Embargo: 00.01 hrs CEST on Monday 14 October 2024

Three key signs of major trauma could speed up treatment of severely injured children brought to emergency departments by carers not ambulances

Copenhagen, Denmark: Severely injured children who are brought to an emergency medical department by their parents or carers are often not seen as quickly as those who arrive at hospital via ambulance, according to findings presented at the European Emergency Medicine Congress today (Monday). [1]

The study’s researchers identified three key trauma features that should prompt doctors to review these patients immediately and potentially prioritise their treatment: boggy swelling to the head, abdominal bruising, and thigh swelling or deformity.

The study was carried out in an inner-city level 1 major trauma centre, the Bristol Royal Hospital for Children, Bristol, UK, and show that children brought in by carers were seen by emergency doctors within an average time of 58.5 minutes, ranging from 3 to 168 minutes [2].

Dr Robert Hirst, who led the study, believes the findings could be applicable to other centres that have similar pre-hospital and urgent and emergency care systems, especially as little is known generally about this group of patients.

Dr Hirst, who is an emergency medicine registrar at the hospital, told the Congress: “We see many injured children brought to the paediatric emergency department each year. Most are transported by ambulance which results in pre-hospital emergency services pre-alerting the emergency department to their arrival. This leads to early trauma team activation, resulting in specialist services and resources being ready and prepared to see these patients as soon as they arrive. This has been shown to be associated with better outcomes for children with significant injuries.

“However, we know there is a group of children who are brought by their carers who do not receive this rapid activation of resources. This can lead to delays in the appropriate level of care being provided. We wanted to find out more about these patients, their ages, the types of injuries they present with, and what happens to them. At present, little is known about this particular group of patients.”

A level 1 major trauma centre is an emergency medical centre that treats injuries that are so severe they are life-altering with a risk of death or disability, and which need immediate medical attention. Injuries can include fractures and head injuries.

Dr Hirst and colleagues looked at children aged younger than 16 years who were brought to the emergency department between 5 August 2020 and 6 May 2022 by carers, without activation of pre-hospital emergency services. During this time, 153 children with major traumas arrived; 24 of them had injuries significant enough to be added to the national Trauma Audit and Research Network (TARN) database and were included in the study. None of them received trauma team activation. All the patients still received appropriate care for their injuries, and none suffered any detrimental effects from being brought to the children’s emergency department by their parents or carers, rather than by ambulance.

The average age of the children was just over six years, and 18 (75%) were boys. Nearly all of them (23, 95.8%) had injuries to one part of their bodies, and most (22, 92%) had obvious external evidence of injury. The majority (13, 54%) had head injuries, eight (33%) had injuries to their arms or legs, and three (12.5%) had intra-abdominal injuries.

The median Injury Severity Score (a scale that measures and categorises injuries to different areas of the body) was 9, and six patients (25%) scored over 15, meaning these were injuries significant enough to be classified as major trauma. Ten (42%) of children required surgery, with seven requiring surgery for a broken thigh bone, and three needing neurosurgery to evacuate blood from swellings around the brain or to correct skull fractures. No children died.

The injuries resulted from falls (12, 50%), sporting injuries (6, 25%), bicycle injuries (2, 8%), being dropped (1, 4%), or were unexplained (3, 12.5%).

Dr Hirst said: “As always with all paediatric injuries, it is important to be aware of the possibility of non-accidental injury. Concerns for non-accidental injury were confirmed in three of our patients, all under the age of one. Consideration of non-accidental injury, robust safeguarding processes, and regular multidisciplinary governance review is vital to safeguard children attending the emergency department.”

He continued: “The most important issue highlighted in our study is a group of severely injured children facing delays to be seen by expert emergency doctors. If emergency departments adopted triage alerts for the three major signs identified by this study – boggy swelling of the head, abdominal bruising, and thigh swelling or deformity – this could prompt an urgent senior clinician review. This could improve management of this particular group of children by triggering trauma teams and appropriate allocation of resources for this high-risk population.”

Dr Hirst and his colleagues are improving processes in their department so that injured children with external evidence of injury are reviewed promptly by a senior clinical decision-maker.

“We will reassess the impact of these changes on our key performance indicators and outcomes for these children,” he concluded.

Dr Barbra Backus is chair of the EUSEM abstract selection committee. She is an emergency physician in Rotterdam, The Netherlands, and was not involved with the research. She said: “If pre-hospital emergency services have not been activated for a severely injured child, then it’s possible that the carer or emergency department medical staff may not recognise the severity of the injury immediately. This is why adoption of triage alerts for the three key features identified in this study could make a significant difference to how quickly these patients are reviewed by a senior clinician and, potentially, to their outcomes.

“Although health systems and procedures for dealing with paediatric patients who arrive at emergency medical departments by means other than an ambulance may vary from centre to centre and country to country, the findings from this study deserve close attention by emergency departments everywhere.”

(ends)

[1] Abstract no: OA004, “Identifying the walk-in wounded: a case series of paediatric major trauma patients self-presenting to a paediatric major trauma centre” by Robert Hirst et al., in the Best Abstracts oral session, 09:00-10:30 hrs CEST, Room 19.

[2] Children arriving by ambulance, or where the emergency department has been alerted before their arrival, are usually seen immediately.

Funding: This study received no funding.

About European Society of Emergency Medicine (EUSEM)

The EUSEM board regretfully must annul the recent election results for Vice-President and announces that a new electoral process for Vice President will be organised next year. 

The board arrived at this decision following the discovery of problems within the electoral procedure.  Routinely EUSEM employs an external IT provider for elections and also, provides instructions of eligibility for members to vote.

It came to the board’s attention that a number of noneligible members had received access to vote and upon further enquiry, it became clear that there had been a failure of voting security checks. The IT company recognised their mistake and apologised. 

In light of these procedural failures, the election can no longer be considered valid.

The EUSEM board has engaged with both candidates and is grateful to both for their understanding and patience and both remain committed to EUSEM.

The Vice-Presidential elections will take place next year and as this year’s election has been annulled, a new, open call for candidates will be made.  EUSEM is also currently in the process of selecting another company that specifically specializes in electronic voting. 

The board officially apologises to its members and more specifically to the two candidates for the inconvenience and uncertainty that this situation has caused.

END

PRESS RELEASE

Embargo: 16:30 hrs CEST on Sunday 13 October 2024

Climate change is a health emergency too

International experts warn of impact on emergency medical services worldwide

Copenhagen, Denmark: International experts in emergency medicine have warned that climate change is likely to have a severe impact on emergency services around the world. Despite this, few countries have assessed the scale of the impact or have a plan to deal with it.

In a special session at the European Emergency Medicine Congress today (Sunday), Luis Garcia Castrillo, a professor in emergency medicine, now retired, at the Hospital Marqués de Valdecilla, Santander, Spain, described how he and colleagues from EUSEM’s Emergency Medicine Day working group had asked 42 focus groups, consisting of experts in emergency medicine, prehospital care and disaster medicine, in 36 countries in 13 UN regions of the world to complete a survey on climate change awareness and preparedness [1]. The research is due to be published in the European Journal of Emergency Medicine [2].

“On a scale of 0 to 9, they rated the severity of the impact of climate change on health systems and specifically on emergency care, both now and in the future, at an average of 7,” he said. “This is a high figure, especially as some regions, such as northern Europe, consider it to be less of a problem than do other countries, such as Australia.

“The focus groups considered that the impact of climate change on emergency medical services would be similar or even higher than on global health systems. However, only 21% of the focus group members reported that assessments of the effect of climate change on emergency medical services had been carried out, and only 38% reported any measures had been taken to prepare for the impact of climate change .

“Out of all the focus group respondents, 62% said their governments or policy makers had made no assessment of the impact of climate change on emergency services, 9% said they didn’t know, 55% said nothing had been done to prepare for the impact of climate change, and 10% didn’t know.

“It is surprising how awareness is lacking in so many countries, as well as among emergency medicine societies. Some countries do not seem to be concerned at all. Yet this is going to affect rich and poor countries alike.”

Dr Roberta Petrino, director of the Emergency Department at Ente Ospedaliero Cantonale, Lugano, Switzerland, co-chaired the session “Climate change is a health emergency too”, and is a co-author of the report.

She said: “One interesting finding is that the need to implement actions to mitigate climate change is considered important everywhere. In particular, our survey showed the need to strengthen emergency medicine services and education programmes for medical students and emergency medicine doctors, as well as research.

“Emergency medical professionals are very worried about the effects of climate change on the care they provide. Our report shows that colleagues feel it’s an important problem around the world, although specific issues vary from one region to another and these relate to geographical position, the economic situation and the types of risks.”

Between 15 February and 15 March 2024, the researchers asked national and international emergency medicine associations around the world to set up focus groups of between four to six members to answer a series of questions. The 42 focus groups reported on general awareness and concern about climate change, and then ranked in terms of severity the different threats, the possible impacts on emergency medical departments, and, finally, the measures needed to mitigate the problems.

Across all the focus group responses, the top three major risks were pollution, flooding and heatwaves. Three minor risks were cold spells, wildfires and vector-borne diseases, such as malaria. The greatest impact was expected to be an increase in demands on the emergency medical services. The focus groups ranked preparation of strategic plans and education as the two strategic actions that were most important.

Focus groups from high income countries were most concerned about the risks of heatwaves, cold spells and wildfires. They considered the greatest impact would be increased numbers of patients, and they thought education and preparation of strategic plans were the most important actions necessary to mitigate the risks. Countries in northern Europe and the eastern Mediterranean were very concerned about displacement of populations and disruption to basic services.

Focus groups from low and middle-income countries ranked the impact of climate change on food production and disruption to health services as being the most significant risks.

Analysis of the data by region showed that climate change was expected to have a greater impact in Australasia, and countries in Eastern Europe, South Asia, South Saharan Africa and Central America. Countries such as Egypt and Nigeria expected the lowest impact, while South Saharan African regions expected the highest. There were significant differences between regions for the risks of vector-borne disease, climate-related diseases, wildfires, extreme weather events and food shortages. Australasia, Central America and South Saharan Africa had the greatest concerns about these compared to European regions.

The focus group concerns were also analysed through the WorldRiskIndex, a statistical model that assesses the risk of 193 countries falling victim to humanitarian disasters caused by extreme natural events and climate change. It ranks countries from very low risk through to very high risk. The fear of increased demand for emergency medical services, and disruption to the chain of supplies and health services was directly related to WorldRiskIndex, with concerns growing with increasing risk.

“It is clear from our findings that climate change is expected to have a significant impact on emergency medical services,” said Dr Petrino. “Much greater awareness of this is needed at national and international level among policymakers, healthcare providers, healthcare professionals and the general public.

“The European Society of Emergency Medicine calls for nations to put in place plans to mitigate the impact on our services from climate change. In addition to publishing our findings, the Society will be setting up a permanent working group to support, help and monitor actions for mitigating the effects of climate change on the emergency medical services. We will also be talking to key people and institutions to raise awareness.

“As we head towards the end of a year that has seen records broken for the planet’s hottest days, action cannot come quickly enough. Climate change is having an impact on all countries, rich and poor, regardless of geographical region. The world faces a climate change emergency, and our medical services face an emergency too.”

Prof. Garcia-Castrillo and Dr Petrino thanked the emergency medicine community and societies worldwide, who had made it possible to conduct the survey.

(ends)

[1] “The results of the survey on awareness and preparedness for climate change” presented by Luis Garcia-Castrillo, in the session “EM Day Campaign 2024: climate change is a health emergency too!”, 16:30 hrs CEST, Room D4-D5.

[2] “Awareness and preparedness of health systems and emergency medicine systems to the climate change challenges and threats: an international survey”, by Roberta Petrino, Luis Garcia-Castrillo, Graziano Uccheddu, Letizia Meucci, Roberta Codecà. To be published soon in the European Journal of Emergency Medicine.

The study received no funding.

About European Society of Emergency Medicine (EUSEM)

Voting opens today for the new chair of EUSEP,  the European Society for Emergency Paediatrics, a branch of EUSEM.  A voting link will be sent to Paediatric members, the deadline to vote is Monday 14 October 18:00.

The nomination for the chair is:

Professsor Patrick Van de Voorde

Dear Members,

I have been involved in the paediatric section of EUSEM for many years now. I’ve seen it grow and thrive, developing into a proper society under the umbrella of EUSEM and a strong research branch via REPEM. This is the work of many highly committed people over the years and I find myself lucky to have been among them.

EUSEP is now at a crucial point in its young trajectory as we need to further enlarge our story and find a second generation of enthusiast colleagues to take over. I want to contribute to this as coming chair and pave the way for this future generation.

A society has an important tasks towards its members – and I tend to bring everyone involved into our ‘membership’- in terms of education, research, representation and advocacy. We again need to build capacity for all of this tasks and this is what I intend to do during my presidency so that we have a strong basis to then build on.

EM for children across Europe is provided in many different ways, a reality I understand and respect. Bringing all relevant actors together, and thus liaise with partner societies, is of the utmost importance and one of the clear tasks for the next board.

Finally, from its start EUSEP has been a special one within EUSEM: diverse, out of the box and young at heart. Let’s stay that way…

Truly yours

Patrick

Prof. Van de Voorde CV