Primary survey: Highlights from this issue

EMS and children This month’s issue has two very different papers in relation to EMS and children. Frequent use of emergency medical services (EMS) is a global issue, although paediatric frequent use is poorly understood. In the first paper, Scott and colleagues in the UK undertook a systematic review to establish what is currently known about frequent use of EMS by children and adolescents with a view to making recommendations for future research. Eight papers were included in the review from four countries. All studies were retrospective designs, with no experimental studies focused on paediatric users. The authors found that paediatric frequent EMS users were more likely to use services for medical reasons rather than trauma, including respiratory complaints, mental health, and seizures, data on gender and ethnicity were inconclusive and there was no data on socioeconomic status. Definitions of paediatric patient or frequent use was inconsistent. Unsurprisingly, the authors concluded that the lack of focused research in this area of practice is worrying, especially when considering the potential for safeguarding concerns among this population. Clearly there is a need for further research to better identify the underlying reasons for frequent EMS use among paediatric patients, and to develop interventions in this population. Having just highlighted the need for more research relating to paediatrics and EMS, I am pleased to recommend the next paper by Andrew and colleagues from Australia. They conducted a retrospective study to describe the characteristics and outcomes of nontransported paediatric patients by EMS. Our paramedic colleagues do amazing work in the pre hospital setting but some of this work is invisible to us in the ED as we know little about the patients they don’t transport to hospital, making such decisions may be difficult in some cases. This is a large study which included 62 975 nontransported patients. Overall, 2.1% re contacted the EMS within 48 hours, 13.8% selfpresented to a public ED, 1.9% were admitted to hospital, and 0.1% had an adverse event, including two deaths. Although adverse events were rare among paramedicinitiated nontransport cases, the authors found that deranged vital signs, attendance at the end of shift, or attendance by paramedics with higher exposure to nontransport cases, were associated with poorer outcome. This study is an eye opener and will have particular resonance for paramedics and pre hospital clinicians.