Pediatric Use of Emergency Medical Services: The Role of Chronic Illnesses and Behavioral Health Problems

Abstract

Objective The increasing use of prehospital emergency medical services (EMS) and its contribution to rising emergency department use and healthcare costs point to the need for better understanding factors associated with EMS use to inform preventive interventions. Understanding patient factors associated with pediatric use of EMS will inform pediatric-specific intervention. We examined pediatric patient demographic and health factors associated with one-time and repeat use of EMS. Methods We reviewed data from Baltimore City Fire Department EMS patient records over a 23-month period (2008–10) for patients under 21 years of age (n=24,760). Repeat use was defined as involvement in more than one EMS incident during the observation period. Analyses compared demographics of EMS users to the city population and demographics and health problems of repeat and one-time EMS users. Health comparisons were conducted at the patient and incident levels of analysis. Results Repeat users (n=1,931) accounted for 9.0% of pediatric users and 20.8% of pediatric incidents, and were over-represented among the 18–20 year age group and among females. While trauma accounted for approximately one-quarter of incidents, repeat versus one-time users had a lower proportion of trauma-related incidents (7.2% versus 26.7%) and higher proportion of medical-related incidents (92.6% versus 71.4%), including higher proportions of incidents related to asthma, seizures, and obstetric/gynecologic issues. In patient-level analysis, based on provider or patient reports, greater proportions of repeat compared to one-time users had asthma, behavioral health problems (mental, conduct and substance use problems), seizures and diabetes. Conclusions Chronic somatic conditions and behavioral health problems appear to contribute to a large proportion of the repeat pediatric use of this EMS system. Interventions may be needed to engage repeat users in primary care and behavioral health services, to train EMS providers on the recognition and management of behavioral health emergencies, and to improve family care and self-management of pediatric asthma and other chronic conditions.

Pediatric Secondary Transfer Percentages: A Retrospective Observational Study

“…It is unclear if the incidence of pediatric diabetic issues is low or if these patients were being informally directed towards the pediatric centre. Knowlton et al previously demonstrated that chronic medical conditions, such as diabetes, are linked to increased ambulance usage, but there are no published studies examining whether these patients benefit from specialized care [4].…”

“…A recent study of adolescents visiting EDs in the United States found a sixfold increase in the odds of transfer or admission for those presenting with mental health complaints. Further study may be of benefit since pediatric patients with mental health and substance abuse have a higher proportion of repeat EMS usage [4].…”

Strengthening Behavioral Health Services Through Partnerships and Data Integration

“…The high number of emergency medical service (EMS) calls coupled with subsequent high ED utilization to address patients’ behavioral health concerns have been well documented [ 4 - 7 ]. Regarding pediatric EMS use, chronic somatic conditions and behavioral health problems appear to contribute to a large proportion of the repeat pediatric EMS use [ 8 ].…”

Understanding the burden and mitigating risks in the utilisation of the Emergency Medical Services in the management of community mental health emergencies

“…Given their role as a significant entry point into the broader health services, utilisation of the emergency medical services has been suggested as a potential solution to partly improve access to specialised mental health services (8)(9)(10)(11). There is, however, limited evidence to indicate that this increase in caseload is likely to be considerable, with the potential to significantly impact service delivery, quality of care, and patient safety (8)(9)(10)(11). This is further confounded by concerns that mental health emergencies have not historically constituted what could be considered a "traditional" case type serviced by or exposed to EMS, such as myocardial infarction, stroke, or respiratory emergencies (10).…”

“…Given their role as a significant entry point into the broader health services, utilisation of the emergency medical services has been suggested as a potential solution to partly improve access to specialised mental health services (8)(9)(10)(11). There is, however, limited evidence to indicate that this increase in caseload is likely to be considerable, with the potential to significantly impact service delivery, quality of care, and patient safety (8)(9)(10)(11).…”