Should Pediatric Emergency Care Be Decentralized ?: An Out‐of‐hospital Destination Model for Critically III Children

Abstract

Abstract. Objectives:A time-to-initial-stabilization model for out-of-hospital destinations of critically ill children (CICs) was developed. Application of this model to assess the impact of changes in different parameters of an emergency medical services for children (EMSC) system is described. Methods: A computer model created a 2,500-square-mile community containing ten community hospitals (CHs) and one pediatric critical care center (PCC). Community hospitals capable of providing initial immediate stabilization of CICs were defined as emergency departments accepting pediatrics (EDAPs). Critically ill children were randomly selected in proportion to population densities across the modeled community. Time to initial stabilization (TIS) was defined as the time to arrival at either an EDAP or a PCC or time to arrival at a non-EDAP CH ϩ travel time for a team from the PCC to the non-EDAP CH ϩ preparation/ dispatch (P/D) time. The following parameters of the model were varied and their effect on TIS was evaluated: location of CHs, location of PCC, primary destinations for CICs, percent of CHs meeting EDAP standards, out-of-hospital compliance with designated hospitals for CICs, P/D time, and ambulance speed. Results: The computer model selected 1,000 CICs in accordance with the population densities of the community. The scenario with the shortest TIS was one in which every CH achieved EDAP designation (9.8 Ϯ 0.5 minutes). The scenario with the longest TIS involved a model in which every CIC was transported directly to the PCC (28.6 Ϯ 0.33 minutes). The number of EDAPs in a community and out-of-hospital compliance with use of EDAPs produced comparable effects on the TIS. Travel speeds had a direct effect on TIS but also exaggerated inefficiencies between scenarios. The P/D time had little effect on the TIS. Conclusions: An out-of-hospital destination model has been developed with the ability to modify multiple EMSC system variables. Application of this model demonstrates the shortest times to stabilization of critically ill children occur in systems that maximize the number of hospitals that meet EDAP standards and decentralize pediatric emergency care.

Should Pediatric Emergency Physicians Be Decentralized in the Medical Community?

“…8 The distributive model in this hypothetical study also takes greater advantage of all the pediatric resources in a community. In essence, the greater the geographic access to a site with a PEP's influence, the greater the impact of the PEP to all patients in the community.…”

“…8 The community model is presented in Figure 1. The population density of this community roughly approximates the number of children 5 years or younger per square mile in a moderately populated state such as Maryland.…”

Geographical Maldistribution of Pediatric Medical Resources in Seattle-King County

“…Regionalization of usual care, however, may be a vulnerability for disaster medical response. 15 Resources, like mechanical ventilators, at tertiary centers could quickly become depleted in the setting of need for mass critical care, such as a severe influenza pandemic. 16 Shortages of specialized resources, including critical care supplies, equipment, and personnel likely would become limiting in terms of providing critical care.…”

Improving emergency care for children: A model of collaboration between emergency departments

“…The ability to provide high quality care to seriously ill and injured children in a timely fashion is directly affected by the transport time to an appropriate centre. With the expansion of cities, transport to a dedicated paediatric facility is, in most instances, not time efficient 3 . This makes it imperative that a high standard of paediatric care is available at general EDs.…”

“…With the expansion of cities, transport to a dedicated paediatric facility is, in most instances, not time efficient. 3 This makes it imperative that a high standard of paediatric care is available at general EDs.…”