Improved prehospital pediatric ALS care after an EMT-paramedic clinical training course.

The objective was to determine the association between the performance rates of pediatric advanced life-support procedures, intubation and vascular access, by emergency medicine technician-paramedics (EMT-P), and introduction of an EMT-P pediatric advanced life support (PALS) clinical course. Prehospital EMT-P care records from January 1990 to December 1991 were retrospectively reviewed to determine endotracheal intubation and vascular access performance rates. These rates were compared with intubation and vascular access performance rates by EMT-Ps from January 1983 to June 1985. In 1986, an EMT-P PALS clinical course was introduced that included rotations during which an EMT-P trainee performed endotracheal intubation of children, under the supervision of a pediatric anesthesiologist, and vascular access, under the supervision of pediatric emergency medicine nurses and physicians. The trainees and all active EMT-Ps were taught the intraosseous infusion procedure. During January 1990 to December 1991, 193 children received prehospital endotracheal intubation attempts and 167 (87%) were intubated. Intubation performance rates for 90 children younger than 18 months of age was 90% and was 83% for 103 children > or = 18 months of age. Vascular access, intravenous or intraosseous, was established in 130 (73%) of the children; no attempt was made in 14 children. The vascular access performance rate was 64% for children younger than 18 months of age and 79% for children > or = 18 months old. Intubation performance rates of EMT-Ps before the EMT-P PALS clinical course (January 1983 to June 1985) were 48% for children younger than 18 months of age and 85% for children > or = 18 months old.(ABSTRACT TRUNCATED AT 250 WORDS)

Five-year experience in prehospital intraosseous infusions in children and adults.

STUDY OBJECTIVE: To evaluate the ability of emergency medical technician-paramedic (EMT-P) units to become and remain proficient in the performance of the intraosseous infusion procedure. DESIGN AND SETTING: Descriptive nonrandomized trial open to all patients meeting protocol criteria over a five-year period; prehospital urban and suburban area with a population of 951,000. PARTICIPANTS: One hundred fifty-two consecutive patients (age range, newborn to 102 years) who had intraosseous infusion line placement attempted by EMT-Ps. INTERVENTION: Jamshidi sternal intraosseous infusion needle placed in the proximal tibia bone marrow in patients requiring emergency vascular access for fluid and/or medication administration. RESULTS: EMT-Ps performed 165 attempts on 152 patients with a five-year success rate of 76% per patient and 70% per attempt. Success rates per patient age group were 78%, 0 to 11 months; 85%, 1 to 2 years; 67%, 3 to 9 years; and 50%, 10 years or older. Success rates were significantly higher in children 3 years old compared with children and adults 3 or more years old (P = .04). Proficiency was maintained over the five-year study period. Infiltration was the most common complication, occurring in 14 patients (12%). Errors in landmark identification and needle bending were the most frequent identifiable causes for unsuccessful attempts. Evidence of clinical response to fluid or medication infused was noted in 28 patients (24%). CONCLUSION: EMT-P units can successfully perform the intraosseous infusion line procedure in patients of all ages. Proficiency is maintained over time despite its infrequent use by individual EMT-Ps.