The Role of the Paediatrician in the Coordination Centre

Introduction

Catalonia is one of the autonomous communities of northern Spain. It has a surface area of 32,114 m2 and a population of 7,747,709 inhabitants. The Emergency Medical System (known in Spanish as the Sistema de Emergencias Médicas, SEM) is part of CatSalut, the Catalan Health Service, and is the public entity that provides support services for medical emergencies in the region. As of 1995, it has two advanced life support ground units that are specialised in paediatric and neonatal transport, located at the Vall d'Hebron University Hospital and the Sant Joan de Déu University Hospital, which operate 24 hours a day, 365 days a year. It also has a specialised paediatric and neonatal aerial unit that is operated by personnel from the Parc Taulí and Santa Creu i Sant Pau university hospitals in Sabadell and Barcelona respectively, plus a nurse paediatric basic life support unit during the winter months. The team is composed of more than 60 professionals, including paediatricians and nurses with training in paediatric and neonatal care and medical emergency technicians specialised in paediatrics.

Since the creation of the paediatric SEM, more than 30,000 children have been transferred, among which approximately 40% were neonates. Around 95% of the activity corresponds to interhospital transfers, involving the stabilisation and transfer of critically ill or injured children to receiving hospitals that can handle their level of complexity. As of several years ago, these teams also respond to incidents in homes, public areas, and primary care centres when they are required to accompany the regional intermediate or advanced life support units. Since 2019, these units can also transfer critically ill patients who are connected to ECMO devices.

The paediatric SEM's activity is managed from the SEM coordination centre, who receives the request for patient transfer, coordinates the transfer to the appropriate hospital centre, and assigns the proper health transport resource.

The Paediatrician as Part of the SEM Coordination Centre

Up to 2017, the activity of the paediatric SEM was managed by SEM professionals from the coordination centre who were not specialised in paediatrics. That year, the SEM Health Coordination Centre began having a paediatric physician on call 24 hours a day, 365 days a year. Since then, that role has become key for coordinating resources, providing both telephone support for healthcare teams in the region and guidance in paediatric emergencies.

This task is carried out by the same paediatricians who are part of the aforementioned paediatric advanced life support units. Thus, they are knowledgeable not only about serious medical conditions, but also about the particularities of initial medical attention outside of health centres and transport. This new facet of their work has been a challenge for these professionals, who up to then had provided only on-site medical support.

Tasks of the Paediatrician in the Coordination Centre

1. Managing interhospital transfers: coordination and assessment

Initially, they directly managed the transfers for patients ≤ 6 years of age and provided support for the interhospital transfer team for patients > 6 years of age. They now currently manage transfers for patients
< 16 years of age.

When a call comes in from a health centre for the transfer of a paediatric or neonatal patient, it will firstly be routed to a call centre operator who will request the basic information needed. Next, it will be immediately transferred to the coordinating paediatrician, who will evaluate the patient's situation, assess the possible additional treatment measures, and decide on the most appropriate destination centre and transportation resource. It is worth noting that the transport may not always be performed by a paediatric unit, depending on the availability, coordination, and time dependence of the medical condition.

2. Telephone support for emergencies

The other function of the coordinating paediatrician is to provide support for consultations that may require specialised care due to their complexity and severity. These may be:

• Calls made by citizens which have first been screened by professional call managers (non-paediatric physicians or nurses). These are usually calls flagged by the system as high priority (Priority 0), where the reason for the call is a serious situation, such as unconsciousness, severe breathing difficulty, and/or other life-threatening circumstances.
• Consultations from SEM healthcare teams caring for paediatric patients or other professionals from healthcare centres.

In all of these cases, we collaborate with other members of the coordination centre to send, if necessary, the proper resource as determined by the evaluation made.