PREHOSPITAL ENDOTRACHEAL INTUBATION OF CHILDREN BY PARAMEDICS

Study objective: To describe the experience of an emergency medical se rvices system with the use of liberal indications for prehospital pedi atric endotracheal intubation. Methods: We performed a retrospective r eview of prehospital and hospital patient records in an urban and subu rban prehospital care system. The study included ail children aged 15 years or younger who were intubated in the prehospital setting by King County paramedics from January 1, 1984, to December 31, 1990. Results : During the 7-year study period, 654 children were intubated, of whic h 355 (54%) were study patients. The median age of the patients was 3 years; 60% had an injury diagnosis. On arrival of the paramedics, 60% of the patients were in sinus rhythm, 62% had a systolic blood pressur e of 70 mm Hg or greater, and 56% had a respiratory rate of 10 breaths per minute or greater. The Glasgow Coma-Scale score was 8 or lower in 83% of the patients. Succinyicholine was used to facilitate intubatio n in 47% of patients. On arrival at the emergency department, 79% of t he patients were in sinus rhythm; 75% had an adequate blood pressure ( 70 mm Hg or greater); 86% had a Pao, Value of 100 mm Hg or greater; an d 74% had a Paco(2) value of 45 mm Hg or lower. Complications of intub ation, more than half of which were classified as minor, were noted in 22.6% of patients. We were unable to determine the number of failed i ntubation attempts. Most of the patients (58%)survived to hospital dis charge. Among cardiac arrest victims, only 12% survived. Conclusion: I n a setting where paramedics practice with close medical direction,app lying liberal indications for pediatric intubation and permitting the use of succinylcholine allowed paramedics to intubate children of diff erent ages and diagnoses.