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Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study
Jelena Oulasvirta1,2, Heini Harve-Rytsälä3, Mitja Lääperi3
1Division of Anesthesiology; Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, HUS, P.O. Box 340, FI-00029, Helsinki, Finland. jelena.oulasvirta@helsinki.fi.
Insights
Emergency medical services (EMS) encounters with infants are infrequent and often nonurgent. While unfavorable outcomes are rare, young age and prior health issues increase risk, highlighting the need for infant-specific dispatch protocols.
Area of Science:
- Pediatric Emergency Medicine
- Out-of-Hospital Care
- Infant Health Services
Background:
- Emergency medical services (EMS) challenges are pronounced in infants, yet their out-of-hospital care remains understudied.
- Understanding infant EMS encounters is crucial for optimizing pediatric emergency care.
- This study addresses the knowledge gap in infant-specific EMS utilization and outcomes.
Purpose of the Study:
- To characterize emergency medical services (EMS) missions involving infants.
- To evaluate the effectiveness of symptom-based dispatch for nonverbal infants.
- To identify patient and EMS mission factors associated with unfavorable infant outcomes.
Main Methods:
- A 5-year retrospective population-based cohort study of 1712 EMS responses for infants (<1 year) in Helsinki, Finland.
- Analysis included EMS mission characteristics, mortality, pediatric intensive care unit (PICU) admissions, emergency department (ED) presentation, treatments, hospitalization, and surgical procedures.
- Investigated associations between outcomes and patient/mission characteristics, including dispatch codes.
Main Results:
- Infants constituted 0.4% of EMS missions, with dyspnea, falls, and choking as common complaints.
- Only 39.9% of infants were transported by EMS; unfavorable outcomes were rare (1 death during 12-month follow-up).
- PICU admissions were linked to young age, prematurity/neonatal issues, and recent EMS contacts; adult dispatch codes were not optimal for infants.
Conclusions:
- Infants represent a distinct group in pediatric EMS, often presenting with nonurgent issues, suggesting potential unmet family support needs.
- Adult-derived dispatch codes are suboptimal for infants, necessitating specialized protocols.
- Younger infants, those with neonatal health problems, and those with recent EMS contact face higher risks for adverse outcomes.
Background:
The challenges encountered in emergency medical services (EMS) contacts with children are likely most pronounced in infants, but little is known about their out-of-hospital care. Our primary aim was to describe the characteristics of EMS contacts with infants. The secondary aims were to examine the symptom-based dispatch system for nonverbal infants, and to observe the association of unfavorable patient outcomes with patient and EMS mission characteristics.
Methods:
In a population-based 5-year retrospective cohort of all 1712 EMS responses for infants (age < 1 year) in Helsinki, Finland (population 643,000, < 1-year old population 6548), we studied 1) the characteristics of EMS missions with infants; 2) mortality within 12 months; 3) pediatric intensive care unit (PICU) admissions; 4) medical state of the infant upon presentation to the emergency department (ED); 5) any medication or respiratory support given at the ED; 6) hospitalization; and 7) surgical procedures during the same hospital visit.
Results:
1712 infants with a median age of 6.7 months were encountered, comprising 0.4% of all EMS missions. The most common complaints were dyspnea, low-energy falls, and choking. Two infants died on-scene. The EMS transported 683 (39.9%) infants. One (0.1%) infant died during the 12-month follow-up period. Ninety-one infants had abnormal clinical examination upon arrival at the ED. PICU admissions (n = 28) were associated with young age (P < 0.01), a history of prematurity or problems in the neonatal period (P = 0.01), and previous EMS contacts within 72 h (P = 0.04). The adult-derived dispatch codes did not associate with the final diagnoses of the infants.
Conclusions:
Infants form a small but distinct group in pediatric EMS care, with specific characteristics differing from the overall pediatric population. Many EMS contacts with infants were nonurgent or medically unjustified, possibly reflecting an unmet need for other family services. The use of adult-derived symptom codes for dispatching is not optimal for infants. Unfavorable patient outcomes were rare. Risk factors for such outcomes include quickly renewed contacts, young age and health problems in the neonatal period.
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