Treating Respiratory Emergencies in Children (T-RECS) Feasibility Study

超过200,000名儿童因呼吸窘迫而被911紧急医疗服务(EMS)激活 去年，他们中的大多数人都有剧烈的喘息。院前环境中的早期治疗可以更快地缓解 呼吸窘迫症状，预防缺氧，减少侵入性干预，减少需要 住院，从而促进早日恢复正常的日常活动。发现了一个站点的初步数据 当EMS系统引入儿科医生时，儿童的住院率从30%下降到21% 口服地塞米松治疗哮喘。目前急诊科(ED)的治疗标准 两岁及以上儿童的急性喘息包括吸入异丙托品和地塞米松。这些治疗方法 有长期的安全历史，在急诊室早期使用可有效防止住院治疗。 具体的治疗方案通常直接进行院前护理。异丙托品和地塞米松 由制定院前护理示范方案的国家EMS组织推荐。然而，只有 来自美国大城市地区的EMS机构中有25%允许异丙托品，只有10%包括 地塞米松在他们的治疗方案。迫切需要一项临床试验来评估 为喘息儿童实施干预措施所需的大量EMS资源已被证明是有益的 ED的结果是改善了患者的预后。这三个地点的试点试验的总体目标是解决 关于实施研究的具体问题，并确保其可行性。这项研究将是 在儿科急救应用研究网络(PECARN)EMS附属机构(EMSA)进行。 我们将包括2-18岁的患者，他们有急性喘息的911电话。具体目标是：1)发展 并为包括异丙托品和地塞米松的治疗包制作一份院前检查表，2) 确定收集在EMS系统中治疗的喘息儿童的患者结果的可行性，以及3) 使用RE-AIM框架评估EMS治疗捆绑包和核对表的实施情况。这 研究将提供必要的数据，以确保最终的试验是可行的，主要是通过建立 衡量感兴趣的结果以及评估执行情况。这项研究的创新之处在于 关于院前环境中的儿科护理，这是我们紧急护理系统的关键组成部分，即 在研究中经常被忽视的。

Over 200,000 children have a 911 Emergency Medical Services (EMS) activation for respiratory distress each year, most of whom have acute wheezing. Early treatment in the prehospital setting could more rapidly relieve respiratory distress symptoms, prevent hypoxia, reduce invasive interventions, and reduce the need to be hospitalized, thereby facilitating earlier return to normal daily activities. Preliminary data from one site found hospital admission was reduced from 30% to 21% among children when an EMS system introduced a pediatric asthma protocol with oral dexamethasone. The current standard for Emergency Department (ED) treatment for acute wheezing for children two and older includes inhaled ipratropium and dexamethasone. These treatments have a longstanding history of safety and are effective in preventing hospitalization when used early in the ED. Specific treatment protocols generally direct prehospital care. Ipratropium and dexamethasone are recommended by national EMS organizations that develop model protocols for prehospital care. However, only 25% of EMS agencies from large US metropolitan areas allow ipratropium, and only 10% include dexamethasone in their treatment protocols. A clinical trial is critically needed to evaluate whether the significant EMS resources required to implement interventions for wheezing children that have proven benefit in the ED result in improved patient outcomes. The overall objective of this three-site pilot trial is to address specific questions related to the implementation of the study and ensure its feasibility. The study will be conducted in the Pediatric Emergency Care Applied Research Network (PECARN) EMS Affiliates (EMSAs). We will include patients aged 2-18 who have a 911 call for acute wheezing. The specific aims are 1) to develop and produce a prehospital checklist for the treatment bundle including ipratropium and dexamethasone, 2) to determine the feasibility of collecting patient outcomes for wheezing children treated in the EMS system, and 3) to evaluate implementation of the EMS treatment bundle and checklist using the RE-AIM framework. This study will provide the necessary data to ensure the eventual trial is feasible, primarily by establishing the ability to measure the outcomes of interest as well as evaluating implementation. This study is innovative by focusing on pediatric care in the prehospital environment, a critical component of our emergency care system that is often neglected in research.