Paramedic PapersTopic
Paediatrics research
47 recent papers on paediatrics in paramedic and prehospital care, newest first. Each has a plain-English summary, the study design, the main finding and caveat, and what it means for Australian practice.
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Neonatal calls rare on South African ambulances
A two-year review of 9,825 neonatal activations in the Western Cape public EMS found neonates were just 0.7% of workload with rare high-risk interventions (prehospital intubation 0.4%), and non-specialist crews attended two-thirds of high-acuity cases despite limited neonatal scope of practice.
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Paediatric deterioration in the field poorly defined
A scoping review of 28 studies found no standardised definition of paediatric out-of-hospital clinical deterioration and almost no research on how crews actually recognise it.
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Paediatric care coordinators linked to fewer EMS errors
A US cross-sectional study of 2,219 paediatric EMS encounters found agencies with a paediatric emergency care coordinator delivered more procedures and medications, with fewer and less severe adverse safety events.
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Infant carry slings rarely linked to OHCA
A five-year English regional registry review of 162 cardiac arrests in children under two found only two linked to infant carry slings, while co-sleeping featured in a third of cases.
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Feedback device lifts paediatric ventilation quality
Randomised crossover simulation study with 123 EMS clinicians testing a ventilation feedback device on a paediatric manikin — guideline-adherent tidal volumes jumped from 16.2% to 87% of breaths with feedback, and rate adherence from 65% to 88.6%.
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Five scene findings flag kids needing blood
Retrospective national trauma registry analysis testing five EMS-observable findings for spotting injured children who need early blood — altered GCS (aOR 8.38), penetrating mechanism (aOR 5.87) and age-adjusted hypotension (aOR 5.39) led, and a three-tier decision tree put 36.8% of early transfusions into just 3.3% of kids.
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Delays in NSW paediatric trauma retrieval
Ten-year review of paediatric trauma retrievals by NSW's specialist paediatric transport service found helicopter launch times worsened after 2017 operational changes and teams took over 10 minutes to depart the referring hospital in 80% of missions.
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Child visitor injuries in Queensland
Descriptive study of 3,802 Queensland Ambulance Service attendances for injuries in child visitors aged ≤15 (2009–18) found interstate visitors accounted for 85.8% of cases, with falls and transport incidents the leading mechanisms and burns third in 0–4-year-olds.
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Paediatric OHCA in Australia and NZ: Aus-ROC report
First Australasian epidemiology report on paediatric OHCA from the Aus-ROC Epistry registry, describing incidence, characteristics and outcomes across Australia and New Zealand — abstract not yet available, so no numbers to quote yet.
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Age-adjusted MAP centiles for sick kids
Large US observational study deriving and validating age-specific mean arterial pressure centile curves in prehospital, ED and critical-care datasets — lower age-adjusted MAP tracked with mortality and greater vasoactive and fluid use, though the curves fitted neonates in the EMS sample poorly.
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Rural paediatric interfacility transfers: US picture
Analysis of 29,992 rural US paediatric interfacility transfers in 2023 found clear age gradients — infants needed specialty critical-care transport most often (32.1%), while teenagers predominated in psychiatric presentations and received more pain and sedation medications.
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Missed prehospital transfusions in paediatric trauma
Analysis of 1.66 million US paediatric trauma EMS activations found only 0.1% of children with a positive shock index — those plausibly benefiting from blood — received a prehospital transfusion, suggesting major underuse.
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Anaphylaxis knowledge gaps in prehospital crews
Cross-sectional survey of 322 prehospital personnel found only about half could identify all three paediatric anaphylaxis diagnostic criteria or use an adrenaline auto-injector correctly, though 82% recognised adrenaline as first-line treatment.
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Nearly half of paediatric doses off-protocol
US quality-registry cohort of 386 prehospital paediatric medication administrations found 46.4% deviated at least 20% from protocolised dosing — mostly underdoses — with ondansetron (aOR 36.9) and the intranasal route (aOR 7.3) the biggest drivers.
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EMS and ED disagree on paediatric asthma signs
Prospective study of 295 children transported with asthma exacerbations found only slight-to-fair agreement between EMS and ED clinicians on asthma severity exam findings, suggesting a prehospital paediatric asthma severity score would be hard to validate.
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Neonatal hyperammonaemia retrievals need early transfer
A Victorian statewide review of 21 retrieved neonates with elevated ammonia found 76% had a confirmed inborn error of metabolism, over half needed haemofiltration, and 81% survived to discharge, supporting early retrieval to a quaternary centre.
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Paediatric non-transport re-call rates low
US retrospective study of 1.85 million paediatric ambulance calls (40% not transported) — only 1% of non-transported children re-called and were transported within 72 hours and deaths were rare (0.1% dead on scene at re-call), with under-5s, neurologic impressions and disadvantaged areas over-represented among re-calls.
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Two-handed neonatal mask ventilation training
Before-and-after simulation study of a respiratory-function-monitor-guided two-handed neonatal PPV training package in 40 clinicians — the two-handed hold cut median facemask leak to 2.5% vs 27% one-handed before training, leak was low with both holds after training, and preference for two-handed ventilation rose from 27% to 50%.
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Paediatric in-hospital arrest trends in Japan
Nationwide Japanese administrative data (2011–2022, 7.1M paediatric admissions) testing whether paediatric in-hospital arrest incidence and outcomes are changing — incidence fell from 1.03 to 0.86 per 1000 admissions while survival to discharge rose from 25.8% to 29.6%, with adrenaline given in 71% and intubation in 62% of arrests.
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Post-ROSC PaCO2 doesn't predict paediatric OHCA outcome
Japanese multicentre registry study of 215 paediatric OHCA patients testing whether the first post-ROSC PaCO2 category predicts 30-day outcomes — no clear association with favourable neurologic outcome or survival for either hypocapnia (aOR 0.83) or hypercapnia (aOR 1.46), though estimates were imprecise with wide confidence intervals.
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Paediatric air medical intubation performance
US national cohort of 1,040 paediatric air medical intubations — 86.5% first-pass success overall but only 69.1% in infants under 1, with ketamine the commonest induction agent and substantial site-to-site variation
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Intranasal dexmedetomidine paediatric sedation
Townsville cohort of 114 children given intranasal dexmedetomidine for ED procedural sedation — effective as a sole agent in 78%, adverse events in 13% (mostly mild bradycardia), but ED stays ran long at a median 395 minutes
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Paediatric IV ketamine sedation very safe
Systematic review of 20 studies covering 67,871 children having IV ketamine procedural sedation in EDs — no deaths or permanent adverse outcomes, sentinel events pooled at about 1 in 11,558 sedations, serious adverse events 0.34%, with age ≥10, upper respiratory infection and opioid co-administration modest predictors while ASA status and benzodiazepine co-administration were not.
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Anonymous video deletion biased newborn RCT
Norwegian analysis of the NeoBeat RCT testing whether anonymous staff deletion of resuscitation videos introduced selection bias — after the anonymous opt-out, enrolled newborns had significantly higher Apgar scores, shorter ventilation and fewer admissions, and the trial was terminated halfway without power to conclude on its outcomes.
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Delphi consensus on paediatric procedural sedation
Two-round Delphi consensus of 28 paediatric emergency clinicians from 23 Spanish centres — strong agreement on monitoring standards, staffing and safety requirements for paediatric procedural sedation, with ketamine the preferred agent for painful procedures.
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Paediatric weight often undocumented before dosing
Analysis of 57,378 US paediatric 9-1-1 responses where weight-based medications were given found 73.1% had a documented weight (or length-based estimate), with documentation less likely for adolescents (OR 0.87), Black patients (OR 0.72) and lower-acuity cases (OR 0.59), and more likely with advanced life support crews (OR 2.02).
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Bronchiolitis discharge criteria cut length of stay
Systematic review for the binational guideline update on discharge criteria for infants under 12 months with bronchiolitis — two retrospective studies (N=2,697) found structured discharge criteria significantly shortened length of stay with no difference in readmissions (low-to-very-low certainty), and informed the 2025 Australasian Bronchiolitis Guideline covering clinical stability, oxygen saturation/support, feeding, caregiver confidence, social factors and follow-up.
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Paediatric trauma diagnosis accuracy in Swiss HEMS
Multi-centre Swiss HEMS study of 282 paediatric trauma patients found moderate diagnostic accuracy between prehospital and in-hospital diagnoses (Cohen's κ=0.64), with polytrauma underdiagnosed and extremity/pelvic injuries overdiagnosed, and overall survival of 92.2%.
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Adrenaline given in only 60% of paediatric OHCA
Retrospective analysis of US NEMSIS data found adrenaline was administered in only 60% of paediatric out-of-hospital cardiac arrests, with longer scene times, advanced airway attempts, and defibrillation associated with higher odds of administration, while public settings and female sex correlated with lower odds.
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Caller triage score for paediatric breathing calls
Development of the PREP score, a caller-reported decision-support tool for children aged 0-4 with breathing problems in a Welsh dispatch system — moderate discrimination (AUC 0.73) with high negative predictive value (93%) for identifying low-risk calls.
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Community paramedics for paediatric concussion follow-up
Experimental mixed-methods study demonstrated that a Mobile Integrated Health program using community paramedics for paediatric concussion follow-up was feasible and acceptable, with 19% patient enrolment and improvement in Post-Concussion Symptoms Scale scores.
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Paediatric teleconsultation during ambulance transport
Simulated RCT testing teleconsultation for paediatric ambulance transports — paramedics found it acceptable (TUS 5.8/7) and experienced less frustration (p=0.03) with 94% attempting physician contact, though physicians reported higher workload (p=0.01) and 92% connected in ≤2 attempts.
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AR decision support grabs clinician gaze
Secondary analysis of a pediatric cardiac arrest simulation trial found AR-based decision support captured 42-59% of visual attention with distinct role-specific fixation patterns among team leaders and medication nurses
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Singapore paediatric OHCA incidence and survival
Abstract not yet available (ahead-of-print). Observational study reporting incidence, aetiologies and survival outcomes of paediatric out-of-hospital cardiac arrest in Singapore.
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US paediatric ED use: low EMS share, high acuity
Retrospective analysis of 202.5 million US pediatric ED visits (2016–2022) found children comprised only 7% of EMS transports but presented with higher acuity, more abnormal vital signs, and increasing psychiatric and behavioral presentations over time.
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Simulation POCUS training in paediatric arrest
Study on: Beyond feasibility: does simulation-based POCUS training translate into clinically meaningful pediatric arrest performance?. No abstract available for detailed assessment.
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Machine learning predicts paediatric code events
Study on: Validation of a Hospital-Wide Risk Stratification Model for Predicting Code Events Among Critically Ill Children. No abstract available for detailed assessment.
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Inconsistent definitions in neonatal ILCOR documents
Study on: Consistency of definitions used in International Liaison Committee on Resuscitation Neonatal Life Support documents. No abstract available for detailed assessment.
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US paediatric drowning OHCA characteristics
Study on: Characteristics of pediatric drowning out-of-hospital cardiac arrests in the United States. No abstract available for detailed assessment.
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Vaccine-preventable diseases in the ED
ABSTRACT Across the globe, there has been a resurgence in vaccine‐preventable diseases reflecting declining immunity, vaccine hesitancy and gaps in vaccine coverage.
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Which paediatric trauma cases warrant prehospital blood
In a nationally representative prehospital sample, many injured children appeared eligible for transfusion.
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Tactile stimulation site in neonatal resuscitation
There was no difference in 5-min SpO2, need for further resuscitation in DR, cerebral oxygenation, and in-hospital complications with the three modes of TS, sole rub, trunk rub and back rub.
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Poor field differentiation of infant upper vs lower airway disease
EMS clinicians documented similar primary impressions and administered many of the same treatments across both upper and lower airway groups, demonstrating minimal differentiation in prehospital management of young children.
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Synchronised ventilation faster ROSC in neonatal piglets
In a neonatal piglet model of asystolic cardiac arrest, CCSV resulted in a significantly faster time to ROSC compared to 3:1 C:V.
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Observation cuts CT in paediatric abdominal trauma
Observation with deferred CT decisionmaking was associated with less frequent CT use, particularly in patients with intermediate clinician suspicion, without an increase in missed injuries.
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Prehospital physicians underconfident in paediatrics
They surveyed emergency physicians and analysed 9,409 protocols to understand pediatric emergency preparedness, and found pediatric cases represent only 6.5% of prehospital physician deployments but physicians reported low confidence in neonatal care, intoxication, and pediatric polytrauma.
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IM beats intranasal midazolam in paediatric seizures
Meta-analysis testing whether intranasal or intramuscular midazolam works better for paediatric seizures without cannula access — intramuscular midazolam was associated with faster seizure termination and less need for rescue therapy, especially in the prehospital setting.