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Factors Influencing Treatment of Asthma in Children in the Prehospital Setting

Published online by Cambridge University Press:  28 June 2012

Bartholomew J. Tortella ,
Annicol D. Marrocco ,
Robert F. Lavery  and
Noel Killeen
Bartholomew J. Tortella*
Affiliation:
Division of Trauma and Emergency Medical Services, The New Jersey Trauma Center, University Hospital and the University of Medicine and Dentistry of New Jersey, Newark, N.J.
Annicol D. Marrocco
Affiliation:
New Jersey Medical School-University of Medicine and Dentistry of New Jersey, Newark N.J.
Robert F. Lavery
Affiliation:
Division of Trauma and Emergency Medical Services, The New Jersey Trauma Center, University Hospital and the University of Medicine and Dentistry of New Jersey, Newark, N.J.
Noel Killeen
Affiliation:
Division of Trauma and Emergency Medical Services, The New Jersey Trauma Center, University Hospital and the University of Medicine and Dentistry of New Jersey, Newark, N.J.
*
150 Bergen Street, J-204, Newark, NJ 07103USA
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Abstract

Study Objective:

The purpose of this study is to describe treatment of asthma in children by paramedics.

Design:

Retrospective review of an advanced life support (ALS) run reports over a one-year period.

Setting:

Review of paramedic response to pediatric respiratory emergencies in an urban, primarily inner-city, prioritized, dual-response emergency medical services (EMS) system.

Participants:

Patients < 19 years of age complaining of shortness of breath, paramedics, pediatric residents, and attending physicians.

Measurements and Main Results:

The medical records of 383 patients were reviewed for demographic and medical information. The population was separated into an ALS treatment group (received ALS) and a NO-ALS group (evaluation and/or oxygen only). Sixty percent of the patients (n = 231) were classified into the ALS group; 89% received epinephrine. Sixty-six percent (n = 101) of the NO-ALS patients received evaluation only, and the remaining 34% (n = 51) were evaluated and received oxygen. The ALS patients were older and had significantly higher respiratory rates and accessory muscle use than did the NO-ALS patients. Relief was reported in 66 % of ALS patients. No adverse reactions were reported in the ALS group. Determining factors influencing ALS treatment included age, the use of medications at home, wheezing, accessory muscle use, respiratory rate, and presence or absence of upper respiratory infection (URI) symptoms.

Conclusions:

This study demonstrates that asthma constitutes the majority of pediatric emergencies in the prehospital setting in this inner-city EMS system. The ALS treatment of pediatric asthma improves patient status. Factors which may influence paramedic judgment in treating asthma in children may be inappropriate. There is a critical need for further research in the prehospital treatment of pediatric asthma and in developing education interventions directed at the entire spectrum of prehospital care of pediatric emergencies.

Keywords

advanced life supportasthmaemergenciesemergency medical services (EMS)epinephrineparamedicpediatricprehospitalrespiratoryshortness of breathtransportation of patients
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 8 , Issue 3 , September 1993 , pp. 241 - 245
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1993

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