UCLA School of Public Health

EMS Pediatric Airway Survey

Background/Rationale:
The Emergency Medical Services (EMS) Airway Survey is a state-wide survey of EMS medical directors about pediatric airway management. EMS systems are diverse across the country and within California in terms of the scope of practice for paramedics in airway management for children. Each local, regional, and state EMS agency can define what procedures will be used by paramedics in the field care of children who have stopped breathing. One previous national survey of EMS training sites has shown that 97% of the schools for paramedics teach bag-mask ventilation (BMV) and endotracheal intubation (ETI).(1) A large, controlled clinical trial of BMV and ETI showed that the addition of ETI to the paramedic scope of practice for children did not improve survival.(2,3) This study also showed improved survival and neurological outcome for children receiving BMV versus ETI in two subgroups: respiratory failure and foreign body aspiration. Complications of ETI were high with 15% of the endotracheal tubes getting dislodged prior to arrival in the emergency department, of which, many were unrecognized, potentially resulting in the death of the child. Although results from this study were published in 2000, many EMS system medical directors have chosen not to remove ETI for children from the scope of practice of paramedics. It is unclear why this information has not been acted upon; however, some possible reasons include disbelief of study results, feelings that the results are not applicable to other EMS systems, and bureaucratic difficulties in changing scope of practice of paramedics within EMS systems. Overall, there has not been a systematic evaluation of what techniques are approved for use to support and manage the airway and breathing for children i the state or the nation, and barriers to implementation of the results of this important study for chldren have not been evaluated.
Aims:
The purpose of this study is to survey all 31 EMS Medical Directors in the state of California to assess which airway procedures are used, quality improvement practices employed, and barriers to implementation of evidence-based recommendations. Differences in adult and pediatric airway management scope of practice and barriers to implementation of evidence-based changes in paramedic scope of practice will be delineated.

References:
1. Stratton SJ, Underwood LA, Whalen SM, Gunter CS: Prehospital pediatric endotracheal intubation, a survey of the United States. Prehosp Dis Med 1993;8:323-326.
2. Gausche M, Lewis RJ, Stratton SJ, Haynes B, Gunter CS, Goodrich SM, Poore PD, McCollough MD, Henderson DP, Pratt FR, Seidel JSS: Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: A controlled clinical trial. JAMA 2000;283:6:783-790.
3. Gausche-Hill M, Lewis RJ, Gunter CS, Henderson DP, Haynes BE, Stratton SJ: Design and implementation of a controlled trial of pediatric endotracheal intubation in the out-of-hosptial setting. Ann Emerg Med 2000;36:4:356-365.