Speaker urges wider use of pediatric CPAP/BiPAP on ambulances and objective criteria for escalation

At a County of San Diego EMS lecture, Dr. Joelle D'Onofrio Odeman urged EMS agencies to adopt noninvasive positive-pressure ventilation (NIPPV) for children where feasible and to pair equipment rollout with objective criteria and staff training.

"Noninvasive positive pressure ventilation has been transformative in pediatrics," D'Onofrio Odeman said, describing a typical escalation from heated high-flow nasal cannula to CPAP and BiPAP and, for neonates, to specialized nasal ventilatory modes.

Devices and practical guidance: She described device-fit issues for small faces, the RamCann/large-diameter nasal interfaces for neonates, and typical starting rules such as a 2 liters per kilogram maximum for heated high-flow nasal cannula in many centers. She advised agencies to bring a child’s home BiPAP equipment when patients present on home support to ease in-hospital transitions.

Field adoption examples and evidence: D'Onofrio Odeman cited programs where pediatric CPAP has been used on ground ambulances with good tolerance (noting a Nationwide Children’s/Columbus Fire program) and referenced the PCARN randomized trial (described in the talk as the PD part trial), which had enrolled more than 900 patients and had not yet produced a definitive winner between supraglottic devices and bag-valve-mask in the speaker’s summary.

QA, training and objective scoring: The speaker recommended objective reactive-airway severity scoring (oxygenation, respiratory rate, work of breathing, breath sounds) to guide when to suction, provide bronchodilator trials, start high-flow, or escalate to CPAP/BiPAP. She said QA monitoring and alignment between EMS impressions and hospital discharge diagnoses are essential to measure appropriate intervention rates.

Q&A highlights: In audience questions, Dr. D'Onofrio Odeman said pediatric supraglottic airways should be an option but called for better prehospital studies. Regarding heated high-flow on long transports, she recommended using equipment already on rigs (for example, adapting BiPAP with pediatric masks) until heated high-flow logistics and oxygen supplies are addressed.

Next steps: The speaker encouraged agencies to pilot pediatric CPAP with objective criteria, coordinate treatment pathways regionally, and await forthcoming publications and shared protocols via the EMS for Children advisory committee.