Albuterol has been shown to improve outcomes in patients presenting with bronchospasm in the prehospital setting. However, the administration of albuterol therapy is restricted by scope of practice to Advanced Life Support (ALS) in many Emergency Medical Services (EMS) systems throughout the country. Basic Life Support (BLS) providers have traditionally only assisted patients with using their own albuterol, but have not been granted authority to identify patients with bronchospasm and administer albuterol to patients who may benefit from bronchodilator therapy.

In January 2000, the trauma system of Delaware implemented the statewide trauma system and the “Pediatric Trauma System without Walls” concept. It is a system regulated by the American College of Surgeons' Committee on Trauma and is a collaborative effort between out-of-hospital personnel, physicians at all Delaware hospitals, and governing bodies. It has been demonstrated that overall trauma mortality has decreased in Delaware since the implementation of the statewide trauma system. Our objective is to show that the pediatric trauma mortality in Delaware has also decreased since the institution of that system led by the Division of Public Health Office of Emergency Medical Services. A query of the Delaware trauma registry from 1998-2007 was performed for all pediatric traumas (n=6,883). Pediatric trauma was defined from ages zero to fifteen. Mortality was defined by the discharge condition of the patient. The patients were classified by injury severity score (1-8, 9-15, 16-24, and >24). The same query was also performed with the National Trauma Database using the same criteria (n=338,225). Using the retrospective view of the trauma database, there is a statistically significant decrease in pediatric mortality among patients with an ISS score >24 (p<0.05). From 1998-2002, the mortality of Delaware's pediatric patients with an ISS score >24 was 45.8%. In contrast, the overall mortality of Delaware pediatric patients with an ISS score >24 in the years 2003-2007 was 17.2%. The mortality of children with an ISS score >24 reported in the National Trauma Database was 23.8% placing Delaware below the national average for the last 5 years. Pediatric mortality in the state of Delaware has decreased since the institution of the statewide trauma system and the “Pediatric Trauma System Without Walls” concept which was introduced in 2000. This especially holds true for pediatric patients with an injury severity score of >24. In fact, Delaware pediatric mortality among patients with a score >24 is actually lower than the national pediatric mortality with the same score.

Patients in an urban environment may utilize emergency departments (ED) differently than patients in a suburban environment. Previous research has demonstrated that significant differences exist among the percentage of patients admitted dependent upon their mode of arrival to the ED. The purpose of this study was to further investigate the admission rates of suburban versus urban hospitals based on patient mode of arrival. The modes of arrival that were investigated include walk-in patients, Basic Life Support (BLS) transports, and Advanced Life Support (ALS) transports.

The purpose of this study is to compare rates of successful endotracheal intubation (ETI) in patients receiving etomidate (ETOM) alone versus those receiving succinylcholine (SUX) in addition to ETOM.