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Outcomes in children evaluated but not transported by ambulance personnel: retrospective cohort study
Jelena Oulasvirta1,2,3, Heli Salmi1,4, Markku Kuisma3
1Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Insights
Ambulance non-transport for children after emergency medical contact did not lead to deaths or intensive care admissions. However, infants and those with specific symptoms like dyspnea require careful consideration for non-transport decisions.
Area of Science:
- Pediatric Emergency Medicine
- Out-of-Hospital Care
- Public Health
Background:
- Not all children with out-of-hospital emergency medical contact are transported by ambulance to the emergency department (ED).
- Non-transport decisions involve on-scene evaluation and potential home monitoring or alternative transport arrangements.
- Optimizing patient safety and resource use necessitates identifying children who benefit from ambulance transport.
Purpose of the Study:
- To evaluate outcomes in children not transported by ambulance after an out-of-hospital emergency medical contact.
- To identify risk groups that might benefit from ambulance transport.
- To assess the safety and efficacy of non-transport decisions in pediatric emergency care.
Main Methods:
- A population-based retrospective cohort study was conducted in Helsinki, Finland (2014-2016).
- The study included children aged 0-15 years encountered by emergency medical services but not transported by ambulance.
- Outcomes evaluated included 12-month mortality, intensive care admissions, unscheduled ED contacts within 96 hours, and clinical status upon secondary ED visit.
Main Results:
- 46% of encountered children (3579/7765) were not transported to the ED.
- No mortality or intensive care admissions were linked to non-transport decisions.
- Risk factors for unscheduled secondary ED visits included young age, early morning non-transport decisions, and specific dispatch codes ('dyspnoea', 'vomiting/diarrhoea', 'mental illness').
- No deterioration in clinical presentation at the ED was attributable to non-transport decisions.
Conclusions:
- Ambulance non-transport for children after out-of-hospital emergency contact was not associated with adverse outcomes like death or intensive care admission.
- Certain subgroups, particularly infants, warrant special attention and formal non-transport protocols.
- The study supports the safety of non-transport decisions in the studied population and healthcare system when applied judiciously.
Background:
Not all children with an out-of-hospital emergency medical contact are transported by ambulance to the emergency department (ED). Non-transport means that after on-scene evaluation and possible treatment, ambulance personnel may advise the patient to monitor the situation at home or may refer the patient to seek medical attention by other means of transport. As selecting the right patients for ambulance transport is critical for optimising patient safety and resource use, we studied outcomes in non-transported children to identify possible risk groups that could benefit from ambulance transport.
Methods:
In a population-based retrospective cohort study of all children aged 0-15 years encountered but not transported by ambulance in Helsinki, Finland, between 1 January 2014 and 31 December 2016, we evaluated (1) 12-month mortality, (2) intensive care admissions, (3) unscheduled ED contacts within the following 96 hours after the non-transport decision and (4) the clinical status of the child on presentation to ED in the case of a secondary ED visit.
Results:
Of all children encountered by out-of-hospital emergency medical services, 3579/7765 (46%) were not transported to ED by ambulance. There was no mortality or intensive care admissions related to the non-transport. The risk factors for an unscheduled secondary ED visit after a non-transport decision were young age (p=0.001), non-transport decision during the early morning hours (p<0.001) and certain dispatch codes, including 'dyspnoea' (p<0.001), 'vomiting/diarrhoea' (p=0.030) and 'mental illness' (p=0.019). We did not detect deterioration in patients' clinical presentation at ED traceable to non-transport decisions.
Conclusions:
Not transporting all children by ambulance after an out-of-hospital emergency medical contact was not associated with deaths, intensive care admissions or significant deterioration in general condition in our study population and healthcare system. Special attention and a formal non-transport protocol are warranted in certain subgroups, including infants.
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