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

Abstract

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.

Emergency medical services (EMS) versus non-EMS transport among injured children in the United States

“…11 Despite these unique needs, Shah et al found that many high-urgency pediatric patients arrive via non-EMS, lacking the specialized judgment of EMS providers. 12 In comparing non-trauma centers and level I-III trauma centers, one study found that 98% of non-trauma center patients are transferred to a higher level trauma center; this study, however, did not distinguish between pediatric and adult trauma patients. 13 A recent analysis of the NHAMCS has shown that within the past 10 years, there has been no change in the percentage of patients using EMS transportation.…”

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

“…According to this study, injured children represented more than half (54%), and the most frequently transported time and season were 16:00 p.m. to 23:59 p.m. (47.0%), and in summer (June to August, 31%). 12 Although our study used a different age definition for the pediatric patients (less than 16 years old) than that of the American study, the most common Korean children age group was relatively younger (2 to 5 years old, 31.0%), and prehospital transports were most frequently requested at a relatively earlier time (12:00 p.m. to 17:59 p.m., 36.3%). This discrepancy suggests that national epidemiologic data is essential to establish and to develop specific prehospital transport systems in each country.…”

“…[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). Over time, the proportion slowly but steadily increased, from 6.3% (n = 71,287; in 2006), 6.5% (n = 80,607; in 2007), and 6.6% (n = 86,750; in 2008) (Fig.…”

Safety Events in High Risk Prehospital Neonatal Calls

“…16 Younger children transported by EMS are more likely to suffer from life-threatening emergencies compared to older children. 1 Younger patients are also the most dissimilar to adults and, in general, may be the pediatric age group at greatest risk for safety events. A previous hospital-based study found that neonates had high rates of potential adverse drug events compared to both adults and other pediatric age groups.…”

“…Children account for 4 to 22% of all emergency medical services (EMS) transports, [1][2][3] with infants less than one year of age being among the most common. 4 Children transported by ambulance for emergency care are often higher acuity than those who arrive by other means 1 ; yet, EMS providers have limited experience, 5 pediatric-specific training, 6,7 and resources 3,8 to make critical decisions in caring for sick pediatric patients, creating a low-frequency, high-stakes situation at risk for patient safety events.…”