[Prehospital treatment of severely injured children in Germany : Epidemiology, interventions and structural perspectives].

BACKGROUND

Severely injured children account for only a small proportion of emergency medical service (EMS) missions but pose major challenges to the emergency teams due to age-related anatomy and physiology, complex injury patterns and high emotional stress. This narrative review summarizes the current evidence on the epidemiology and prehospital management of pediatric trauma patients in the German EMS system and places these findings in an international context.

MATERIAL AND

METHODS

A PubMed search was carried out using the terms "children", "trauma" and "prehospital". Studies reporting the prehospital management of injured children and adolescents were included. Out of 421 records 20 studies were selected and complemented by backward citation searches, with a focus on data from Germany and comparable high-income countries.

RESULTS

Pediatric emergencies account for approximately 5% of ground EMS (GEMS) and 6-13% of helicopter EMS (HEMS) missions; severely injured children (e.g. NACA IV-VII) constitute only a small fraction, making pediatric polytrauma a classical low-frequency, high-impact scenario. The proportion of traumatic emergencies increases with age and peaks during adolescence; boys are overrepresented in all cohorts. Falls and traffic incidents dominate, predominantly resulting in blunt trauma with injuries mainly to the head and extremities. Polytrauma is reported in only around 5% of injured children and primarily affects older children and adolescents. Oxygen administration, intravenous access, immobilization and analgesia are frequent measures, whereas intubation, intraosseous access, chest drainage and other invasive procedures are rare. Several studies indicate an association between HEMS or direct admission to a (pediatric) major trauma center and improved survival.

CONCLUSION

Pediatric trauma patients represent a small but high-risk group in whom invasive procedures must be performed under time pressure and emotional stress. The management of complex cases by specialized HEMS teams and clearly designated (pediatric) major trauma centers, the strengthening of paramedic-based care, simulation-based training, standardized prehospital and in-hospital outcome-oriented data collection and the further expansion of regionally coordinated trauma networks are key steps towards improving prehospital care for injured children.