What is your research about?
“My research is about children who have been treated by the Mobile Medical Team (MMT). Most people know us as the trauma helicopter, but we don’t only deal with emergencies and don’t always go there by helicopter. Our team comprises a medical specialist, usually an anaesthetist or trauma surgeon, a specialised nurse and a pilot. We can be at the scene quickly and immediately provide specialised care. With seriously ill or injured children in particular, it can make a big difference whether we are called in, as my research has shown.
How did you come up with the idea of exploring this topic in a PhD program?
“The combination of emergency care and paediatrics has always held my interest. During my studies, I worked as an ambulance driver and later on as an ambulance nurse. In the event of serious accidents, a helicopter would come and someone in a red suit would get out who could provide more help than we could. Usually an anaesthetist. Eventually I myself became a paediatric anaesthetist.
“I have been with the MMT since 2011 and am also Chair of the Foundation for Emergency Care for Children. We had some questions there that didn’t have any answers. For example, how many children are resuscitated each year in the Netherlands? Did those resuscitations have a greater chance of success if the MMT was involved?”
How did you go about finding answers to those questions?
“In the national trauma registration and the municipal basic registration, I sought information about the children that the MMT or an ambulance were involved with. I especially wanted to know about the quality of care for these children outside the hospital and whether they had a greater chance of survival when the MMT came into action. With that data, I also examined the quality of the medical interventions of the ambulance staff and MMT members. Using the results, we were able to adjust the national protocols for emergency care for children.”
What are the main changes that your research recommends?
“The first is that intubations in children should no longer be done by the ambulance service, but by the MMT. Specialists treat children much more often and do a lot more intubations than ambulance crews. If you do something often, you will naturally become better at it. In addition, in cases of resuscitation, we should treat children on site with the help of the MMT instead of trying to rush them to hospital. With the deployment of the MMT, we can save two and a half additional lives per hundred cases. That is the added value of the MMT.”
Is the mobilisation of a helicopter and team of specialists also affordable?
“What is a child’s life worth? That is not my decision; I am not allowed to decide that. What I have learned above all in emergency care is that children have an enormous amount of resilience. Sometimes you think: how is this going to turn out? And then a month later, they show up at your door with a thank-you letter and chocolates.”
Is that also what the front cover of your dissertation is about?
“The cover is made of drawings by school children who witnessed the resuscitation of their schoolmate. We were there as the MMT and flew the patient by helicopter to the Sophia hospital because there were too many road closures for the ambulance. This left such an impression on the children of that school that they drew pictures of it. Normally, you can brush off such an intense case when you drop the patient off at the hospital. But when someone visits you again, it all comes back. So when I got the envelope with the drawings, it really moved me.”
What was it like doing research on your own work?
“In the beginning, I mainly wanted to be able to answer questions. I looked in the databases and saw the children that I myself had treated. I was deeply saddened to see that some of them had died. Then you’re keeping count, but each number is a child with a brother or sister, a mother and father, grandfather, grandmother, a whole life. I wanted to know why some children did not make it.
“It really comes down to the most obvious questions that you as a doctor have that research is able to answer to some extent. I had been a staff member for five years by then and didn’t want to sit around or wait in the coffee lounge between procedures, so I focused on doing research. My wife had just received her doctorate; she is the first nurse specialist at Erasmus MC to do that. When I told her I was interested in a PhD, she said I would need perseverance. Well, I have shown her that I do.”