MDA Pediatric Transport

Pediatric Emergency Medicine October 13th 2004

Talk Topics

EMS in Israel. Pediatric EMS in Israel. Pediatric transport in MCI. The Use of Pediatric I/O in MDA.

Level Of Level Of TreatmentTreatmentTwo Tier System Two Tier System

Basic And Advanced Life Support.Basic And Advanced Life Support.Basic LevelBasic Level : :

B.L.S. Ambulance ( Including rural Ambulances)B.L.S. Ambulance ( Including rural Ambulances)

Medic/Driver (E.M.T) + E.M.T / Volunteer.Medic/Driver (E.M.T) + E.M.T / Volunteer.

E.M.T. Course - 205 Hours.E.M.T. Course - 205 Hours.

125 Ambulances In Morning125 Ambulances In Morningshift. All equipped with A.E.D.’sshift. All equipped with A.E.D.’s

50-150 additional B.L.S. 50-150 additional B.L.S. Units “on call”.Units “on call”.

Level Of Level Of TreatmentTreatment

A.L.S. LevelA.L.S. Level : :

M.I.C.U - Mobile Intensive Care UnitM.I.C.U - Mobile Intensive Care Unit

Physician, Paramedic, E.M.T / Driver. Physician, Paramedic, E.M.T / Driver.

Physicians - From Regional Hospitals.Physicians - From Regional Hospitals.

22 Units In Central Cities.22 Units In Central Cities.

I.C.A - Intensive Care AmbulanceI.C.A - Intensive Care Ambulance

Paramedic, E.M.T / Driver.Paramedic, E.M.T / Driver.

29 Units In Small Cities / Rural Areas29 Units In Small Cities / Rural Areas

ProfessionalProfessional ActivitiesActivities

A.L.S Level Of TreatmentA.L.S Level Of Treatment

•50% Cardiac, Cardiopulmonary, and 50% Cardiac, Cardiopulmonary, and respiratory Problemsrespiratory Problems

•4%-7% Resuscitations4%-7% Resuscitations

•3%-5% Pediatric Cases3%-5% Pediatric Cases

•10%-15%10%-15% Trauma CasesTrauma Cases

Magen David Adom Magen David Adom General and trauma activityGeneral and trauma activity

ALSALS5252

BLSBLS125125

ALSALS150.000150.000

BLSBLS300.000300.000

ALSALS14.00014.000

BLSBLS36.00036.000

AmbulancesAmbulances per Shiftper Shift

CallsCalls per yearper year

Trauma callsTrauma calls per year (12%)per year (12%)

MICU 22MICU 22(Physician)(Physician)

ICA 30ICA 30(Paramedic(Paramedic))

Training of M.D.A. B.L.S. providers

Total 205 course hours. Pediatric resuscitation - 3 hours. Pediatric Trauma – 1hour. Pediatric Emergencies – 1 hour Care of the newly born – 1hour

Training of M.D.A. Paramedics

Total 1565 hours. Stage 1: Class based - 18w. Stage 2: Hospital clerkship – 10w. Stage 3: Mobile Intensive care unit

clerkship 80 shifts.

Pediatric training in the various stages

Stage 1: Pediatric resuscitation - 20h. Pediatric emergencies - 16h. The newly born -6h.

Stage 2: Pediatric ED / PICU - 30h. Labor and Delivery - 30h. Adult and Trauma ED - 100h. Anesthesia – 60h.

Pediatric training in the various stages

Stage 3: MICU – 640h. PALS course. PHTLS course.

Pediatric Prehospital Care

In Israel: 3-5% of EMS calls. In U.S.: 5-10% of EMS calls and only

5% involve life threatening problems.

A weak link in most EMS systems. Controversial issues:

Scoop and Run Vs. Stay and play. A.W. management in trauma.

Pediatric Bone Injection Gun usage in MDA

MDA experience

2 types an adult and pediatric device.

Introduced to all A.L.S. units in 2001.

All attempts to use the device require reporting to medical division on a “special procedure form”.

Success rate

Pediatric BIG

83%

13%4%

good flow

device malfunction

insertion error

Age distribution

47%

24%

29%

0-1y

1-2y

>2y

Indication

Indication

29%

11%

60%

Trauma

SIDS

Other

Prehospital outcome

58%

42%

Alive to ED

pronounced dead

Bus number 2 explosion in Jerusalem

August 20, 2003, 12:35pm EDT

TWENTY KILLED, SCORES HURT IN JERUSALEM BUS BOMBINGA suicide attacker detonated a bomb on a packed Jerusalem bus Tuesday, killing at least 20 people and wounding more than 100.

Time table 21.10- initial phone call: ”explosion

heard”. 21.11- M.C.I. protocol activated. 21.15- First B.L.S. unit at the scene. 21.17- Second B.L.S. unit at the

scene. 21.18- First A.L.S. unit at the scene. 21.27- 5-B.L.S. and 3 A.L.S. units at

the scene.

Time table-evacuation

21.10 Initial call 21.20- 4 non urgent victims

evacuated. 21.21- 2 urgent and 1 non

urgent victims evacuated. 21.38- last urgent victim

evacuated.

Total units activated in this incident

39 B.L.S. units. 9 A.L.S. units. 1 M.C.R.V. Manpower:

Physicians-7 Paramedics-30 E.M.T.s -100

TOTALPr. 3Pr. 2Pr. 1

289910Hadassah E.C. ( level 1)

251852Hadassah M.S. ( level 2)

271854Shaarei Zedek ( level 2)

292630Bikur Cholim ( level 3)

109713216TOTAL

18Dead on the scene

DISTRIBUTIONDISTRIBUTION ofof CASUALTIESCASUALTIES

Pediatric victims

Of the 136 injured 45 were children and babies.

Of the 23 casualties 6 were children. 4 pediatric intubations were made

at the scene. 3 pediatric patients were

transported in secondary diversion.

Jerusalem bus explosion Secondary Diversion

2

2

Shaarei ZedekLevel II

Hadassah EKLevel I

Bikur HolimLevel III

Hadassah MSLevel II

QUESTIONSQUESTIONS

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