Paramedic Initiated Non-transport Of Pediatric Patients
children; emergency medical-services; Emergency Medicine; EMS; Environmental & Occupational Health; life; non-transport; Pediatrics; physician; pramedic triage; prehospital evaluation; Public; system
Introduction. In a time of emergency department overcrowding and increased utilization of emergency medical services, a highly functional prehospital system will balance the needs of the individual patient with the global needs of the community. Our community addressed these issues through the development of a multitiered prehospital care system that incorporated EMS initiated non-transport of pediatric patients. Objective. To describe the outcome of pediatric patients accessing a progressive prehospital system that employed EMS initiated non-transport. Methods. A prospective observational case series was performed on pediatric patients (< 21 years old) designated EMS initiated non-transport. Patients were designated non-transport after an initial EMS protocol driven, complaint-specific clinical assessment in conjunction with medical oversight affirmation. Telephone follow-up was completed on all consecutively enrolled non-transport patients to collect information about outcome ( safety) as well as overall satisfaction with the system. A five-point Likert scale was utilized to rate satisfaction. Results. There were 5,336 EMS requests during the study period. Seven hundred and four were designated non-transport, of which 74.8% completed phone follow-up. Categories of EMS request included minor; medical illness 43.4%, trauma 55.9%, and other 1.1%. There were 13 admissions (2.4%) to the hospital after EMS initiated non-transport designation. Admissions after non-transport had trends toward younger age ( p = 0.002) and medical etiology ( p = 0.006). There were no PICU admissions or deaths. Conclusion. Our EMS system provides an alternative to traditional protocols, allowing EMS initiated non-transport of pediatric patients, resulting in effective resource utilization with a high level of patient safety and family satisfaction.
Haines C J; Lutes R E; Blaser M; Christopher N C
Prehospital Emergency Care
2006
2006-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1080/10903120500541308" target="_blank" rel="noreferrer noopener">10.1080/10903120500541308</a>
Initial Urinary Epinephrine And Cortisol Levels Predict Acute Ptsd Symptoms In Child Trauma Victims
catecholamine; catecholamines; children; combat veterans; cortisol; dexamethasone-suppression; Endocrinology & Metabolism; excretion; Neurosciences & Neurology; pituitary; posttraumatic-stress-disorder; psychiatric diagnoses; Psychiatry; PTSD; severity; survivors; trauma; women
Delahanty D L; Nugent N R; Christopher N C; Walsh M
Psychoneuroendocrinology
2005
2005-02
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.psyneunen.2004.06.004" target="_blank" rel="noreferrer noopener">10.1016/j.psyneunen.2004.06.004</a>
Paramedic judgment of the need for trauma team activation for pediatric patients
assessment; emergency medical technicians; Emergency Medicine; impact; injury; judgment; major trauma; mechanism; Pediatrics; rule; score; severity; system; trauma; triage criteria; victims
Objective: To determine the value of paramedic judgment in determining the need for trauma team activation (TTA) for pediatric blunt trauma patients. Methods: A prospective, observational study was conducted at the ED of Children's Hospital Medical Center of Akron between July 12, 1996, and February 28, 1997, in cooperation with Akron Fire Department emergency medical technician-paramedics (EMT-Ps). The ED provides on-line and off-line medical control for pediatric transports. Patients with minor or no identifiable injuries are released at the scene with the instructions to see a physician. The remainder are transported to the ED. The decision for TTA is based on ED trauma protocols as well as emergency physician judgment of injury severity in combination with the judgment of the treating paramedic. During the study, EMT-Ps were asked (before physician input) whether, based solely on their judgment, a patient needed TTA. Patients 0-14 years old who were involved in motor vehicle crashes, bike crashes, or falls from a height of >10 feet were included in the study. TTA was defined as necessary if the patient was admitted to the intensive care unit (ICU) or operating room (OR) for nonorthopedic surgical procedures. Out-of-hospital, ED, and hospital records were reviewed. Coroners' records as well as medical records of all trauma admissions during the study period were reviewed to ensure that the patients released at the scene were not mistriaged. Results: One hundred ninety-two patients met study criteria. Eighty-five patients (44%) were transported to the ED, of whom 12 had TTA. EMT-Ps requested TTA for 10 of these patients, and 2 patients had TTA per ED trauma protocol. Two of the patients who were judged by EMT-Ps to need TTA were admitted to the ICU/OR, and neither of the patients identified by ED trauma protocol to require TTA were admitted to the ICU/OR. Two initially stable patients who did not have TTA deteriorated after arrival to the ED. Both were admitted to the ICU. The sensitivity and specificity of paramedic judgment of the need for TTA for pediatric blunt trauma patients were 50% (95% CI 9.2-90.8) and 87.7% (95% CI 78.0-93.6), respectively. The positive and negative predictive values were 16.7% (95% CI 2.9-49.1) and 97.3% (95% CI 89.6-99.5). None of the patients released at the scene was mistriaged based on the review of the coroners' and trauma admission records. Conclusion: Results of this investigation indicate that a small percentage of pediatric blunt trauma patients require TTA. EMT-P judgment alone of the need for TTA for pediatric blunt trauma patients is not sufficiently sensitive to be of clinical use. The low sensitivity is explained by the deterioration in the clinical condition of 2 initially stable patients. The paramedic disposition decisions from the scene were always accurate. Nontransport by emergency medical services (EMS) may be acceptable in some uninjured pediatric trauma patients. Injured pediatric trauma patients who appear to be stable may deteriorate shortly after injury. However, if a pediatric patient appears injured, transport from the scene and examination by a trauma specialist are needed. Finally, the role of paramedic judgment must be further defined by larger studies with urban, rural, and suburban EMS systems before it can be used as a sole predictor of TTA.
Qazi K; Kempf J A; Christopher N C; Gerson L W
Academic Emergency Medicine
1998
1998-10
Journal Article
<a href="http://doi.org/10.1111/j.1553-2712.1998.tb02780.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.1998.tb02780.x</a>
Curling iron-related injuries presenting to US emergency departments
accident/injury prevention; burns; consumer product safety; Emergency Medicine; eye burns; wounds and injuries
Objective: To describe curling iron-related injuries reported to the National Electronic Injury Surveillance System (NEISS) between January 1, 1992, and December 31, 1996. Methods: The authors retrospectively reviewed data from NEISS, a weighted probability sample of emergency departments (EDs) developed to monitor consumer product-related injuries. The information reported includes patient demographics, injury diagnosis, body part injured, incident locale, patient disposition, and a brief narrative description. The authors reviewed the narrative in the hair care products category and abstracted records indicating the injury was caused by contact with a curling iron. Also analyzed were the design features of commonly available curling irons purchased from national discount department stores. Results: There were an estimated 105,081 hair care product-related injuries in the five-year period, of which 82,151 (78%) involved a curling iron. Seventy percent of injuries were to females. The patient's median age was 8 years (range 1 month to 96 years). The most commonly occurring injury was thermal burns (97%; 79,912/82,151). Ninety-eight percent of the injuries occurred in the home and 99% of the patients were discharged home from the ED. In patients <4 years old, 56% of burns occurred by grabbing or touching, while in those 10 years the burns occurred by contact while in use. In the older group 69% of burns were of the cornea. Most curling irons use small amounts of power, yet there are no standards for temperature settings or control. The cylinder containing the heating element is mostly exposed, and many irons do not have a power switch. Conclusions: The most common injury resulting from curling irons is thermal burns. The mechanisms and patterns of injury in developmentally distinct age groups suggest that many of these injuries could be prevented by public education and the re-engineering of curling irons.
Qazi K; Gerson L W; Christopher N C; Kessler E; Ida N
Academic Emergency Medicine
2001
2001-04
Journal Article
<a href="http://doi.org/10.1111/j.1553-2712.2001.tb02121.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2001.tb02121.x</a>
Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter
decision-analysis; epidemiology; febrile children; General & Internal Medicine; hospital; infection-control; management; occult bacteremia; pediatric emergency; quality-control methods; resource utilization; risk
Context Blood culture is the criterion standard for identifying children with bacteremia. However, elevated false-positive rates are common and are associated with substantial health care costs. Objective To compare contamination rates in blood culture specimens obtained from separate sites vs through newly inserted intravenous catheters. Design, Setting, and Participants Observational study conducted January 1998 through December 1999 among patients aged 18 years or younger who were seen at a US children's hospital emergency department and had a blood culture obtained as part of their care. Medical records were reviewed in all cases with a positive blood culture. Patients with indwelling vascular catheters were excluded. Intervention All phlebotomy was performed by emergency department registered nurses. During the baseline phase, blood specimens for culture were obtained simultaneously with intravenous catheter insertion. During the postintervention phase, specimens were obtained by a separate, dedicated procedure. Main Outcome Measure Contamination rate in the postintervention period compared with the baseline period. Results A total of 4108 blood cultures were evaluated, including 2108 during the baseline phase and 2000 in the postintervention phase. The false-positive blood culture rate decreased from 9.1% to 2.8% (P<.001). A statistical process control chart demonstrated a steady-state process in the baseline phase and the establishment of a significantly improved steady state in the postintervention phase. Young age was associated with increased contamination rate in both the baseline and postintervention periods. Conclusion Blood culture contamination rates were lower when specimens were drawn from a separate site compared with when they were drawn through a newly inserted intravenous catheter.
Norberg A; Christopher N C; Ramundo M L; Bower J R; Berman S A
Jama-Journal of the American Medical Association
2003
2003-02
Journal Article
<a href="http://doi.org/10.1001/jama.289.6.726" target="_blank" rel="noreferrer noopener">10.1001/jama.289.6.726</a>