aggressive approach to prehospital airway management.
> My own opinion is that EMT personnel should strive for competence in BLS
>for children (it would be rare to not be able to manage an airway
Which is exactly what a study in Southern California (Marianne Gausche's
study) appears to be finding. With over 600 pedi subjects so far, no sig
outcome differences have surfaced when BVM management is compared with ETI.
>... IM empiric antibiotics (!)
Prehospital antibiotics surfaced in a draft form in California, but seems
to get little support. You're suggesting treatment without transport?
>Has anyone had experience teaching PALS or APLS adapted specifically
>to EMT personnel?
"Paramedic Education for Paramedics (PEP)" by Drs. Dieckmann, Brownstein,
Gausche and the National PEP Task Force, appears to adapt these
hospital-based courses for prehospital providers. I've heard Dr. Dieckmann
describe the course, read the 250pp manual. My understanding the course is
being classroom tested now.
The Preface notes: "None of the 15 core prehospital procedures taught have
been rigorously evaluated in the out-of-hospital setting...treatments are
empirical...(the course) emphasizes careful assessment and pediatric BLS
care, supports prudent use of ALS interventions...
Opinions on the unmanageable airway/needle cric question? Thanks.
TI - Prehospital endotracheal intubation of children by paramedics.
SO - Ann Emerg Med 1996 Jul;28(1):34-9
AU - Brownstein D; Shugerman R; Cummings P; Rivara F; Copass M
AD - Department of Pediatrics, University of Washington, Seattle, USA.
PT - JOURNAL ARTICLE
AB - STUDY OBJECTIVE: To describe the experience of an emergency medical
services system with the use of liberal indications for prehospital
pediatric endotracheal intubation. METHODS: We performed a retrospective
review of prehospital and hospital patient records in an urban and suburban
prehospital care system. The study included all children aged 15 years or
younger who were intubated in the prehospital setting by King County
paramedics from January 1, 1984, to December 31, 1990. RESULTS: During the
7-year study period, 654 children were intubated, of which 355 (54%) were
study patients. The median age of the patients was 3 years; 60% had an
injury diagnosis. On arrival of the paramedics, 60% of the patients were in
sinus rhythm, 62% had a systolic blood pressure of 70 mm Hg or greater, and
56% had a respiratory rate of 10 breaths per minute or greater. The Glasgow
Coma Scale score was 8 or lower in 83% of the patients. Succinylcholine was
used to facilitate intubation in 47% of patients. On arrival at the
emergency department, 79% of the patients were in sinus rhythm; 75% had an
adequate blood pressure (70 mm Hg or greater); 86% had a PaO2 value of 100
mm Hg or greater; and 74% had a PaCO2 value of 45 mm Hg or lower.
Complications of intubation, more than half of which were classified as
minor, were noted in 22.6% of patients. We were unable to determine the
number of failed intubation attempts. Most of the patients (58%) survived
to hospital discharge. Among cardiac arrest victims, only 12% survived.
CONCLUSION: In a setting where paramedics practice with close medical
direction, applying liberal indications for pediatric intubation and
permitting the use of succinylcholine allowed paramedics to intubate
children of different ages and diagnoses.
Thomas J. McGuire ([log in to unmask])
Chabot College Paramedic Program
Berkeley Fire Department (California)
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