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Bertone S, Denina M, Pagano M, Delmonaco AG, Castagno E, Bondone C. Red Code Management in a Pediatric Emergency Department: A Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:462. [PMID: 38671679 PMCID: PMC11048913 DOI: 10.3390/children11040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024]
Abstract
The "red code" (RC) represents the highest level of emergency in the emergency department (ED). This study retrospectively analyzed RCs in the Regina Margherita Children's Hospital ED, a regional referral center in north Italy, between 1 July 2020 and 30 June 2023. The aim was to describe RC characteristics and to identify significant correlations between presenting complaints and clinical management. The study includes 934 RCs (0.9% of overall ED admissions); 64% were assigned based on the Pediatric Assessment Triangle alteration. Most patients, 86.5%, followed the medical pathway, while 13.5% were surgical cases. Admission complaints were respiratory (46.9%), neuropsychiatric (26.7%), traumatic (11.8%), cardiologic (9.3%), metabolic (3.8%), and surgical (1.5%). Seventy-six percent of patients received vascular access, and intraosseous access was obtained in 2.2% of them. In one-third of RCs, an urgent critical care evaluation was necessary, and 19% of cases required admission to the intensive care unit. The overall mortality rate was 3.4% (0.4% in ED setting). The study identified six distinct diagnostic pathways, each associated with specific characteristics in clinical presentation, management, therapeutic interventions, and outcomes. Our findings underscore the need for a systematic approach in pediatric emergency settings, supported by international and national guidelines but also by clearly defined diagnostic pathways, aiming to enhance the quality of care and patient outcomes.
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Affiliation(s)
- Serena Bertone
- Paediatric Unit, Ospedale Regina Montis Regalis, 12084 Mondovì, Italy;
| | - Marco Denina
- Paediatric Infectious Diseases Unit, Regina Margherita Children’s Hospital, University of Turin, Città della Salute e della Scienza, 10126 Turin, Italy
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Manuela Pagano
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Angelo Giovanni Delmonaco
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Emanuele Castagno
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children’s Hospital, Città della Salute e della Scienza, 10126 Turin, Italy; (M.P.); (A.G.D.); (E.C.); (C.B.)
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Leszczyński PK, Wejnarski A, Rzońca P, Gajowniczek A, Gałązkowski R, Mitura K, Sholokhova D. Arrhythmias Occurring in Children during HEMS Intervention: A Retrospective Cohort Study. Emerg Med Int 2023; 2023:2974648. [PMID: 38046470 PMCID: PMC10689065 DOI: 10.1155/2023/2974648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023] Open
Abstract
Background Arrhythmias in patients during medical transport remain a challenge for medical personnel. Helicopter emergency medical service (HEMS) crews, as the only medical rescue teams in Poland to conduct rescue flights, keep detailed documentation of monitoring vital functions over short time intervals during the flight. Aims The aim of this study was to determine the characteristics of cardiac arrhythmia in pediatric patients (up to 12 years of age) transported by HEMS operatives, considering life-threatening rhythms and those that occur during out-of-hospital cardiac arrest (OHCA). Methods The analysis of HEMS medical documentation covered 90345 missions carried out from 2011 to 2020. Among all activations, 820 cases of arrhythmias in pediatric patients up to 12 years of age were extracted. Results Missions for males accounted for 60% of all activations (n = 492), while flights for females accounted for 40% (n = 328). A statistically significant relationship between the number of HEMS flights and the season was demonstrated (p = 0.015). During the study period, pediatric patients mostly experienced cardiac arrhythmias in the form of supraventricular tachycardia (sVT) (n = 504). Asystole (n = 178) and pulseless electrical activity (PEA) (n = 52) ranked second and third in terms of occurrence, respectively. A statistically significant relationship between the type of heart rhythm disorder and age was demonstrated (p < 0.05). Conclusions Heart rhythm disorders most often affected children between 0 and 3 years of age. As the patient's age increased, the incidence of arrhythmias decreased. Among pediatric patients, supraventricular tachycardia proved to be the predominant arrhythmia during the study period.
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Affiliation(s)
| | - Arkadiusz Wejnarski
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, Siedlce, Poland
| | - Patryk Rzońca
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | | | - Robert Gałązkowski
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, Siedlce, Poland
| | - Kryspin Mitura
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, Siedlce, Poland
| | - Daryna Sholokhova
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, Siedlce, Poland
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Leszczyński PK, Sobolewska P, Muraczyńska B, Gryz P, Kwapisz A. Impact of COVID-19 Pandemic on Quality of Health Services Provided by Emergency Medical Services and Emergency Departments in the Opinion of Patients: Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031232. [PMID: 35162255 PMCID: PMC8835461 DOI: 10.3390/ijerph19031232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
Abstract
Background: The aim of this study was to assess the quality of assistance provided by emergency medical service (EMS) and hospital emergency department (ED) staff in the opinion of patients. Methods: Simple random sampling was performed to select the responders. A group of 131 people who correctly completed the questionnaire form was included in the study. The questionnaire was directed only to patients receiving EMS and/or ED assistance during the time period when the pandemic was announced in Poland. Results: Problems in the ED were reported by 38 people (31.15%), and calling EMS was reported as generating problems by 7 people (16.67%). Dissatisfaction with the help provided in EDs was reported by 33 patients (27.05%), and dissatisfaction with the help by EMS was reported by eight people (19.05%). The assessment of the patient’s satisfaction level significantly correlated with the waiting time in the ED (Spearman = 0.217; p = 0.016) as well as with the waiting for EMSs (Spearman = 0.403; p = 0.008). Conclusions: Patients of the ambulance service and hospital emergency departments during the pandemic positively assessed the actions of medical services, despite significant delays in providing health services.
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Affiliation(s)
- Piotr Konrad Leszczyński
- Faculty of Medical Sciences and Health Sciences, University of Natural Sciences and Humanities, 08-110 Siedlce, Poland; (B.M.); (P.G.)
- Correspondence:
| | - Paulina Sobolewska
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Łódź, 90-419 Łódź, Poland; (P.S.); (A.K.)
| | - Bożena Muraczyńska
- Faculty of Medical Sciences and Health Sciences, University of Natural Sciences and Humanities, 08-110 Siedlce, Poland; (B.M.); (P.G.)
| | - Paulina Gryz
- Faculty of Medical Sciences and Health Sciences, University of Natural Sciences and Humanities, 08-110 Siedlce, Poland; (B.M.); (P.G.)
| | - Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Łódź, 90-419 Łódź, Poland; (P.S.); (A.K.)
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Rzońca E, Bączek G, Podgórski M, Gałązkowski R. Polish Medical Air Rescue Crew Interventions Concerning Neonatal Patients. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8070557. [PMID: 34209488 PMCID: PMC8304995 DOI: 10.3390/children8070557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 06/13/2023]
Abstract
The purpose of the study was to present the characteristics of Helicopter Emergency Medical Service (HEMS) and Emergency Medical Service (EMS) interventions concerning newborns in Poland. The study involved a retrospective analysis of missions by Polish Medical Air Rescue crews concerning newborns, carried out in Poland between January 2011 and December 2020. Polish Medical Air Rescue crews were most commonly dispatched to urban areas (86.83%), for patient transfer (59.67%), using an airplane (65.43%), between 7 AM and 6:59 PM (93.14%), and in the summer (28.67%). Further management involved handing over the neonatal patient to a ground neonatal ambulance team. Most of the patients studied were male (58.02%), and the most common diagnosis requiring the HEMS or EMS intervention was a congenital heart defect (31.41%). The most common medical emergency procedure performed by Polish Medical Air Rescue crew members for the neonatal patients was intravenous cannulation (43.07%). The odds ratio for congenital malformations was higher in male newborns. The type of Polish Medical Air Rescue mission was associated with the location of the call, time of the call, ICD-10 diagnosis associated with the dispatch, selected clinical findings, most commonly performed medical emergency procedures, and mission duration and distance covered.
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Affiliation(s)
- Ewa Rzońca
- Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland;
| | - Marcin Podgórski
- Department of Emergency Medical Services, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.P.); (R.G.)
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Faculty of Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.P.); (R.G.)
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Rogers CJ, Gausche-Hill M, Brown LL, Burke RV. Prehospital Emergency Provider's Knowledge of and Comfort With Pediatric and Special Needs Cases: A Cross-Sectional Study in Los Angeles County. Eval Health Prof 2021; 44:362-370. [PMID: 33759591 DOI: 10.1177/01632787211003972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The current study assesses the relationship between continuing education (CE) with a focus on pediatrics and children with special heath care needs and how CE influences the knowledge and comfort levels of prehospital providers who treat these cases. Data are survey responses provided by paramedic and emergency medical technician (EMT) level providers (N = 575) in Los Angeles County. Regression models assessed the relationship between pediatric-focused continuing education and EMTs' knowledge of and comfort with pediatric cases, adjusting for relevant covariates. EMTs' participation in continuing education focusing on pediatrics and special health care needs was significantly associated with an increase in perceived comfort and knowledge. Among EMTs who did not receive continuing education focused on either pediatrics or special health care needs, the most frequently reported barrier to education was a perceived lack of availability. The impact of continuing education on perceived comfort and knowledge was more pronounced than the effect of prior experience, especially considering the limited prevalence of provider exposure to pediatric and childhood special health care needs cases compared to adult cases. Expanding educational opportunities is a promising approach to increasing the comfort and knowledge of EMTs who transport and care for pediatric cases.
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Affiliation(s)
- Christopher J Rogers
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Marianne Gausche-Hill
- Department of Emergency Medicine and Pediatrics, University of California-Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA.,Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA.,Los Angeles Biomedical Research Institute, Torrance, CA, USA.,Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CA, USA
| | - Laurie Lee Brown
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, CA, USA
| | - Rita V Burke
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Pediatric Surgery, Children's Hospital Los Angeles, CA, USA
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