126 - Frequency of Prehospital Trauma Interventions in the Care of Injured Children

Publication Number: 126.4969

Hanna Heintz, Children's Hospital of Wisconsin, Nashotah, WI, United States; Matthew Pinsoneault, Children's Wisconsin, Milwaukee, WI, United States; Thomas W. Engel, Medical College of Wisconsin, Milwaukee, WI, United States; Mark Nimmer, Children's Wisconsin, Milwaukee, WI, United States; Lorin R. Browne, Medical College of Wisconsin, Milwaukee, WI, United States

Background: Injuries are the most frequent complaint encountered in the prehospital care of children. For severely injured children, timely identification and delivery of a limited number of trauma interventions can be life-sustaining and allow for successful transport to definitive trauma care. While life-sustaining trauma interventions are within the scope of practice for paramedic Emergency Medical Services (EMS) clinicians, the frequency with which these interventions are performed on injured children in the prehospital setting and their relationship with subsequent emergency department (ED) care is unknown.

Objective: We aimed to describe the frequency with which trauma interventions are performed during the prehospital care of injured children and to assess their relationship with subsequent interventions performed in the ED.

Design/Methods: This is a retrospective observational study of children 18 years and younger transported to a Level I Pediatric Trauma Center by a single municipal urban/suburban EMS agency between 1/1/2018-12/31/2023. We reviewed EMS and ED records using electronic queries and manual abstraction. We present descriptive statistics as simple counts and percentages.

Results: We identified 417 eligible children. Injured children were predominately male (n=295, 71%) with a median age of 14 years (IQR, 8-16). Table 1 presents the frequency of interventions performed. Overall, 220 children (53%) received no prehospital trauma interventions or received only interventions limited to vascular access and/or spinal motion restriction. Prehospital airway interventions (n=37, 9%), tourniquet application (n=35, 8%), needle thoracostomy (n=10, 2%), and needle pericardiocentesis (n=1, < 1%) were less commonly performed.

In relationship to ED interventions, 119 children (29%) ultimately required definitive airway placement in the ED. Of these, 87 (73%) received no prehospital airway interventions. Additionally, of those with tourniquets placed in the prehospital setting, 14 (40%) had documentation of distal pulses suggesting ineffective placement. Finally, 9 children required ED thoracostomy in addition to the 10 who received prehospital needle thoracostomy.

Conclusion(s): Most injured children transported by EMS receive no or limited prehospital trauma interventions. Life-sustaining trauma interventions are less common in the prehospital setting, and consequently, some may be missed, ineffectively performed, or deferred to the ED. Further work is needed to assess the impact of EMS trauma interventions on patient outcomes for injured children.

Table 1
Frequency of trauma interventions performed during the prehospital care of 417 injured children