Medically Unnecessary Pediatric Ambulance Transports: A Medical Taxi Service?

Camasso-Richardson, Karen; Wilde, James A.; Petrack, Emory M.

doi:10.1111/j.1553-2712.2000.tb03845.x

Cited by 24 publications

(39 citation statements)

References 17 publications

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“…These findings are consistent with previous studies. 4,8,15,18 Ironically, Kost and colleagues 18 found that 87% of high-acuity pediatric cases arrived by private vehicle, suggesting that ambulance services may sometimes be used inappropriately to transport low-acuity patients, while many high-acuity patients are transported by other means.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors note the high proportion of inappropriate EMS transports for nonurgent patients, [12][13][14] and in one report the authors described the majority of pediatric ambulance transports as being a medically unnecessary "taxi service." 15 Other studies have pointed out important EMS interventions that are underused among children, such as aggressive treatment for respiratory distress and seizure. 16,17 It has also been noted that a large proportion of critically ill or injured children who present to the emergency department (ED) do not use the EMS system.…”

Section: Introductionmentioning

confidence: 99%

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Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system

Richard

Osmond

Nesbitt³

et al. 2006

CJEM

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Objectives: There is uncertainty around the types of interventions that are provided by emergency medical services (EMS) to children during prehospital transport. We describe the patient characteristics, events, interventions provided and outcomes of a cohort of children transported by EMS. Methods: This prospective cohort study was conducted in a city of 750 000 people with a 2-tiered EMS system. All children <16 years of age who were attended by EMS during a 6-month period were enrolled. Data were extracted from ambulance call reports and hospital charts, and analyzed using descriptive statistics. Results: During the study period there were 1377 pediatric EMS calls. Mean age was 8.2 years (standard deviation 5.4), and the most common diagnoses were trauma (44.9%), seizure (11.8%) and respiratory distress (8.8%). The ambulance return code was Urgent in 7%, Prompt in 57%, Deferrable in 8% and Not Transported in 28%. Fifty-six percent received either an Advanced Life Support or Basic Life Support prehospital intervention. Common procedures included cardiac monitoring (20.0%), oxygen administration (19.8%), blood glucose monitoring (16.3%), spine board (12.2%), limb immobilization (11.1%) and cervical collar (10.0%). Uncommon procedures included administering medications intravenously (IV) (1.4%), bag-valve-mask ventilation (0.3%) and endotracheal intubation (0.1%). Seventy-eight percent of attempted IV lines were successful. Only 9.0% of EMS-transported children were admitted to hospital, and 2.2% were admitted to the intensive care unit. Conclusions: This first study of Canadian pediatric prehospital interventions shows a high rate of non-transport, and a low rate of Urgent transports and hospital admissions for children. Very few children receive prehospital airway management, ventilation or IV medications; consequently EMS personnel have little opportunity to maintain these pediatric skills in the field.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system

Richard

Osmond

Nesbitt³

et al. 2006

CJEM

View full text Add to dashboard Cite

show abstract

“…Adult patients with high rates of ambulance utilization, especially for low acuity complaints, are disproportionately uninsured or have public insurance [7][8][9]. This non-urgent ambulance and Emergency Department (ED) use is a contributor to ED overcrowding, leading to higher rates of ambulance diversions and delaying care for higher acuity emergencies [5,9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Most pediatric ambulance studies have utilized data from individual hospitals or statewide databases and very few have examined the effect of insurance on ambulance use [13][14][15][16]. Some studies that focus on adults have suggested that those patients without insurance or public insurance view the ambulance as a "taxi service" since they do not see a bill Other studies that focus on adults suggest that the utilization pattern is multifactorial [8,9,[17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

The role of health insurance in pediatric ambulance use: are children just small adults?

Bober¹,

Stefanov²,

Paladino³

et al. 2017

Trauma Emerg Care

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Objective: Rapidly rising healthcare costs require a thorough analysis of all the components of care. Multiple studies of adult patients with public insurance or without private insurance have shown that they are more likely than those with private insurance to use the ambulance. Multiple studies of pediatric ambulance use have been limited in generalizability because they rely on individual hospital or single statewide databases and do not specifically look at insurance. The purpose of this study was to describe pediatric ambulance use and its association with specific health insurances using the National Hospital Ambulatory Medical Survey (NHAMCS) database.Methods: NHAMCS data between 2008 to 2010 for all pediatric (age <19 years) visits were analyzed. Multivariate logistic regression was used to model ambulance utilization on insurance status while controlling for variability in demographics and severity levels.Outcomes Measured: A total of 25,215 pediatric ED visits were included representing a national sample of approximately 97,341,191 million ED visits between 2008-2010. Non-insured (9.9%) compared to privately insured (6.6%) children had significantly higher rates of ambulance use. No significant difference in ambulance utilization was noted between those with Medicaid/State Children's Health Insurance Program (SCHIP) (5.8%) versus private (6.6%) insurance. Even after controlling for demographic and severity variables the adjusted odds ratio (1.66, 95% CI 1.30-2.13, p<0.0001) identified those visits without insurance as an independent predictor of ambulance utilization. In addition, older children (12-18 years), those of black race and residing in urban areas or the Northeast also had significantly higher odds of ambulance utilization. Visits by older children, specifically those without insurance, had increased odds of ratio of ambulance utilization (1.83, CI: 1.36-2.45, p<0.0001). Conclusions:Similar to adult patients, non-uninsured versus insured visits by pediatric patients have increased ambulance utilization. Different from the adults, public the type of insurance public versus private did not affect pediatric ambulance use. Health policies that facilitate continuous insurance coverage for children may be one way to maximize resource utilization in regards to ambulance use.

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“…Further, there has been an increase in the number of the cases in which a person with mild symptoms was transported to the hospital in an ambulance, especially in the metropolitan area of Japan. Additionally, some individuals called for an ambulance because they had no other means of transportation [10]. Consequently, the time taken to arrive at the hospital has increased with each consecutive year, which has become a serious social problem.…”

Section: Introductionmentioning

confidence: 99%

Beneficiaries’ Willingness to Pay for Resuscitation Provided by Ambulance Attendants: A Survey Using the Contingent Valuation Approach

Ito¹,

Akahane²,

Maeyashiki³

et al. 2017

Health

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Background: Japanese emergency medical services (EMS) can be used by anyone for free. Recently, EMS usage has increased; the increased costs and the prolonged time for ambulance transport have become recent social problems. Objective: We surveyed the willingness to pay (WTP) for resuscitation provided by EMS. Methods: In November 2011, men and women (3160) aged 20 -59 years were asked to assume that they were experiencing a cardiopulmonary arrest (CPA), and their WTP for EMS services was assessed in the following three situations: Case A, ambulance transport alone; Case B, chest compression in addition to ambulance transport; and Case C, artificial ventilation through chest compression and intratracheal intubation, in addition to ambulance transport. We calculated the mean WTP for each case. Results: The WTP for Case A, B, and C were ¥6,696 ($65.0), ¥16,081 ($156.1), and ¥27,505 ($267.0), respectively. The WTP for Case B was significantly higher in respondents aged 40 -59 years compared to those aged 20 -39 years. The WTP for case B and C were significantly higher in males compared to females. WTP was significantly lower in students than it was in private employees. Although women's intention to pay was higher than that of men, their WTP was lower than that of men. Public employees' and students' intention to pay was significantly lower than that of private employees. Conclusions: Our study provides information about the optimal fee for EMS, which will be useful for discussions on the feasibility of introducing a fee for EMS in Japan.

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Medically Unnecessary Pediatric Ambulance Transports: A Medical Taxi Service?

Cited by 24 publications

References 17 publications

Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system

Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system

The role of health insurance in pediatric ambulance use: are children just small adults?

Beneficiaries’ Willingness to Pay for Resuscitation Provided by Ambulance Attendants: A Survey Using the Contingent Valuation Approach

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