Epidemiology of Pediatric Transports andNon-Transports in an Urban Emergency Medical Services System

Kannikeswaran, Nirupama; Mahajan, Prashant; Dunne, Robert; Compton, Scott; Knazik, Stephen R.

doi:10.1080/10903120701536677

Cited by 20 publications

(22 citation statements)

References 18 publications

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“…Non-conveyance rates for people who had fallen ranged from 11%–56% [26, 27, 73, 74]. For paediatric patients non-conveyance rates ranged from 13.2%–27.7% [36, 62, 79]. Two studies reported non-conveyance rates for patients with an opioid overdose , ranging from 6.0%–77.0% [44, 54].…”

Section: Resultsmentioning

confidence: 99%

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

Ebben

Vloet

Speijers

et al. 2017

Scand J Trauma Resusc Emerg Med

136

208

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BackgroundThis systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives. The review specifically focussed at describing (1) ambulance non-conveyance rates, (2) characteristics of non-conveyed patients, (3) follow-up care after non-conveyance, (4) existing guidelines or protocols, and (5) influencing factors during the non-conveyance decision making process.MethodsWe systematically searched MEDLINE, PubMed, CINAHL, EMBASE, and reference lists of included articles, in June 2016. We included all types of peer-reviewed designs on the five topics. Couples of two independent reviewers performed the selection process, the quality assessment, and data extraction.ResultsWe included 67 studies with low to moderate quality. Non-conveyance rates for general patient populations ranged from 3.7%–93.7%. Non-conveyed patients have a variety of initial complaints, common initial complaints are related to trauma and neurology. Furthermore, vulnerable patients groups as children and elderly are more represented in the non-conveyance population. Within 24 h–48 h after non-conveyance, 2.5%–6.1% of the patients have EMS representations, and 4.6–19.0% present themselves at the ED. Mortality rates vary from 0.2%–3.5% after 24 h, up to 0.3%–6.1% after 72 h. Criteria to guide non-conveyance decisions are vital signs, ingestion of drugs/alcohol, and level of consciousness. A limited amount of non-conveyance guidelines or protocols is available for general and specific patient populations. Factors influencing the non-conveyance decision are related to the professional (competencies, experience, intuition), the patient (health status, refusal, wishes and best interest), the healthcare system (access to general practitioner/other healthcare facilities/patient information), and supportive tools (online medical control, high risk card).ConclusionsNon-conveyance rates for general and specific patient populations vary. Patients in the non-conveyance population present themselves with a variety of initial complaints and conditions, common initial complaints or conditions are related to trauma and neurology. After non-conveyance, a proportion of patients re-enters the emergency healthcare system within 2 days. For ambulance professionals the non-conveyance decision-making process is complex and multifactorial. Competencies needed to perform non-conveyance are marginally described, and there is a limited amount of supportive tools is available for general and specific non-conveyance populations. This may compromise patient-safety.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-017-0409-6) contains supplementary material, which is available to authorized users.

show abstract

Section: Resultsmentioning

confidence: 99%

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

Ebben

Vloet

Speijers

et al. 2017

Scand J Trauma Resusc Emerg Med

136

208

View full text Add to dashboard Cite

show abstract

“…However, there were no control groups of transported patients in the Moss study. A study specifically examining pediatric patients found that the odds ratio for refusal was highest for assaults, difficulty breathing, and MVCs (22).…”

Section: Discussionmentioning

confidence: 99%

Effect of Gender on Prehospital Refusal of Medical Aid

Waldron

Finalle

Tsang

et al. 2012

The Journal of Emergency Medicine

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“…8 However, the overall frequency of pediatric ETI is much lower than adults since only 7–13% of EMS transports are for children. 9–11 …”

Section: Discussionmentioning

confidence: 99%

Out-of-hospital pediatric airway management in the United States

Hansen¹,

Lambert²,

Guise³

et al. 2015

Resuscitation

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Epidemiology of Pediatric Transports andNon-Transports in an Urban Emergency Medical Services System

Abstract: In this system, the majority of pediatric patients are not severely ill, and a large number are not transported. Non-transports are more likely to be young adolescents, have been involved in assaults, and have a longer on-scene time.

Cited by 20 publications

References 18 publications

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

Effect of Gender on Prehospital Refusal of Medical Aid

Out-of-hospital pediatric airway management in the United States

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