Abstract
INTRODUCTION: Development of emergency care systems and provision of quality pre-hospital care have been identified as a priority to reduce childhood morbidity and mortality in low-resource settings. A dedicated paediatric and neonatal retrieval transfer team (SPRINTT) service was established in the Western Cape, South Africa, in 2016. This study describes the utilisation of Emergency Medical Services (EMS) for children and neonates identified as requiring SPRINTT. Additionally, the indications, clinical profile, and outcomes for a sub-group of children transferred to a tertiary paediatric emergency department (PED) are described. METHODS: This retrospective study reviewed cases requiring SPRINTT from November 2019 to November 2020. Data were obtained from EMS Electronic Patient Care Records (ePCR) and Computer Aided Dispatch (CAD) databases. A sub-group of cases transferred to a tertiary PED were reviewed using hospital records. RESULTS: A total of 2361 inter-facility transfers logged as SPRINTT incident-types occurred during the study period, with 54% being neonates <29 days. The majority (87%) were from urban facilities. Most cases (82%) were high acuity, being triaged as an emergency or very urgent. Of the sub-group of 203 cases transferred to the PED, acute respiratory illnesses (42%) and gastroenteritis (24%) were the most frequent presenting complaints. Eight children (4%) died, and 16% of children were unstable on arrival. Cardiovascular instability and escalation of respiratory support within 60 min of PED arrival were associated with PICU admission and death (p < 0.001). CONCLUSION: This study is the first description of the utilisation of the SPRINTT service that includes a description of patient outcomes. The large number of SPRINT-type transfers reflects the considerable burden of acutely ill paediatric and neonatal cases and highlights the need for specialised pre-hospital care services. For the PED sub-group, 84% were stable on arrival suggesting that the retrieval service performs an important role in pre-hospital care and transfer in this setting.