Infrequent exposure to prehospital neonatal interventions and resource utilisation by a public EMS in the Western Cape, South Africa

The neonatal period is the most vulnerable time of every child’s life, with approximately 6,300 neonatal deaths occurring globally every day. Emergency medical services (EMS) are responsible for managing critically ill neonates during emergency response and interfacility transfers (IFTs), however, prehospital provider proficiency is challenged by low-frequency exposure rates. Understanding the emergency care utilisation and associated clinical interventions among this vulnerable population can inform future research and, ultimately, paramedicine training needs, strategic service planning, and system development. A retrospective review of electronic patient care records was conducted for neonates < 28 days old managed by the Western Cape public EMS in South Africa between 01 January 2022 and 31 December 2023. Electronic records were analysed for demographic, clinical presentations, and prehospital interventions using descriptive statistics, following STROBE reporting guidelines. Neonatal activations ( n = 9,825) accounted for 0.7% of EMS activations during the study period, with interventions performed infrequently across the cohort, particularly high-risk procedures such as prehospital intubation (0.4%). Specialised retrieval teams (SRTs) managed a preponderance of high-acuity neonates requiring IFT relative to their caseload and were strongly associated with increased administration of advanced interventions. Non-SRT crews attended the majority of high acuity cases (3,206; 65.4%), despite being predominantly staffed by lower-qualified practitioners with limited neonatal scope of practice. The recorded incidence of mechanical ventilation ( n = 451, 4.6%) was significantly higher than that of sedation/analgesia ( n = 105, 1.1%). This study analysed the interventions and resources utilised by a public EMS to stabilise and transport neonates in a low-resource setting. Key findings included infrequent exposure to neonates, limited reporting of sedation and analgesia in mechanically ventilated patients, and the prevalence of specialised retrieval teams in managing high-acuity IFTs in this patient population.