Neighborhood Disadvantage and Injury Mechanism, Severity, and Outcomes in Pediatric Trauma.

Background: Traumatic injuries remain the leading cause of death in children aged 1-14. Previous research demonstrates a link between lower socioeconomic status (SES) and higher pediatric injury morbidity and mortality. There is scant research exploring the relationship between neighborhood disadvantage and pediatric trauma.

A Smart Glass Telemedicine Application for Prehospital Communication: User-Centered Design Study.

Background: Smart glasses have emerged as a promising solution for enhancing communication and care coordination among distributed medical teams. While prior research has explored the feasibility of using smart glasses to improve prehospital communication between emergency medical service (EMS) providers and remote physicians, a research gap remains in understanding the specific requirements and needs of EMS providers for smart glass implementation.

Objective: This study aims to iteratively design and evaluate a smart glass application tailored for prehospital communication by actively involving prospective users in the system design process.

Enhancing Prehospital Decision-Making: Exploring User Needs and Design Considerations for Clinical Decision Support Systems.

Background: In prehospital emergency care, providers face significant challenges in making informed decisions due to factors such as limited cognitive support, high-stress environments, and lack of experience with certain patient conditions. Effective Clinical Decision Support Systems (CDSS) have great potential to alleviate these challenges. However, such systems have not yet been widely adopted in real-world practice and have found to cause workflow disruptions and usability issues.

Deliberate Practice as an Effective Method for Reducing Diagnostic Error in Identifying Burn and Bruise Injuries Suspicious for an Abusive Injury.

Objective: To examine the effectiveness of an education intervention for reducing physician diagnostic error in identifying pediatric burn and bruise injuries suspicious for abuse, and to determine case-specific variables associated with an increased risk of diagnostic error.

Study Design: This was a multicenter, prospective, cross-sectional study. A convenience sample of pediatricians and other front-line physicians who treat acutely injured children in the United States and Canada were eligible for participation.

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study.

Background: Cervical spine injuries in children are uncommon but potentially devastating; however, indiscriminate neck imaging after trauma unnecessarily exposes children to ionising radiation. The aim of this study was to derive and validate a paediatric clinical prediction rule that can be incorporated into an algorithm to guide radiographic screening for cervical spine injury among children in the emergency department.

Methods: In this prospective observational cohort study, we screened children aged 0-17 years presenting with known or suspected blunt trauma at 18 specialised children's emergency departments in hospitals in the USA affiliated with the Pediatric Emergency Care Applied Research Network (PECARN).

Public support for and concerns regarding pediatric dose optimization for seizures in emergency medical services: An exception from informed consent (EFIC) trial.

Background: Federal regulations allow exception from informed consent (EFIC) to study emergent conditions when obtaining prospective consent is not feasible. Little is known about public views on including children in EFIC studies. The Pediatric Dose Optimization for Seizures in EMS (PediDOSE) trial implements age-based, standardized midazolam dosing for pediatric seizures.

Information Seeking and Sensemaking in Emergency Medical Service through Simulation Video Review.

Emergency medical services (EMS) providers often face significant challenges in their work, including collecting, integrating, and making sense of a variety of information. Despite their criticality, EMS work is one of the very few medical domains with limited technical support. To design and implement effective decision support, it is essential to examine and gain a holistic understanding of the fine-grained process of sensemaking in the field.

Pediatric Sepsis in General Emergency Departments: Association Between Pediatric Sepsis Case Volume, Care Quality, and Outcome.

Study Objective: To assess whether a general emergency department's (ED) annual pediatric sepsis volume increases the odds of delivering care concordant with Surviving Sepsis pediatric guidelines.

Methods: A retrospective cohort study of children <18 years with sepsis presenting to 29 general EDs. Emergency department and hospital data were abstracted from the medical records of 2 large health care systems, including all hospitals to which children were transferred.

Frequency, Type, and Degree of Potential Harm of Adverse Safety Events among Pediatric Emergency Medical Services Encounters.

Background: Only 5-10% of emergency medical services (EMS) patients are children, and most pediatric encounters are low-acuity. EMS chart review has been used to identify adverse safety events (ASEs) in high-acuity and high-risk pediatric encounters. The objective of this work was to evaluate the frequency, type, and potential harm of ASEs in varied acuity pediatric EMS encounters.

Prehospital Management of Pediatric Behavioral Health Emergencies: A Scoping Review.

Pediatric behavioral health emergencies (BHE) are increasing in prevalence, yet there are no evidence-based guidelines or protocols for prehospital management. The primary objective of this scoping review is to identify prehospital-specific pediatric BHE research and publicly available emergency medical services (EMS) protocols for pediatric BHE. Secondary objectives include identifying the next priorities for research and EMS protocol considerations for children with neurodevelopmental conditions.

Pediatric trauma surgery in Iraq and Afghanistan: Mortality, indicators, and most common operating room interventions from 2007 to 2016.

Background: The wars in Afghanistan and Iraq produced thousands of pediatric casualties, using substantial military medical resources. We sought to describe characteristics of pediatric casualties who underwent operative intervention in Iraq and Afghanistan.

Methods: This is a retrospective analysis of pediatric casualties treated by US Forces in the Department of Defense Trauma Registry with at least one operative intervention during their course.

Prehospital Recognition and Management of Pediatric Sepsis: A Qualitative Assessment.

Background And Purpose: Sepsis is a life-threatening disease in children and is a leading cause of morbidity and mortality. Early prehospital recognition and management of children with sepsis may have significant effects on the timely resuscitation of this high-risk clinical condition. However, the care of acutely ill and injured children in the prehospital setting can be challenging.

Smart Glasses for Supporting Distributed Care Work: Systematic Review.

Background: Over the past 2 decades, various desktop and mobile telemedicine systems have been developed to support communication and care coordination among distributed medical teams. However, in the hands-busy care environment, such technologies could become cumbersome because they require medical professionals to manually operate them. Smart glasses have been gaining momentum because of their advantages in enabling hands-free operation and see-what-I-see video-based consultation.

Adding age-adjusted shock index to the American College of Surgeons' trauma team activation criteria to predict severe injury in children.

Background: The American College of Surgeons (ACS) requires trauma centers to use six minimum criteria (ACS-6) for full trauma team activation. Our goal was to evaluate the effect of adding age-adjusted shock index (SI) to the ACS-6 for the prediction of severe injury among pediatric trauma patients with the hypothesis that SI would significantly improve sensitivity with an acceptable decrease in specificity.

Methods: We performed a secondary analysis of prospectively collected EMS and trauma registry data from two urban pediatric trauma centers.

Impact of Race and Ethnicity on Emergency Medical Services Administration of Opioid Pain Medications for Injured Children.

Background: Treatment with analgesics for injured children is often not provided or delayed during prehospital transport.

Objective: Our aim was to evaluate racial and ethnic disparities with the use of opioids during transport of injured children.

Methods: We conducted a prospective study of injured children transported to 1 of 10 emergency departments from July 2019 to April 2020.

Designing and implementing smart glass technology for emergency medical services: a sociotechnical perspective.

Objective: This study aims to investigate key considerations and critical factors that influence the implementation and adoption of smart glasses in fast-paced medical settings such as emergency medical services (EMS).

Materials And Methods: We employed a sociotechnical theoretical framework and conducted a set of participatory design workshops with 15 EMS providers to elicit their opinions and concerns about using smart glasses in real practice.

Results: Smart glasses were recognized as a useful tool to improve EMS workflow given their hands-free nature and capability of processing and capturing various patient data.

Pediatric Emergency Care Coordination in EMS Agencies: Findings of a Multistate Learning Collaborative.

Background: In 2017, the Health Resources and Services Administration's Maternal Child and Health Bureau's Emergency Medical Services for Children program implemented a performance measure for State Partnership grants to increase the percentage of EMS agencies within each state that have designated individuals who coordinate pediatric emergency care, also called a pediatric emergency care coordinator (PECC). The PECC Learning Collaborative (PECCLC) was established to identify best practices to achieve this goal. This study's objective is to report on the structure and outcomes of the PECCLC conducted among nine states.

Identification of Factors Associated with Return of Spontaneous Circulation after Pediatric Out-of-Hospital Cardiac Arrest Using Natural Language Processing.

Introduction: Prior studies examining prehospital characteristics related to return of spontaneous circulation (ROSC) in pediatric out-of-hospital cardiac arrest (OHCA) are limited to structured data. Natural language processing (NLP) could identify new factors from unstructured data using free-text narratives. The purpose of this study was to use NLP to examine EMS clinician free-text narratives for characteristics associated with prehospital ROSC in pediatric OHCA.

Emergency Medical Services Provider Acceptance of and Attitudes About Pediatric SimBox Simulations.

Objective: SimBox simulations allow for high-frequency open-access health care education, overcoming cost and resource barriers. Prehospital paramedics and emergency medical technician (EMT) care for children infrequently. In this study, prehospital providers evaluated pediatric SimBox simulations.

User Needs and Challenges in Information Sharing between Pre-Hospital and Hospital Emergency Care Providers.

Effective communication between pre-hospital and hospital providers is a critical first step towards ensuring efficient patient care. Despite many efforts in improving the communication process, inefficiencies persist. It is critical to understand user needs, work practices, and existing barriers to inform technology design for supporting pre-hospital communication.

State emergency medical services guidance and protocol changes in response to the COVID-19 pandemic: A national investigation.

Objectives: The COVID-19 pandemic has had an impact on emergency medical services (EMS) and its guidelines, which aid in patient care. This study characterizes state and territory EMS office recommendations to EMS statewide operational and clinical guidelines and describes the mechanisms of distribution and implementation during the COVID-19 pandemic.

Methods: A mixed-methods study was conducted in 2 phases.

Applications and User Perceptions of Smart Glasses in Emergency Medical Services: Semistructured Interview Study.

Background: Smart glasses have been gaining momentum as a novel technology because of their advantages in enabling hands-free operation and see-what-I-see remote consultation. Researchers have primarily evaluated this technology in hospital settings; however, limited research has investigated its application in prehospital operations.

Objective: The aim of this study is to understand the potential of smart glasses to support the work practices of prehospital providers, such as emergency medical services (EMS) personnel.

Predictive accuracy of adding shock index to the American College of Surgeons' minimum criteria for full trauma team activation.

Background: The American College of Surgeons requires trauma centers to use six minimum criteria (ACS-6) for full trauma team activation: hypotension, gunshot wound to the neck or torso, Glasgow Coma Scale (GCS) score < 9, respiratory compromise, transfers receiving blood transfusion, or physician discretion. Our goal was to evaluate the effect of adding varying shock index (SI) thresholds to the ACS-6 in an adult trauma population with the hypothesis that SI would significantly improve sensitivity at the expense of an acceptable decrease in specificity.

Methods: We performed a secondary analysis of EMS and trauma registry data from an urban Level I trauma center.

Impact of Prehospital Pain Management on Emergency Department Management of Injured Children.

Objective: Provision of analgesia for injured children is challenging for Emergency Medical Services (EMS) clinicians. Little is known about the effect of prehospital analgesia on emergency department (ED) care. We aimed to determine the impact of prehospital pain interventions on initial ED pain scale scores, timing and dosing of ED analgesia for injured patients transported by EMS.