Does emergency medical services transport for pediatric ingestion decrease time to activated charcoal?

Activated charcoal (AC) is a potentially beneficial intervention for some toxic ingestions. When administered within one hour, it can reduce absorption of toxins by up to 75%. This study evaluated whether pediatric emergency department (ED) patients arriving by ambulance receive AC more quickly than patients arriving by alternative modes of transport.

This was a retrospective review of AC administration in children in a large, urban pediatric ED from January 2000 until January 2006. Patients aged 0-18 years were identified from pharmacy billing codes and the National Capital Poison Center's database. Charts were reviewed for age, gender, triage acuity, disposition, transportation mode, triage time, and time of AC administration; analysis of variance (ANOVA) controlling for these covariates tested the equality of mean time intervals.

Pharmacy billing codes identified 394 cases, and poison center records identified 34 cases. Three hundred fifty-one patients met the inclusion criteria. One hundred thirty-eight (39%) were male; 216 (61%) were female. Two-hundred twenty-one (63%) patients were aged 5 years and under; in this subset, 116 were male and 105 were female. Twenty-one (6%) patients were aged 6-12 years; nine were male and 12 were female. One hundred nine (31%) patients were aged 13-18 years; 13 were male and 96 were female. One hundred eighteen (34%) arrived by emergency medical services (EMS). Time from triage to charcoal administration in patients transported via EMS was a mean of 65 minutes (standard deviation [SD] = 44 minutes). Time for the alternative transport group was a mean of 70 minutes (SD = 40 minutes) (p = 0.59). In the subset of patients triaged as most acute and arriving by EMS, time to charcoal administration was a mean of 42 minutes (SD = 22 minutes); time to AC in the alternative transport group was a mean of 67.8 minutes (SD = 42 minutes) (p = 0.013).

The sickest patients arriving by EMS had a faster time from triage to AC administration. However, when comparing patients of all triage categories, EMS arrival alone did not influence time to AC administration. Furthermore, the interval from triage to charcoal administration was often insufficiently long. This suboptimal timing of charcoal administration demonstrates the need for reevaluation of triage and prehospital practices.