Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial.

CONTEXT: Endotracheal intubation (ETI) is widely used for airway management of children in the out-of-hospital setting, despite a lack of controlled trials demonstrating a positive effect on survival or neurological outcome. OBJECTIVE: To compare the survival and neurological outcomes of pediatric patients treated with bag-valve-mask ventilation (BVM) with those of patients treated with BVM followed by ETI. DESIGN: Controlled clinical trial, in which patients were assigned to interventions by calendar day from March 15, 1994, through January 1, 1997. SETTING: Two large, urban, rapid-transport emergency medical services (EMS) systems. PARTICIPANTS: A total of 830 consecutive patients aged 12 years or younger or estimated to weigh less than 40 kg who required airway management; 820 were available for follow-up. INTERVENTIONS: Patients were assigned to receive either BVM (odd days; n = 410) or BVM followed by ETI (even days; n = 420). MAIN OUTCOME MEASURES: Survival to hospital discharge and neurological status at discharge from an acute care hospital compared by treatment group. RESULTS: There was no significant difference in survival between the BVM group (123/404 [30%]) and the ETI group (110/416 [26%]) (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.61-1.11) or in the rate of achieving a good neurological outcome (BVM, 92/404 [23%] vs ETI, 85/416 [20%]) (OR, 0.87; 95% CI, 0.62-1.22). CONCLUSION: These results indicate that the addition of out-of-hospital ETI to a paramedic scope of practice that already includes BVM did not improve survival or neurological outcome of pediatric patients treated in an urban EMS system.

Dua Dua Theatre: an experiment in health education.

This is an account of an attempt to use theatre as a tool to alleviate health problems. The advantages of using a trained theatre group, and the benefits to audiences and to performers are discussed in the context of two plays devised and presented to community (primary) schools within a province of Papua New Guinea. No formal evaluation has been attempted, but audience involvement and participation has been enthusiastic.

PIP: The Dua Dua Theatre Company was formed in Lae, Papua New Guinea in 1978 by 2 voluntary social workers as an outlet for unemployed "school leavers." The original group consisted of 6 boys and girls aged 13-17, each with an average of 6 years of primary education. They had poor job prospects and some had been in trouble with the police. In March, 1980 the Morobe Province Food and Nutrition Group--an informal group which was concerned with improving health and nutrition--asked Dua Dua to prepare a short play about nutrition, to be performed in urban community schools. 2000 kina (about $1500 US) was made available to fund this project. A play was written about the importance of the food groups and the dangers of eating junk food. Teachers were asked to discuss the production with their classes the following day. Nutrition and health were already in the primary schools' syllabus. The tour of the play was extended to urban health centers and rural schools and communities. The play was seen in more than 40 schools, health centers, and villages by an estimated 10,000 adults and children. The value of this experience to the Dua Dua players was immense. Having previously been recognized as a "rascal group," (local terminology for young offenders) they were now recognized as a professional theater company doing important community work. In 1981, the local committee for the International Year of Disabled Persons voted a small proportion of their budget to the promotion of accident prevention. They invited Dua Dua Theatre to prepare a play on this topic. The play evolved from discussions with the players about accidents experienced in early childhood. These included falling from trees, drinking kerosene from unmarked bottles, incidents involving knives, razor blades, and traffic accidents. All these and more were shown in the play. The Dua Dua Theatre was receiving financial support from the province.