Citation

Macnab AJ, Wensley DF, Sun C. Prehosp. Emerg. Care 2001; 5(1): 1-5.

Affiliation

Department of Pediatrics, University of British Columbia, Vancouver, Canada. amacnab@cw.bc.ca

Copyright

(Copyright © 2001, National Association of EMS Physicians, Publisher Informa - Taylor and Francis Group)

DOI

unavailable

PMID

11194060

Abstract

INTRODUCTION: Care during transport influences the outcome of head-injured children. Secondary adverse events, e.g., hypotension and hypoxia, worsen morbidity and mortality. Trained transport teams lower the incidence of such secondary "insults." OBJECTIVE: To estimate the cost-benefit of improved care from trained escorts. METHODS: The setting was a provincial air ambulance service during transition to trained pediatric escort paramedics. A retrospective review of transport and hospital records for a 12-month period was conducted. All children with head injuries (n = 43) transported to tertiary care [11 by untrained escorts (UE), 32 by trained escorts (TE)] were enrolled. Severity of injury was classified by Glasgow Coma Score (GCS); incidence of adverse events was counted and cost of change of severity resulting from preventable insults was estimated using published care costs. RESULTS: There were 13 preventable insults in six patients (55%) in the UE group and five preventable insults in four patients (12%) in the TE group (p<0.05). Among those in the UE group, two changed in severity from moderate to severe, one moderate worsened (decrease in GCS of 2 or more), and two severe worsened. In the TE group, there were no changes >1. Cost-benefit estimates based on change in severity were $136,000 (median) to $238,000 (mean). CONCLUSION: Significant cost-benefit likely accrues from training escorts who transport children with significant head injuries to tertiary care.

Language: en