The impact of EMS transport models on pediatric life-saving interventions and outcomes in emergency care: a prospective observational study based on the REPEM survey

Abstract

Background Pediatric patients requiring life-sustaining interventions (LSIs) constitute a critically ill population characterized by a high risk of rapid clinical deterioration, necessitating precise and timely medical interventions. Emergency Medical Services (EMS) transport strategies vary, with the Franco-German (FG) (physician-led) “stay and play” model emphasizing advanced prehospital care and the Anglo-American (AA) (paramedic-led) “scoop and run” approach prioritizing rapid transport. This study evaluates the influence of transport modality on prehospital LSIs, clinical outcomes, and the personnel performing these interventions.

Methods This prospective, multicenter, observational study included 16 emergency departments (EDs) across four European countries over a four-week period. Children (≤ 18 years) who received LSIs in the ED were included. Patients were stratified by transport modality: FG-EMS (physician-led) and AA-EMS (paramedic-led). The study analyzed the rate and type of LSIs performed, the personnel administering interventions, prehospital transport times, and clinical outcomes including pediatric intensive care unit (PICU) admission and mortality.

Results A total of 133,634 patients visited during the study period, of whom 12,087 (9.0%) were transported via EMS. Among these, 4.7% (n = 631) received LSIs in the ED and were included in the study. The median daily ED visits were 136 (IQR:110–251), with 8 ambulance arrivals (IQR:5–12). Most LSIs were performed on patients transported by parents (56.7%), while 43.3% were EMS transports. Among EMS transports, 18.6% utilized the physician-led (FG) model, and 81.4% used the paramedic-led (AA) model. LSIs during transport occurred in 19.4% of EMS patients, significantly more in FG than AA (43.1 vs. 13.9%) (p < 0.001). No invasive procedures were performed in AA transports, which had shorter transport times compared to FG (median 20 vs. 31 min) (p = 0.001). Most patients requiring LSIs presented with medical emergencies (75.1%). FG transports had higher PICU admission (41.2% vs. 21.6%) and mortality rates (9.8% vs. 1.8%) (p = 0.004 and p = 0.012, respectively).

Conclusion The transport modality significantly influenced the pre-hospital management and clinical outcomes of children requiring LSIs. FG transports were associated with more comprehensive pre-hospital interventions but longer transport times and higher PICU admission and mortality rates. These findings highlight the need for optimizing pre-hospital care and transport protocols to improve outcomes in critically ill children.