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Factors associated with destination of pediatric EMS transports
Kyle A Schmucker1, Elizabeth A Camp2, Jennifer L Jones2
1University of Pittsburgh Medical Center, Department of Pediatrics, Section of Emergency Medicine, Pittsburgh, PA, USA.
Insights
Pediatric emergency medical services (EMS) transports to children's hospitals are influenced by patient age, transport protocols, and paramedic decisions. Socioeconomic factors and emergency department proximity also play a role.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Public Health
Background:
- Pediatric patients represent a significant portion of emergency medical services (EMS) transports, with most directed to general emergency departments (EDs).
- Current EMS transport destination policies may not adequately guide optimal patient routing to specialized children's hospitals for medical complaints.
- Factors influencing EMS providers' decisions regarding pediatric transport destinations remain largely uncharacterized.
Purpose of the Study:
- To evaluate the key factors associated with the destination choices for pediatric emergency medical services transports involving medical complaints.
- To identify variables that predict transport to a children's hospital versus a general emergency department.
Main Methods:
- A cross-sectional study analyzed 10,065 pediatric transports (ages 0-17) over 12 months in a large, urban EMS system.
- Data included demographics, medical presentation, management, comorbidities, and reasons for destination choice, extracted from the EMS database.
- Logistic regression analyses determined associations between independent variables and transport destination (children's hospital vs. general ED).
Main Results:
- Of 6982 medical complaint transports, 50.4% went to a children's hospital ED.
- Factors favoring children's hospital transport included advanced life support (ALS), longer transport distance, protocol-driven decisions, developmental delay, and altered consciousness.
- Factors favoring general EDs included older age, unknown insurance, lower income, proximity to facilities, diversion status, abnormal vital signs, psychiatric impressions, and communication barriers.
Conclusions:
- Pediatric patient age, EMS protocols, and paramedic scene assessment significantly influence transport destination for both children's and community hospitals.
- Socioeconomic status, ED proximity, diversion status, patient condition (respiratory rate, chief complaint), and communication challenges are also critical factors.
- Further research is necessary to confirm the generalizability of these findings across diverse EMS systems.
Objective:
Pediatric patients comprise 13% of emergency medical services (EMS) transports, and most are transported to general emergency departments (ED). EMS transport destination policies may guide when to transport patients to a children's hospital, especially for medical complaints. Factors that influence EMS providers 'decisions about where to transport children are unknown. Our objective was to evaluate the factors associated with pediatric EMS transports to children's hospitals for medical complaints.
Methods:
We performed a cross-sectional study of a large, urban EMS system over a 12-month period for all transports of patients 0-17 years old. We electronically queried the EMS database for demographic data, medical presentation and management, comorbidities, and documented reasons for choosing destination. Distances to the destination hospital and nearest children's and community hospital (if not the transport destination) were calculated. Univariate and multiple logistic regression analyses were conducted to determine the association between independent variables and the transport destination.
Results:
We identified 10,065 patients, of which 6982 (69%) were for medical complaints. Of these medical complaints, 3518 (50.4%) were transported to a children's hospital ED. Factors associated with transport to a children's hospital include ALS transport, greater transport distance, protocol determination, developmental delay, or altered consciousness. Factors associated with transport to general EDs were older age, unknown insurance status, lower income, greater distance to children's or community hospital, destination determined by closest facility or diversion, abnormal respiratory rate or blood glucose, psychiatric primary impression, or communication barriers present.
Conclusions:
We found that younger patient age, EMS protocol requirements, and paramedic scene response may influence pediatric patient transport to both children's and community hospitals. Socioeconomic factors, ED proximity, diversion status, respiratory rate, chief complaints, and communication barriers may also be contributing factors. Further studies are needed to determine the generalizability of these findings to other EMS systems.
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