MDA Pediatric Transport Pediatric Emergency Medicine October 13 th 2004

Talk Topics  EMS in Israel.  Pediatric EMS in Israel.  Pediatric transport in MCI.  The Use of Pediatric I/O in MDA.

Level Of Treatment Two Tier System Basic And Advanced Life Support. Basic And Advanced Life Support. Basic Level : B.L.S. Ambulance ( Including rural Ambulances) Medic/Driver (E.M.T) + E.M.T / Volunteer. E.M.T. Course Hours. 125 Ambulances In Morning shift. All equipped with A.E.D.’s additional B.L.S. Units “on call”.

Level Of Treatment A.L.S. Level : M.I.C.U - Mobile Intensive Care Unit Physician, Paramedic, E.M.T / Driver. Physicians - From Regional Hospitals. 22 Units In Central Cities. I.C.A - Intensive Care Ambulance Paramedic, E.M.T / Driver. 29 Units In Small Cities / Rural Areas

Professional Activities A.L.S Level Of Treatment 50% Cardiac, Cardiopulmonary, and respiratory Problems50% Cardiac, Cardiopulmonary, and respiratory Problems 4%-7% Resuscitations4%-7% Resuscitations 3%-5% Pediatric Cases3%-5% Pediatric Cases 10%-15% Trauma Cases10%-15% Trauma Cases

Magen David Adom General and trauma activity ALS52 BLS125 ALS BLS ALS BLS Ambulances per Shift per Shift Calls per year per year Trauma calls per year (12%) per year (12%) MICU 22 (Physician) ICA 30 (Paramedic)

Training of M.D.A. B.L.S. providers  Total 205 course hours.  Pediatric resuscitation - 3 hours.  Pediatric Trauma – 1hour.  Pediatric Emergencies – 1 hour  Care of the newly born – 1hour

Training of M.D.A. Paramedics  Total 1565 hours.  Stage 1: Class based - 18w.  Stage 2: Hospital clerkship – 10w.  Stage 3: Mobile Intensive care unit clerkship 80 shifts.

Pediatric training in the various stages  Stage 1: Pediatric resuscitation - 20h. Pediatric emergencies - 16h. The newly born -6h.  Stage 2: Pediatric ED / PICU - 30h. Labor and Delivery - 30h. Adult and Trauma ED - 100h. Anesthesia – 60h.

Pediatric training in the various stages  Stage 3: MICU – 640h. PALS course. PHTLS course.

Pediatric Prehospital Care  In Israel: 3-5% of EMS calls.  In U.S.: 5-10% of EMS calls and only 5% involve life threatening problems.  A weak link in most EMS systems.  Controversial issues: Scoop and Run Vs. Stay and play. A.W. management in trauma.

Pediatric Bone Injection Gun usage in MDA

MDA experience  2 types an adult and pediatric device.  Introduced to all A.L.S. units in  All attempts to use the device require reporting to medical division on a “ special procedure form ”.

Success rate

Age distribution

Indication

Prehospital outcome

Bus number 2 explosion in Jerusalem

August 20, 2003, 12:35pm EDT TWENTY KILLED, SCORES HURT IN JERUSALEM BUS BOMBING A suicide attacker detonated a bomb on a packed Jerusalem bus Tuesday, killing at least 20 people and wounding more than 100.

Time table  initial phone call: ”explosion heard”.  M.C.I. protocol activated.  First B.L.S. unit at the scene.  Second B.L.S. unit at the scene.  First A.L.S. unit at the scene.  B.L.S. and 3 A.L.S. units at the scene.

Time table-evacuation  Initial call  non urgent victims evacuated.  urgent and 1 non urgent victims evacuated.  last urgent victim evacuated.

Total units activated in this incident  39 B.L.S. units.  9 A.L.S. units.  1 M.C.R.V.  Manpower: Physicians-7 Paramedics-30 E.M.T.s -100

DISTRIBUTION of CASUALTIES

Pediatric victims  Of the 136 injured 45 were children and babies.  Of the 23 casualties 6 were children.  4 pediatric intubations were made at the scene.  3 pediatric patients were transported in secondary diversion.

Jerusalem bus explosion Secondary Diversion 2 2 Shaarei Zedek Level II Hadassah EK Level I Bikur Holim Level III Hadassah MS Level II

QUESTIONS ????????