References

Bridgwater: Class Professional Publishing; 2013

Adewale L Anatomy and assessment of the pediatric airway. Paediatr Anaesth. 2009; 19:1-8 https://doi.org/10.1111/j.1460-9592.2009.03012.x

Biarent D, Bingham R, Eich C European Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Paediatric life support. Resuscitation. 2010; 81:(10)1364-88 https://doi.org/10.1016/j.resuscitation.2010.08.012

Bouglé A, Harrois A, Duranteau J Resuscitative strategies in traumatic hemorrhagic shock. Ann Intensive Care. 2013; 3:(1) https://doi.org/10.1186/2110-5820-3-1

Brown RL, Brunn MA, Garcia VF Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg. 2001; 36:(8)1107-14 https://doi.org/10.1053/jpsu.2001.25665

Choi SC, Narayan RK, Anderson RL, Ward JD Enhanced specificity of prognosis in severe head injury. J Neurosurg. 1988; 69:(3)381-5 https://doi.org/10.3171/jns.1988.69.3.0381

Cowley A, Durge N The impact of parental accompaniment in paediatric trauma: a helicopter emergency medical service (HEMS) perspective. Scand J Trauma Resusc Emerg Med. 2014; 22:(1) https://doi.org/10.1186/1757-7241-22-32

Cullen PM Paediatric trauma. Continuing Education in Anaesthesia, Critical Care and Pain. 2012; 12:(3)157-161 https://doi.org/10.1093/bjaceaccp/mks010

Czosnyka M, Smielewski P, Piechnik S, Steiner LA, Pickard JD Cerebral autoregulation following head injury. J Neurosurg. 2001; 95:(5)756-63 https://doi.org/10.3171/jns.2001.95.5.0756

D'Amore A, Hewson GC The management of acute upper airway obstruction in children. Paediatr Child Health. 2002; 12:(1)17-21 https://doi.org/10.1054/cupe.2001.0242

Davenport R Haemorrhage control of the pre-hospital trauma patient. Scand J Trauma Resusc Emerg Med. 2014; 22 https://doi.org/10.1186/1757-7241-22-S1-A4

Doran CM, Doran CA, Woolley T Targeted resuscitation improves coagulation and outcome. J Trauma Acute Care Surg. 2012; 72:(4)835-43 https://doi.org/10.1097/TA.0b013e318248347b

Greene N, Bhananker S, Ramaiah R Vascular access, fluid resuscitation, and blood transfusion in pediatric trauma. Int J Crit Illn Inj Sci. 2012; 2:(3)135-42 https://doi.org/10.4103/2229-5151.100890

Haddad SH, Arabi YM Critical care management of severe traumatic brain injury in adults. Scand J Trauma Resusc Emerg Med. 2012; 20:(1) https://doi.org/10.1186/1757-7241-20-12

Heather NL, Derraik JGB, Beca J Glasgow Coma Scale and outcomes after structural traumatic head injury in early childhood. PloS One. 2013; 8:(12) https://doi.org/10.1371/journal.pone.0082245

Hodgetts TJ, Mahoney PF, Russell MQ, Byers M ABC: redefining the military trauma paradigm. Emerg Med J. 2006; 23:(10)745-6 https://doi.org/10.1136/emj.2006.039610

Holm-Knudsen RJ, Rasmussen LS Paediatric airway management: basic aspects. Acta Anaesthesiol Scand. 2009; 53:(1)1-9 https://doi.org/10.1111/j.1399-6576.2008.01794.x

Karason S, Reynisson K, Sigvaldason K, Sigurdsson GH Evaluation of clinical efficacy and safety of cervical trauma collars: differences in immobilization, effect on jugular venous pressure and patient comfort. Scand J Trauma Resusc Emerg Med. 2014; 22:(1) https://doi.org/10.1186/1757-7241-22-37

Kokoska ER, Smith GS, Pittman T, Weber TR Early hypotension worsens neurological outcome in pediatric patients with moderately severe head trauma. J Pediatr Surg. 1998; 33:(2)333-8 https://doi.org/10.1016/S0022-3468(98)90457-2

Laerdal Medical. 2014. http//www.laerdal.com/gb/LSU (accessed 21 August 2015)

Lee C, Porter K The prehospital management of pelvic fractures. Emerg Med J. 2007; 24:(2)130-3 https://doi.org/10.1136/emj.2006.041384

Lee C, Revell M, Porter K, Steyn R The prehospital management of chest injuries: a consensus statement. Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. Emerg Med J. 2007; 24:(3)220-4 https://doi.org/10.1136/emj.2006.043687

Lyttle MD, Ardolino A, Berry K Using existing paediatric pre-hospital trauma triage tools to identify children with severe traumatic brain injury-an analysis of national trauma registry data. Emerg Med J. 2013; 30:(10) https://doi.org/10.1136/emermed-2013-203113.33

Michaud LJ, Rivara FP, Grady MS, Reay DT Predictors of survival and severity of disability after severe brain injury in children. Neurosurgery. 1992; 31:(2)254-64

Midwinter MJ, Woolley T Resuscitation and coagulation in the severely injured trauma patient. Philos Trans R Soc Lond B Biol Sci. 2011; 366:(1562)192-203 https://doi.org/10.1098/rstb.2010.0220

Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg. 2012; 147:(2)113-19 https://doi.org/10.1001/archsurg.2011.287

Moss R, Porter K, Greaves I Minimal patient handling: a faculty of prehospital care consensus statement. Emerg Med J. 2013; 30:(12)1065-6 https://doi.org/10.1136/emermed-2013-203205

Ng I, Lim J, Wong HB Effects of head posture on cerebral hemodynamics: its influences on intracranial pressure, cerebral perfusion pressure, and cerebral oxygenation. Neurosurgery. 2004; 54:(3)593-7 https://doi.org/10.1227/01.NEU.0000108639.16783.39

Nystrup KB, Stensballe J, Bøttger M, Johansson PI, Ostrowski SR Transfusion therapy in paediatric trauma patients: a review of the literature. Scand J Trauma Resusc Emerg Med. 2015; 23:(1) https://doi.org/10.1186/s13049-015-0097-z

Platzer P, Jaindl M, Thalhammer G Cervical spine injuries in pediatric patients. J Trauma. 2007; 62:(2)389-396 https://doi.org/10.1097/01.ta.0000221802.83549.46

Paediatric Advanced Life Support.London: Resuscitation Council UK; 2010

Roberts I, Shakur H, Coats T The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess. 2013; 17:(10)1-79 https://doi.org/10.3310/hta17100

Isono S One hand, two hands, or no hands for maximizing airway maneuvers?. Anesthesiology. 2008; 109:(4)576-7 https://doi.org/10.1097/ALN.0b013e3181870a5d

Simpson AJ, Rivara FP, Pham TN Quality care in pediatric trauma. Int J Crit Illn Inj Sci. 2012; 2:(3)149-55 https://doi.org/10.4103/2229-5151.100893

Cervical collars slashed from guidelines. 2015. http//www.scancrit.com/2015/02/12/cervical-collars-slashed-guidelines/ (accessed 21 August 2015)

Udomphorn Y, Armstead WM, Vavilala MS Cerebral blood flow and autoregulation after pediatric traumatic brain injury. Pediatr Neurol. 2008; 38:(4)225-34 https://doi.org/10.1016/j.pediatrneurol.2007.09.012

Walls RM, Murphy MF, Luten RC, Schneider RE, 2nd edn. Philadelphia, PA: Lippincott Williams and Wilkins; 2004

Essex and Herts Air Ambulance: a focused case series for pre-hospital practice

02 September 2015
Volume 7 · Issue 9

Abstract

Due to the relative infrequency of major trauma in the paediatric population, along with the presence of family members during the resuscitation, management of trauma in this age group can be both emotive and highly challenging. Through comprehensive assessment, targeted resuscitation and considered triage to an appropriate paediatric trauma facility, pre-hospital care clinicians can help to improve outcomes in the paediatric trauma patient (Simpson et al, 2012; Nystrup et al, 2015).

This article aims to provide a structured, evidence-based approach to the assessment and management of the injured child in the pre-hospital setting. We report the case of a 10-year old female involved in a pedestrian versus van road traffic collision (RTC). The principles of systematic assessment and holistic management of the paediatric trauma patient are discussed. We also discuss where an extended care service such as a Helicopter Emergency Medical Service may be of assistance.

Essex and Herts Air Ambulance Trust (EHAAT) is a publically funded charity that operates two doctor-paramedic pre-hospital care teams to provide support to land ambulance crews in two counties in the South East of England. The service is predominantly helicopter-based but operates a rapid response car outside daylight hours or in poor weather. The total population covered numbers approximately 1.8 million. The team responds to major trauma and medical emergencies, with the latter accounting for approximately 20% of all taskings. The paramedics who work for the service are all employed by the East of England Ambulance Service NHS Trust, and are seconded to EHAAT for a period of 24 months. A comprehensive selection process is undertaken and an extensive training programme covering aviation practice and extended clinical management is in place for successful candidates. In addition, EHAAT paramedics have been among the first to enrol and undergo enhanced skill training in anaesthetics and intensive care medicine as part of a postgraduate certificate in advanced paramedic practice in critical care. We believe that one of the strengths of the service provided by EHAAT lies in our paramedics acting as role models and ambassadors for both our service and the ambulance service in general.

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