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How well do General EMS 911 dispatch protocols predict ED resource utilization for pediatric patients?

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Area of Science:

  • Emergency Medicine
  • Pediatrics
  • Health Services Research

Background:

  • Emergency Medical Services (EMS) are frequently used for pediatric patients with low-acuity conditions.
  • Existing EMS dispatch protocols, effective for adults, have limited data supporting their use in children.
  • There's a need to evaluate the accuracy of EMS protocols in identifying pediatric acuity and resource requirements.

Purpose of the Study:

  • To assess pediatric emergency department (PED) resource utilization for children initially categorized as "low-acuity" by EMS dispatch protocols.
  • To determine the effectiveness of current EMS protocols in predicting the actual healthcare needs of pediatric patients.

Main Methods:

  • A retrospective review of pediatric patients classified as "low-acuity" by EMS and transported to a PED during 2010.
  • Data collected included chief complaint, PED visit details, and resource utilization (medications, labs, procedures, admission, transfer).
  • Patients were analyzed based on chief complaint groups to identify variations in resource utilization and "under-triage" (low-acuity transport requiring emergent intervention).

Main Results:

  • Out of 801 included pediatric patients, 409 (51%) required resource utilization in the PED.
  • The majority (737/801) were discharged home, but 64/801 were admitted.
  • A low under-triage rate of 0.12% was observed, with only one patient requiring emergent intervention.

Conclusions:

  • The studied EMS dispatch protocols demonstrated limitations in accurately predicting overall pediatric resource utilization.
  • Despite limitations, the protocols safely identified the majority of low-acuity pediatric patients with a low risk of under-triage.
  • Findings suggest potential for refining EMS protocols or implementing secondary triage systems to better manage pediatric transports and resource allocation.