Safety of a prehospital emergency medical services protocol for an alternative destination for pediatric behavioral emergencies in Alameda County

Glomb, Nicolaus W; Trivedi, Tarak; Grupp‐Phelan, Jacqueline; Schriger, David L.; Sporer, Karl A.

doi:10.1002/emp2.12930

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…The substantial transport rate in conjunction with the low frequency of interventions in this particular patient subgroup lends itself to exploration of protocols that allow for transport to non-ED/alternative destinations, a model that has been tested with some success in Alameda County, California (USA). 27 …”

Section: Discussionmentioning

confidence: 99%

EMS Responses for Pediatric Behavioral Health Emergencies in the United States: A 4-Year Descriptive Evaluation

Boland,

Anderson,

Powell

et al. 2023

Prehosp. Disaster med.

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Background:The occurrence of behavioral health emergencies (BHEs) in children is increasing in the United States, with patient presentations to Emergency Medical Services (EMS) behaving similarly. However, detailed evaluations of EMS encounters for pediatric BHEs at the national level have not been reported.Methods:This was a secondary analysis of a national convenience sample of EMS electronic patient care records (ePCRs) collected from January 1, 2018 through December 31, 2021. Inclusion criteria were all EMS activations documented as 9-1-1 responses involving patients < 18 years of age with a primary or secondary provider impression of a BHE. Patient demographics, incident characteristics, and clinical variables including administration of sedation medications, use of physical restraint, and transport status were examined overall and by calendar year.Results:A total of 1,079,406 pediatric EMS encounters were present in the dataset, of which 102,014 (9.5%) had behavioral health provider impressions. Just over one-half of BHEs occurred in females (56.2%), and 68.1% occurred in patients aged 14-17 years. Telecommunicators managing the 9-1-1 calls for these events reported non-BHE patient complaints in 34.7%. Patients were transported by EMS 68.9% of the time, while treatment and/or transport by EMS was refused in 12.5%. Prehospital clinicians administered sedation medications in 1.9% of encounters and applied physical restraints in 1.7%. Naloxone was administered for overdose rescue in 1.5% of encounters.Conclusion:Approximately one in ten pediatric EMS encounters occurring in the United States involve a BHE, and the majority of pediatric BHEs attended by EMS result in transport of the child. Use of sedation medications and physical restraints by prehospital clinicians in these events is rare. National EMS data from a variety of sources should continue to be examined to monitor trends in EMS encounters for BHEs in children.

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Section: Discussionmentioning

confidence: 99%

EMS Responses for Pediatric Behavioral Health Emergencies in the United States: A 4-Year Descriptive Evaluation

Boland,

Anderson,

Powell

et al. 2023

Prehosp. Disaster med.

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“…To identify MBH emergency encounters for the current study, we employed a previously published strategy that also used the current data set. 8 First, we excluded encounters for pediatric patients ≥18 years of age at time of encounter, Next, we identified encounters as a MBH emergency if the immediate transport destination was the local pediatric psychiatric facility. We then identified encounters containing Medical Priority Dispatch System codes “25A” or “5150” and labeled them as MBH emergencies.…”

Section: Methodsmentioning

confidence: 99%

Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting

Foster,

Watkins,

Trivedi

et al. 2023

JACEP Open

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ObjectiveEmergency medical services (EMS) transport for mental and behavioral health (MBH) emergencies occurs frequently in children, yet little is understood regarding prehospital physical restraint use despite the potential for serious adverse events. We aim to describe restraint use prevalence and primary impressions among children with MBH emergencies.MethodsThis is a retrospective cross‐sectional study of children with MBH emergencies evaluated by Alameda County (ALCO), California EMS from January 1, 2012 to December 31, 2018. Patient demographics and clinical variables were collected from the EMS records including sex, age at time of encounter, year of encounter, transport destination, medication use, and primary impression(s). The primary outcome was the use of physical restraints. Descriptive statistics were used to characterize the primary outcome and associated demographic and diagnostic features, as well as temporal use patterns. Sex and age were compared between restrained and non‐restrained youth using chi‐square analysis.ResultsOver the 7‐year study period, ALCO EMS transported 9775 children with MBH emergencies. Of these transports, 1205 (12.3%) were physically restrained. Most children restrained had the primary impression of “behavioral/psychiatric crisis” (51.1%), “psychiatric crisis” (27.4%), and “behavioral–other” (12.4%) and the remaining children (9.1%) had a non‐psychiatric/behavioral health primary impression. Over time, there was no statistically significant change in either number of children with MBH emergencies transported or physical restraint rate.ConclusionsMore than 1 in 8 children with MBH emergencies are being physically restrained during EMS transport. Restraint rate did not substantially change over time. Further studies to understand existing restraint rates and EMS resources available to address acute agitation in children are needed to inform quality and care enhancing initiatives.

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Pediatric mental health emergency department visits from 2017 to 2022: A multicenter study

Hoffmann,

Carter,

Olsen

et al. 2024

Academic Emergency Medicine

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BackgroundThe COVID‐19 pandemic adversely affected children's mental health (MH) and changed patterns of MH emergency department (ED) utilization. Our objective was to assess how pediatric MH ED visits during the COVID‐19 pandemic differed from expected prepandemic trends.MethodsWe retrospectively studied MH ED visits by children 5 to <18 years old at nine U.S. hospitals participating in the Pediatric Emergency Care Applied Research Network Registry from 2017 to 2022. We described visit length by time period: prepandemic (January 2017–February 2020), early pandemic (March 2020–December 2020), midpandemic (2021), and late pandemic (2022). We estimated expected visit rates from prepandemic data using multivariable Poisson regression models. We calculated rate ratios (RRs) of observed to expected visits per 30 days during each pandemic time period, overall and by sociodemographic and clinical characteristics.ResultsWe identified 175,979 pediatric MH ED visits. Visit length exceeded 12 h for 7.3% prepandemic, 8.4% early pandemic, 15.0% midpandemic, and 19.2% late pandemic visits. During the early pandemic, observed visits per 30 days decreased relative to expected rates (RR 0.80, 95% confidence interval [CI] 0.78–0.84), were similar to expected rates during the midpandemic (RR 1.01, 95% CI 0.96–1.07), and then decreased below expected rates during the late pandemic (RR 0.92, 95% CI 0.86–0.98). During the late pandemic, visit rates were higher than expected for females (RR 1.10, 95% CI 1.02–1.20) and for bipolar disorders (RR 1.83, 95% CI 1.38–2.75), schizophrenia spectrum disorders (RR 1.55, 95% CI 1.10–2.59), and substance‐related and addictive disorders (RR 1.50, 95% CI 1.18–2.05).ConclusionsDuring the late pandemic, pediatric MH ED visits decreased below expected rates; however, visits by females and for specific conditions remained elevated, indicating a need for increased attention to these groups. Prolonged ED visit lengths may reflect inadequate availability of MH services.

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Safety of a prehospital emergency medical services protocol for an alternative destination for pediatric behavioral emergencies in Alameda County

Cited by 3 publications

References 30 publications

EMS Responses for Pediatric Behavioral Health Emergencies in the United States: A 4-Year Descriptive Evaluation

EMS Responses for Pediatric Behavioral Health Emergencies in the United States: A 4-Year Descriptive Evaluation

Physical restraint use in children with mental and behavioral health emergencies in the prehospital setting

Pediatric mental health emergency department visits from 2017 to 2022: A multicenter study

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