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Pre-hospital emergency medical services: a population based study of pediatric utilization
A Suruda1, D D Vernon, J Reading
1Intermountain Injury Control Research Center, University of Utah, Salt Lake City 84112-0512, USA. asuruda@dfpm.utah.edu
Insights
Emergency medical services (EMS) are primarily used for pediatric trauma. Children under 5 receive fewer EMS interventions, and immobilization techniques are less frequent for this age group, potentially impacting outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Trauma Care
Background:
- Emergency Medical Services (EMS) are critical for pediatric trauma response.
- Understanding patterns of EMS usage in children is essential for optimizing care.
- Previous research has not fully detailed EMS utilization specifically for pediatric trauma in all regions.
Purpose of the Study:
- To investigate the utilization of EMS by children within a specific state.
- To analyze the types of interventions provided by EMS for pediatric trauma patients.
- To identify age-related differences in EMS response and treatment for children.
Main Methods:
- Retrospective analysis of EMS 'runs' in Utah from 1991-1992.
- Linking EMS records with hospital data for comprehensive patient information.
- Assigning Abbreviated Injury Severity Scores (AISs) using ICDMAP-90 software to quantify injury severity.
Main Results:
- An average of at least 15 EMS runs per 100 children annually, with noted underreporting from rural areas.
- EMS response and scene times were consistent across age groups, but interventions were less common for children under 5.
- Cervical immobilization was less frequent (54%) in younger children (<5 years) compared to older children (76%) for head/neck/face injuries, and associated with lower hospital charges, suggesting improved outcomes.
Conclusions:
- Pediatric EMS usage is predominantly for trauma-related incidents.
- Younger children (<5 years) experience fewer EMS interventions compared to older children.
- The reasons for reduced interventions in younger children, such as equipment size or other factors, require further investigation.
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 differences 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.