Prehospital paediatric trauma: equipping prehospital providers to deliver high-quality care.

Abstract

Introduction: Trauma is the leading cause of death in children over 1 year of age in the UK. However, individual prehospital clinicians only encounter paediatric trauma patients rarely. This study describes the frequency and type of paediatric trauma experienced by a mature prehospital trauma service in an urban environment to inform prehospital services about the type of injuries likely to be attended, and the key interventions that might be required on scene.

Study design: Retrospective review of patients 16 years of age and under attended by a physician-led prehospital trauma service between January 2017 and June 2022. Patients were divided into subgroups of 0-4 years, 5-11 years and 12-16 years.

Results: 782 paediatric patients were included, which comprised 8.3% of total patient workload. The median age was 15 years old (IQR 5-16 years) and the majority were male (n=597, 76.3%). The most common mechanism of injury for subgroups were falls from height (>2 m) in 0-4 year olds, road traffic collisions in 5-11 year olds and penetrating trauma in 12-16 year olds. 20.2% (n=158) of patients attended received critical care interventions. 9.8% (n=77) underwent prehospital emergency anaesthesia (PHEA) and 7.4% (n=58) received a blood transfusion.

Conclusion: Paediatric major trauma constitutes only a small minority of prehospital care workload. However, cases are attended regularly. Attending prehospital teams need to be trained to perform difficult resuscitations and perform high acuity, low frequency interventions. Educational and training strategies required to equip prehospital providers treating paediatrics may include checklists, algorithms, simulation training and mental health support.