Pediatric ambulance utilization in a large American city

Foltin, George L.; Pon, Steven; Tunik, Michael G.; Fierman, Arthur H.; Dreyer, Benard P.; Cooper, Arthur; Welborne, C.; Treiber, Marsha

doi:10.1097/00006565-199808000-00002

Cited by 29 publications

(19 citation statements)

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“…11 EMS interventions for trauma patients increased with severity of injury (table 3). Whether interventions such as establishment of intravenous access by EMS personnel contribute to improved outcome for injured children is unknown and has been reported to be inconsequential.…”

Section: Discussionmentioning

confidence: 99%

Pre-hospital emergency medical services: a population based study of pediatric utilization

et al. 1999

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Objectives-To examine emergency medical services (EMS) usage by children in one state. Methods-Dispatch of an EMS vehicle in response to a call in the US is referred to as a "run". Runs for Utah for 1991-92 were linked to corresponding hospital records. Abbreviated injury severity scores (AISs) were assigned using ICDMAP-90 software. Results-For the two year period there were at least 15 EMS runs per 100 children per year, with incomplete reporting from rural areas. EMS response and scene times were similar for all age groups, but interventions were less frequent for children under 5 years of age. When the principal AIS region of injury was the head, neck, or face, cervical immobilization was less frequent for children less than 5 years of age (54%) than for older children (76%) and immobilization was associated with improved outcome, using the crude measure of lower hospital charges. There was a similar association between splinting of upper extremity fractures and reduced hospital charges. Both associations did not appear to be due to diVerences in injury severity. Conclusions-The majority of EMS use by children is for trauma. Children less than 5 years of age are less likely to have an EMS intervention than older children. Whether the lower frequency of interventions is due to the lack of properly sized equipment on the vehicle, or to other factors, is undetermined. (Injury Prevention 1999;5:294-297) Keywords: emergency medical services; splints; infusions, intravenousThere is little population based information concerning use of pre-hospital emergency medical services (EMS) by children. The limited data available suggest that children, especially the youngest children, may be underserved by EMS. For example, a Kentucky study found that advanced life support interventions were performed for 25% of adolescents but only for 2% of those less than 1 year old. 1Children use ambulances less frequently than adults 2 and account for approximately 10% of all EMS usage. The present study combined pre-hospital and hospital data for children using the EMS system in order to provide additional information concerning usage, interventions, and outcomes and to address a research need identified in the US Institute of Medicine report Emergency Medical Services for Children.5 This question was whether data from several diVerent components of the EMS system, such as pre-hospital care and hospital care, could be linked. If they could, this would allow additional research concerning pre-hospital care, such as analysis of intervention for specific anatomic sites of injury. Methods DATA FILESWhen an ambulance is dispatched in response to a call for assistance in the US, this is commonly referred to as an "EMS run". EMS run reports for Utah for 1991-92 were obtained from the Bureau of EMS, Utah Department of Health. All EMS records were complete except for those from several rural counties, comprising 8% of the population. Reports for canceled runs were excluded. Hospital records were obtained and included demographic inf...

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Section: Discussionmentioning

confidence: 99%

Pre-hospital emergency medical services: a population based study of pediatric utilization

et al. 1999

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“…9,11,12 Despite this low utilization rate, children transported by EMS have more complaints related to injury and poisoning 7,13 and have admission rates of up to 26%, approximately three times greater than that for children arriving to the ED by other means. 11 Although previous studies have examined various aspects of EMS use by children, their results have varied and none have simultaneously examined multiple demographic, clinical, and system characteristics within a heterogeneous population of pediatric EMS users. 6−15 Further, previous work on the epidemiology of EMS use by children utilized information from individual hospitals, 10,11 or statewide databases, 8,12 and the results have limited nationwide generalizability.…”

Section: Introductionmentioning

confidence: 99%

The Epidemiology of Emergency Medical Services Use by Children: An Analysis of the National Hospital Ambulatory Medical Care Survey

Shah

Cushman

Davis

et al. 2008

Prehospital Emergency Care

176

131

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Objective There is an absence of nationally representative data describing pediatric patients who use emergency medical services (EMS) and the factors associated with EMS use by children. This study characterizes pediatric emergency department (ED) visits for which the patient arrived by EMS and identifies factors associated with those visits using a nationally representative database. Methods A secondary analysis of the ED component of the 1997–2000 National Hospital Ambulatory Medical Care Survey was performed. The dependent variable was the mode of arrival to the ED (EMS vs. not EMS), and independent variables were grouped into four domains: demographic, clinical, system, and service characteristics. Bivariate analyses and multivariate logistic regression analyses were conducted. Results There were 110.9 million ED visits by children aged <19 years between 1997 and 2000. Pediatric patients constituted 27.3% of all ED visits during this time, and 7.9 million (7.1%) of these patients arrived via EMS. Pediatric patients represented 13% of all EMS transports. The annual EMS utilization rate by children was 26 per 1,000, compared with 66 per 1,000 in the adult population (p < 0.001). Sixteen percent of children transported by EMS were admitted to the hospital. Sixty-two percent of pediatric patients arriving at the ED by EMS were transported as a result of injury or poisoning. Characteristics significantly associated with arrival by EMS in the final multivariate model included demographic (age, African American race, urban residence), clinical (need for greater immediacy of care, illnesses associated with certain diagnoses), and service (greater number of diagnostic services) variables. Conclusions Pediatric patients transported by EMS are more likely to have injuries and poisoning, and have higher-acuity illness than those arriving at the ED by other means. The epidemiology of pediatric EMS use may have important operational, training, and public health implications and requires further study.

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“…[7][8][9][10][11][12] The children transported by EMSS had about a three times higher admission rate than the children brought by other vehicles. 11,12 During the three years of the study, the pediatric proportion of the prehospital transports was 6.5% (n = 238,644).…”

Section: Discussionmentioning

confidence: 99%

Prehospital transport of critically ill children via 119 emergency medical service providers: problems and improvement plan

Noh¹

2017

Pediatr Emerg Med J

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Pediatric ambulance utilization in a large American city

Cited by 29 publications

References 0 publications

Pre-hospital emergency medical services: a population based study of pediatric utilization

Pre-hospital emergency medical services: a population based study of pediatric utilization

The Epidemiology of Emergency Medical Services Use by Children: An Analysis of the National Hospital Ambulatory Medical Care Survey

Prehospital transport of critically ill children via 119 emergency medical service providers: problems and improvement plan

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