Article

Emergency medical services and the adolescent patient

Authors:
To read the full-text of this research, you can request a copy directly from the author.

Abstract

A study of 10,493 prehospital care report forms from 11 counties in California demonstrated that the adolescent age group (ages 12 to 18 years) accessed prehospital care through the emergency medical service (EMS) system more frequently than other pediatric patients (5978 reports). They did so most commonly for trauma (87.6%), but also for behavioral emergencies such as suicide and psychiatric problems. The most common cause of injury was automobiles, and care rendered was most commonly wound care and splinting. The most common substances given to adolescents in the prehospital setting were naloxone and 50% dextrose. EMS systems need to address the need for triage and care of adolescent patients.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the author.

... A five-level triage tool in the EMS might be favourable for detecting a severely ill patient [21]. The use of triage in the EMS to assess paediatric patients was proposed 25 years ago [22]. However, implementing more complex triage systems for adult patients has shown only moderate agreement between the EMS assessment and ED nurses [23,24]. ...
Article
Full-text available
Background The assessment of children in the Emergency Medical Service (EMS) is infrequent representing 5.4% of the patients in an urban area in the western part of Sweden. In Sweden, patients are assessed on scene by an EMS nurse whom independently decides on interventions and level of care. To aid the EMS nurse in the assessment a triage instrument, Rapid Emergency Triage and Treatment System-paediatrics (RETTS-p) developed for Emergency Department (ED) purpose has been in use the last 5 years. The aim of this study was to evaluate the EMS nurse assessment, management, the utilisation of RETTS-p and patient outcome. Methods A prospective, observational study was performed on 651 children aged < 16 years from January to December 2016. Statistical tests used in the study were Mann-Whitney U test, Fisher’s exact test and Spearman’s rank statistics. Results The dispatch centre indexed life-threatening priority in 69% of the missions but, of all children, only 6.1% were given a life threatening RETTS-p red colour by the EMS nurse. A total of 69.7% of the children were transported to the ED and, of these, 31.7% were discharged without any interventions. Among the non-conveyed patients, 16 of 197 (8.1%) visited the ED within 72 h but only two were hospitalised. Full triage, including five out of five vital signs measurements and an emergency severity index, was conducted in 37.6% of all children. A triage colour was not present in 146 children (22.4%), of which the majority were non-conveyed. The overall 30-day mortality rate was 0.8% (n = 5) in children 0–15 years. Conclusions Despite the incomplete use of all vital signs according to the RETTS-p, the EMS nurse assessment of children appears to be adapted to the clinical situation in most cases and the patients appear to be assessed to the appropriate level of care but indicating an over triage. It seems that the RETTS-p with full triage is used selectively in the pre-hospital assessment of children with a risk of death during the first 30 days of less than 1%.
... According to 1 study, naloxone is the drug most commonly administered to adolescents in the prehospital setting. 5 Prehospital use of this drug is routine, 6 serious adverse effects are rare, and it has no abuse potential. 7 The drug overdose mortality rate rose 159% in nonmetropolitan rural counties between 1999 and 2004, compared with 54% in metropolitan counties. ...
... According to 1 study, naloxone is the drug most commonly administered to adolescents in the prehospital setting. 5 Prehospital use of this drug is routine, 6 serious adverse effects are rare, and it has no abuse potential. 7 The drug overdose mortality rate rose 159% in nonmetropolitan rural counties between 1999 and 2004, compared with 54% in metropolitan counties. ...
Article
We determined the factors that affect naloxone (Narcan) administration in drug overdoses, including the certification level of emergency medical technicians (EMTs). In 2012, 42 states contributed all or a portion of their ambulatory data to the National Emergency Medical Services Information System. We used a logistic regression model to measure the association between naloxone administration and emergency medical services certification level, age, gender, geographic location, and patient primary symptom. The odds of naloxone administration were much higher among EMT-intermediates than among EMT-basics (adjusted odds ratio [AOR] = 5.4; 95% confidence interval [CI] = 4.5, 6.5). Naloxone use was higher in suburban areas than in urban areas (AOR = 1.41; 95% CI = 1.3, 1.5), followed by rural areas (AOR = 1.23; 95% CI = 1.1, 1.3). Although the odds of naloxone administration were 23% higher in rural areas than in urban areas, the opioid drug overdose rate is 45% higher in rural communities. Naloxone is less often administered by EMT-basics, who are more common in rural areas. In most states, the scope-of-practice model prohibits naloxone administration by basic EMTs. Reducing this barrier could help prevent drug overdose death. (Am J Public Health. Published online ahead of print April 23, 2015: e1-e7. doi:10.2105/AJPH.2014.302520).
... Younger teens' true understanding of their condition and treatment may be less sophisticated than it appears, leading clinicians and parents to an erroneously positive assessment of their readiness to take responsibility for health care decisions and for self-care after discharge. During an ED visit, the intensity of adolescent self-examination may lead to extreme selfconsciousness, as well as concern about loss of autonomy, body image, and the effects of injury or treatment on their appearance, (i.e., what they will look like with a splint, or with a scar) (Seidel, 1991). In addition, adolescents with chronic illnesses can experience a deep sense of hopelessness and despair during medical crises, with anger at ED staff, family members, and the disease. ...
Article
Full-text available
Objective: To address the mental health needs of children involved in emergency medical services (EMS). Methods: A multidisciplinary consensus conference convened to identify mental health needs of children and their families related to pediatric medical emergencies, to examine the impact of psychological aspects of emergencies on recovery and satisfaction with care, and to delineate research questions related to mental health aspects of medical emergencies involving children. Results: The consensus group found that psychological and behavioral factors affect physical as well as emotional recovery after medical emergencies. Children's reactions are critically affected by age and developmental level, characteristics of the emergency medical event, and parent reactions. As frontline health care providers, EMS staff members are in a pivotal position to recognize and effectively manage the mental health needs of patients and their families. Conclusions: Ecological changes in emergency departments, such as linkages to mental health follow-up services, training of EMS providers and mental health professionals, and focused research that provides an empirical basis for practice, are necessary components for improving current standards of health care.
... Gathering of retrospective data is often limited by the use of arbitrary age cutoffs for triage by individual EMS systems. 63 The pediatric Utstein guidelines recommend stratification of results by the following age groups: 0 to 12 months, 1 to 4 years (preschool), 5 to 12 years (child), and 13 to 21 years (adolescent). Newborns in the first day of life and neonatal ICU patients should be studied separately. ...
Article
Pediatric cardiopulmonary arrest carries a very poor prognosis that has not improved over the last few decades. Many unanswered questions remain regarding pediatric CPR and how best to improve survival and neurologic outcome. High-quality research is needed to resolve these issues. This research should consist of population-based, prospective studies using the case definitions and outcomes specified by the Utstein guidelines. Prevention as a critical link in the chain of survival deserves special emphasis and attention.
... Gathering of retrospective data is often limited by the use of arbitrary age cutoffs for triage by individual EMS systems. 63 The pediatric Utstein guidelines recommend stratification of results by the following age groups: 0 to 12 months, 1 to 4 years (preschool), 5 to 12 years (child), and 13 to 21 years (adolescent). Newborns in the first day of life and neonatal ICU patients should be studied separately. ...
Article
Little information is available about the effects of CPR in children, although it is known that the outcomes are dismal. Examples of unanswered questions include which advanced life support (ALS) procedures should be performed out-of-hospital, whether high-dose epinephrine improves survival, and the true prevalence of ventricular fibrillation as a presenting rhythm. Children differ from adults as to the cause and pathophysiology of cardiopulmonary arrest, but prehospital EMS and hospital resuscitation teams were initially designed for the care of adults. Because pediatric cardiopulmonary arrest is rare, prospective data are difficult to gather, and there are few large published studies. The purpose of this collective review was to review the current body of knowledge regarding survival rates and outcomes in pediatric CPR and, based on this review, to outline a course for future research.
... Younger teens' true understanding of their condition and treatment may be less sophisticated than it appears, leading clinicians and parents to an erroneously positive assessment of their readiness to take responsibility for health care decisions and for self-care after discharge. During an ED visit, the intensity of adolescent self-examination may lead to extreme selfconsciousness, as well as concern about loss of autonomy, body image, and the effects of injury or treatment on their appearance, (i.e., what they will look like with a splint, or with a scar) (Seidel, 1991). In addition, adolescents with chronic illnesses can experience a deep sense of hopelessness and despair during medical crises, with anger at ED staff, family members, and the disease. ...
Article
To address the mental health needs of children involved in emergency medical services (EMS). A multidisciplinary consensus conference convened to identify mental health needs of children and their families related to pediatric medical emergencies, to examine the impact of psychological aspects of emergencies on recovery and satisfaction with care, and to delineate research questions related to mental health aspects of medical emergencies involving children. The consensus group found that psychological and behavioral factors affect physical as well as emotional recovery after medical emergencies. Children's reactions are critically affected by age and developmental level, characteristics of the emergency medical event, and parent reactions. As frontline health care providers, EMS staff members are in a pivotal position to recognize and effectively manage the mental health needs of patients and their families. Ecological changes in emergency departments, such as linkages to mental health follow-up services, training of EMS providers and mental health professionals, and focused research that provides an empirical basis for practice, are necessary components for improving current standards of health care.
Chapter
Viewing adolescent behavior as reckless, in need of restraint and modification, is not new. Whereas earlier generations of thinkers and educators were concerned with building character, a growing segment of their counterparts today are couching the discussion in terms of health. Expressions such as youthful recklessness, problem behaviors, excessive or deviant risk-taking, health-compromising behaviors, and behavioral misadventures are being used not only to describe adolescent behavior, but also to explain adverse health outcomes in this population. A review of the current literature on adolescent behavior and health reveals a repeated theme of attributing ill health in this age group primarily to risk-taking behavior. Injuries, as the major contributor to adolescent death and disability, are being used as a principal example of such a link.
Article
Objective To determine the complaints leading adolescents to a third level emergency department, as well as the distinguishing features between the different groups of complaints. Material and methods Retrospective study of the emergency department reports of 170 adolescents selected from the 1,172 adolescents who visited the Hospital Sant Joan de Déu pediatric emergency department in May 1997. We excluded 517 patients with trauma. Statistical analysis was carried out with the chi-square test for qualitative variables and analysis of variance for quantitative variables; differences were accepted as significant at p < 0.05. Results Eighty-nine patients were female and 81 were male. Median age was 13.8 years. The most frequent discharge diagnoses were abdomen pain in 26 patients, viral illness in 15 and depression-anxiety in 14. Complementary investigations were carried out in 60 patients. One hundred forty-one patients were discharged. Of the 26 patients with psychiatric disorders, 18 were girls and 8 were boys. The proportion of girls was also higher among patients with abdominal and neurological symptoms, although not among patients with organic disorders (p = 0.03). Most of the patients with psychiatric antecedents were diagnosed with a psychiatric disorder. Ten (11.8 %) of the 85 patients with organic complaints were admitted to hospital compared with 13 (50 %) of the 26 patients with psychiatric disorders (p < 0.001). Conclusions Adolescents visit emergency departments for a variety of complains. The proportion of psychiatric disorders and non-specific symptoms is high.
Article
Mental illness significantly impairs the lives of 10% of all children and adolescents in the United States (National Institute of Mental Health. Brief Notes on the Mental Health of Children and Adolescents. Bethesda, MD: National Institute of Mental Health, 1999). Of the myriad mental health problems afflicting children, an alarming number are known to have grim outcomes. Some illnesses continue into adulthood, while others may culminate in death during adolescence. Despite the serious consequences of children's mental health problems, early treatment can improve or control these conditions. Even with this knowledge, seemingly little effort is geared toward removing barriers to treatment for these diseases that plague our children. As a part of its five-year plan, Emergency Medical Services for Children (EMSC) has collaborated with the National Association of EMS Physicians (NAEMSP) to examine childhood and adolescent mental health emergencies—particularly their presentation and management within the emergency medical services system. This document presents a critical review of current practices and models for treatment of children and adolescents that includes identification of barriers to mental health treatment and recommendations for their resolution.
Article
The emergency department (ED) management of suicidal patients often requires the staff to enter into complex negotiations to gain the patient's cooperation or even save his or her life on rare occasions. ED personnel must adapt to a changing role under dynamic conditions. The critical role played by the ED requires a significant amount of preparation through policy development and training. Suicidal patients may lash out at the ED staff with extremely violent actions that require the staff to know proper safety techniques, as well as their own limitations. Staff must be trained to recognize the potential for violence and be given the tools to manage the suicidal patient effectively to prevent an escalation of the encounter. ED personnel should also receive training on how to survive a hostage situation and the actions they can take to increase their chances of survival. The ED encounter with the suicidal patient also requires excellent assessment and negotiation skills in addition to the clinical skills normally used with routine patients. Personnel must also have a clear understanding of the institution's use of force policy to detain suicidal patients while limiting the potential for staff injury and liability. With proper planning and training, ED personnel can effectively and safely manage suicidal patients. (C) 1994 Aspen Publishers, Inc.
Article
Previous reports on emergency medical services (EMS) transportation of pediatric patients have demonstrated a high rate of overutilization. However, there is also a concern that pediatric patients may underutilize EMS for emergencies that might benefit from EMS. This article compares EMS utilization rate between adult and pediatric patients for high-acuity patients and for the most common reasons for transport. This study was a secondary analysis of the National Hospital Ambulatory Medical Care Survey to compare hospital arrival by EMS to walk-in arrivals. Primary variables were age category, mode of arrival, immediacy to be seen (triage category), reason for visit, and disposition. There were 253,898 records, weighted to represent 914.4 million emergency department visits, included. Emergency medical services mode of arrival was significantly higher for adult patients at 19.1% as compared with pediatric patients at 6.5% (odds ratio, 3.38). For the subgroup of patients requiring critical care interventions, adult patient arrival by EMS was 87.3% as compared with pediatric patients at 66.3% (odds ratio, 3.50). When considering the top 20 most common medical complaints in which pediatric patients used EMS transport, adult patients utilized EMS more frequently in 85% (17/20) of those complaints. As compared with adults, pediatric patients are less likely to utilize EMS for transport to the hospital for both routine and emergent complaints. The definition of inappropriate utilization of EMS for pediatric transport, which has largely focused on inappropriate overutilization, should also incorporate the potential of underutilization for critical patients.
Article
This statement is the product of a task force meeting held June 8, 1994, in Washington DC in conjunction with the First International Conference on Pediatric Resuscitation and a follow-up task force writing group meeting held September 18, 1994, in Chicago. Draft versions of the statement were circulated for comment to all members of the task force, the American Heart Association Subcommittee on Pediatric Resuscitation, and several outside reviewers. This statement and the International Conference on Pediatric Resuscitation were cosponsored by the American Academy of Pediatrics and the American Heart Association. The development of this statement was authorized by the American Academy of Pediatrics; the American Heart Association National Subcommittees on Pediatric Resuscitation, Basic Life Support, and Advanced Cardiac Life Support, the Committee on Emergency Cardiac Care, the Science Advisory Committee; and the European Resuscitation Council. In addition to the writing group, members of the Pediatric Utstein Task Force are Paul Anderson, M Douglas Baker, Jane Ball, Desmond Bohn, Dena Brownstein, J Michael Dean, Niranjan Kissoon, Bruce Klein, Patrick Malone, Karin McCloskey, James McCrory, P Pearl O'Rourke, Mary Patterson, Charles Schleien, James Seidel, Joseph J Tepas III, and Becky Yano.
Article
This consensus document is an attempt to provide an organized method of reporting pediatric ALS data in out-of-hospital, emergency department, and in-hospital settings. For this methodology to gain wide acceptance, the task force encourages development of a common data set for both adult and pediatric ALS interventions. In addition, every effort should be made to ensure that consistent definitions are used in all age groups. As health care changes, we will all be challenged to document the effectiveness of what we currently do and show how new interventions or methods of treatment improve outcome and/or reduce cost. Only through collaborative research will we obtain the necessary data. For these reasons, and to improve the quality of care and patient outcomes, it is the hope of the task force that clinical researchers will follow the recommendations in this document. It is recognized that further refinements of this statement will be needed; these recommendations will improve only when researchers, clinicians, and EMS personnel use them, work with them, and modify them. Suggestions, emendations, and other comments aimed at improving the reporting of pediatric resuscitation should be sent to Arno Zaritsky, MD, Eastern Virginia Medical School, Children's Hospital of the King's Daughter, Division of Critical Care Medicine, 601 Children's Lane, Norfolk, VA 23507.
Article
To describe the clinical effects of carbamazepine ingestion in a pediatric population. Case series of prospectively evaluated patients and a historical retrospective group. All patients younger than 18 years who presented to an urban emergency department with history of carbamazepine ingestion and positive laboratory confirmation. Patient demographics, findings on physical examination, serum carbamazepine levels, analysis of 12-lead ECGs, and time and doses of activated charcoal were recorded. Seventy-seven patients were enrolled, of whom 17 were evaluated prospectively. Serum carbamazepine levels were greater than 12 micrograms/mL (50 mumol/L) in 61 patients. In those 61 patients, mean peak serum level was significantly higher in patients with dystonic reactions (P = .009), coma (P = .002), and apnea (P = .008) than in patients without these symptoms. There was no significant difference in mean peak serum levels between patients with and without seizures. Serum carbamazepine half-life was significantly shorter (P = .022) in patients who received multiple doses of activated charcoal (8.2 +/- 1.6 hours) than in those who received a single dose (12.1 +/- hours). Pediatric patients with suspected carbamazepine ingestion are at higher risk for dystonic reactions, coma, and apnea if the peak serum carbamazepine level exceeds 28 micrograms/mL (117 mumol/L). The development of seizures is not related to peak serum level. Multiple doses of activated charcoal can significantly shorten serum carbamazepine half-life.
Article
To determine the requirements in all states and the District of Columbia for use of restraints on patients in ambulances. A structured telephone survey was conducted with all state Emergency Medical Services (EMS) agencies or the agency responsible for the regulation of ambulances. Questions were asked regarding restraint of patients in ambulances. The age definition of a pediatric patient was also queried. Ambulances are regulated in 47% of states by EMS, 14% by law enforcement, 3% by a public safety agency, and in some states by other agencies such as the Department of Motor Vehicles. In 27% of the states no agency is responsible for ambulance regulations. Most states do not require patients of any age to be restrained in ambulances; however, the drivers and passengers are required to wear seat belts. Most of the states with laws regulating ambulance restraints for infants and children were in the northeast. There is great variance in the age that defines a pediatric patient for EMS. A means of safely restraining infants and children in ambulances is needed. Until new restraints are available, ambulances should restrain infants and children in car seats and on gurneys. A national age standard for defining a pediatric patient using EMS is needed.
Article
Full-text available
To compare pediatric ambulance patients transported for chief complaints of suicide, assault, alcohol, and drug intoxication (SAAD) with pediatric patients transported for all other chief complaints. An out-of-hospital database for the primary transporting service in an urban area was analyzed for patients 0-20 years of age from 1992 to 1995. Chief complaints by age, gender, and billing status were analyzed. There were 17,722 transports. The SAAD group comprised 14.9% of all transports (suicide attempt 1.6%, assault 5.9%, alcohol intoxication 3.2%, and drug abuse 4.2%). The proportion of transports due to SAAD increased with age: 0-11-year-olds (4.2%); 11-16-year-olds (17.5%); and 17-20-year-olds (20.3%) (p = 0.0001). Genders were equally represented in the overall group, while males comprised 52.6% of the SAAD transports (p = 0.032). In the SAAD group, the majority of transports for assaults (55.9%) and alcohol (58.8%) involved males, while females were the majority in transports for suicide (52.3%) and drug abuse (66%) (p = 0.0001). Reimbursement sources differed, with those in the SAAD group less likely to be reimbursed by private or public (Medicaid, government) insurance (p < 0.0001) compared with the overall group. A substantial proportion of pediatric emergency medical services transports are for high-risk conditions. This patient population differs from the overall group by age distribution and reimbursement source.
Article
To determine the complaints leading adolescents to a third level emergency department, as well as the distinguishing features between the different groups of complaints. Retrospective study of the emergency department reports of 170 adolescents selected from the 1,172 adolescents who visited the Hospital Sant Joan de Déu pediatric emergency department in May 1997. We excluded 517 patients with trauma. Statistical analysis was carried out with the chi-square test for qualitative variables and analysis of variance for quantitative variables; differences were accepted as significant at p,0.05. Eighty-nine patients were female and 81 were male. Median age was 13.8 years. The most frequent discharge diagnoses were abdomen pain in 26 patients, viral illness in 15 and depression-anxiety in 14. Complementary investigations were carried out in 60 patients. One hundred forty-one patients were discharged. Of the 26 patients with psychiatric disorders, 18 were girls and 8 were boys. The proportion of girls was also higher among patients with abdominal and neurological symptoms, although not among patients with organic disorders (p50.03). Most of the patients with psychiatric antecedents were diagnosed with a psychiatric disorder. Ten (11.8%) of the 85 patients with organic complaints were admitted to hospital compared with 13(50%) of the 26 patients with psychiatric disorders (p,0.001). Adolescents visit emergency departments for a variety of complains. The proportion of psychiatric disorders and non-specific symptoms is high.
Article
Mental illness significantly impairs the lives of 10% of all children and adolescents in the United States (National Institute of Mental Health. Brief Notes on the Mental Health of Children and Adolescents. Bethesda, MD: National Institute of Mental Health, 1999). Of the myriad mental health problems afflicting children, an alarming number are known to have grim outcomes. Some illnesses continue into adulthood, while others may culminate in death during adolescence. Despite the serious consequences of children's mental health problems, early treatment can improve or control these conditions. Even with this knowledge, seemingly little effort is geared toward removing barriers to treatment for these diseases that plague our children. As a part of its five-year plan, Emergency Medical Services for Children (EMSC) has collaborated with the National Association of EMS Physicians (NAEMSP) to examine childhood and adolescent mental health emergencies--particularly their presentation and management within the emergency medical services system. This document presents a critical review of current practices and models for treatment of children and adolescents that includes identification of barriers to mental health treatment and recommendations for their resolution.
Article
Emergency departments (EDs) are vital in the management of pediatric patients with mental health emergencies (MHE). Pediatric MHE are an increasing part of emergency medical practice because EDs have become the safety net for a fragmented mental health infrastructure which is experiencing critical shortages in services in all sectors. EDs must safely, humanely, and in a culturally and developmentally appropriate manner manage pediatric patients with undiagnosed and known mental illnesses including those with mental retardation, autistic spectrum disorders, attention deficit hyperactivity disorder (ADHD), and those experiencing a behavioral crisis. EDs also manage patients with suicidal ideation, depression, escalating aggression, substance abuse, post traumatic stress disorder, maltreatment, and those exposed to violence and unexpected deaths. EDs must address not only the physical but also the mental health needs of patients during and after mass casualty incidents and disasters. The American Academy of Pediatrics and the American College of Emergency Physicians support the following actions: advocacy for increased mental health resources, including improved pediatric mental health tools for the ED, increased mental health insurance coverage, adequate reimbursement at all levels; acknowledgment of the importance of the child's medical home, and promotion of education and research for mental health emergencies.
Article
This Policy Statement was reaffirmed June 2009, April 2013, and April 2020 Emergency departments are vital in the management of pediatric patients with mental health emergencies. Pediatric mental health emergencies are an increasing part of emergency medical practice because emergency departments have become the safety net for a fragmented mental health infrastructure that is experiencing critical shortages in services in all sectors. Emergency departments must safely, humanely, and in a culturally and developmentally appropriate manner manage pediatric patients with undiagnosed and known mental illnesses, including those with mental retardation, autistic spectrum disorders, and attention-deficit/hyperactivity disorder and those experiencing a behavioral crisis. Emergency departments also manage patients with suicidal ideation, depression, escalating aggression, substance abuse, posttraumatic stress disorder, and maltreatment and those exposed to violence and unexpected deaths. Emergency departments must address not only the physical but also the mental health needs of patients during and after mass-casualty incidents and disasters. The American Academy of Pediatrics and the American College of Emergency Physicians support advocacy for increased mental health resources, including improved pediatric mental health tools for the emergency department, increased mental health insurance coverage, and adequate reimbursement at all levels; acknowledgment of the importance of the child’s medical home; and promotion of education and research for mental health emergencies.
Article
School injuries occurring in a municipal school system during a 2-year period were reviewed to identify epidemiologic features of school injuries, to determine data requirements for ongoing injury surveillance, and to identify potential preventive strategies. Overall, 3,009 injuries were reported (2.82/100 students per year). Elementary school students had only a slightly higher rate (2.85) than secondary school students (2.78). However, the cause, nature, school location of injury, and body area injured formed distinct patterns in these two groups. Playgrounds were responsible for the highest overall and elementary school rates, whereas sports areas and classrooms had the highest rates among secondary school students. Falls were the most frequent cause of injury in elementary schools whereas, as expected, sports injuries were the most frequent cause among secondary school students. Contusions and abrasions of the head were the most frequent type of injury for both groups, although more common among elementary school students, whereas fractures, sprains, strains, and dislocations were more frequent among secondary school students. Although the proportion of severe injuries to secondary school students was slightly higher (39 v 35%), the rate of referral of students to a hospital or physicians among secondary school students (1.21 per 100 student-hours) was almost twice the rate of elementary school students (0.65 per 100 student-hours). Problems with definition of injury severity and the need to explore the social aspects of schools as a factor in injuries emerged as important considerations for future research.
Article
Injuries represent the single greatest threat to the health and well-being of US children. A large number of childhood injuries are sustained in schools, yet little is currently known of the epidemiologic features of school-related injuries. A surveillance of injuries occurring in a large, urban school district during a 2-year period was conducted. Nurses in each of the district's 96 schools completed reporting forms on all injuries meeting standardized criteria, and both principals and nurses completed questionnaires on school characteristics that were judged potentially important to the injury rate in individual schools. A total of 5,379 injuries were reported, among the district's 55,000 students, for an overall injury rate of 49 injuries/1,000 student-years. Injury rates were higher for boys than girls at all age levels. Self-caused and sports-related injuries comprised nearly half of all those reported, and 14% were related to use of playground or sports equipment. Eighteen percent of injuries were severe, and playground- and equipment-related injuries were significantly more likely to be severe (P less than .001). Rates of injury among individual schools varied markedly, with schools at the two extremes separated by a 25-fold difference in rates. Higher overall injury rates were found in schools with longer hours, alternative educational programs, less experienced school nurses, and lower student-to-staff ratios (P less than .0001).
Article
Emergency medical systems are being developed throughout the United States primarily to deal with myocardial infarction and trauma. These programs often fail to recognize the special needs of the critically ill child. Data collected in Los Angeles County from the LA County Trauma Surveys, Mobile Intensive Care Unit Rescue Reports, and Base Station Hospitals demonstrate that children represent approximately 10% of the paramedic calls. The calls are for medical problems as well as trauma. These data suggest that children have a higher death rate in the field than adults, and deaths occur more commonly in areas where there are no pediatric centers. Children are often secondarily transferred from emergency departments to other centers for definitive care. This study suggests that the needs of children in the prehospital setting are not being met.
Article
Endorsed emergency medicine (EM) residency programs were surveyed as to the nature and extent of training they provided in pediatric emergency care (PEC). In the surveys returned (82%) there were several important findings. The amount of time in PEC training was generally two months per year of training. This accounted for 16% of training time. However, the volume of pediatric patients was 25% of the overall patient population. There was wide variation in the sites of PEC training. Didactic sessions often did not cover even core topics. The training program directors were equally divided in their satisfaction with this aspect of their programs. Changes were recommended by 80% of the directors. Changes most often suggested were increasing pediatric patient exposure and obtaining PEC specialists as trainers.
Committee on Trauma. Field The author would like 'to thank the following people for their categorization of trauma patients
  • American College
  • Surgeons
American College of Surgeons, Committee on Trauma. Field The author would like 'to thank the following people for their categorization of trauma patients. ACS Bull 1986;71:17-22. invaluable help with this study: Deborah Parkman Henderson,.
for her guidance in every aspect of the CaIif@r.ria olescent Health Age limits of pediatrics project; the staff of Santa Cruz County EMS Division
  • American Academy
  • Pediatrics
  • Child An I Ad-R N Council
American Academy of Pediatrics, Council on Child an I Ad-R.N., M.A., for her guidance in every aspect of the CaIif@r.ria olescent Health. Age limits of pediatrics. Pediatrics 1988; EMSC project; the staff of Santa Cruz County EMS Division; San 81:736. Luis Obispo EMS Agency; NorCal EMS Agency; LA County EMS
Age limits of pediatrics
  • American Academy of Pediatrics
Results from the national adolescent health survey
  • Center for Disease Control
Department Of Health Services, Division of
  • San Diego County, Department Of Health Services, Division of Emergency Medical Services