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Emergency Medical Services and Police Utilization for Pediatric Mental and Behavioral Health Concerns Within a Large
Victoria Hartwell1, Lauren Riney1, Alexandra Cheetham1
1From the Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati.
Insights
The number of pediatric mental or behavioral health (MBH) emergencies transported by emergency medical services (EMS) is increasing. These MBH patients require more emergency department (ED) resources, including restraints and admissions, compared to other pediatric cases.
Area of Science:
- Pediatric Emergency Medicine
- Mental and Behavioral Health
- Healthcare Systems Analysis
Background:
- Pediatric mental or behavioral health (MBH) emergencies present unique challenges to emergency medical services (EMS) and emergency departments (EDs).
- Understanding utilization trends and patient outcomes is crucial for optimizing resource allocation and care delivery.
Purpose of the Study:
- To compare EMS and police transport trends, patient demographics, and ED outcomes for pediatric MBH emergencies versus non-MBH concerns.
- To analyze the increasing burden of MBH emergencies on prehospital and ED systems.
Main Methods:
- Retrospective cohort study of pediatric patients (ages 5-18) transported by EMS and police to a children's hospital system from 2012-2020.
- Data abstracted from electronic health records, identifying MBH emergencies via diagnostic codes and chief complaints.
- Comparison of patient demographics and ED outcomes between MBH and non-MBH emergency groups.
Main Results:
- EMS transports for pediatric MBH emergencies increased by 1.4% annually, comprising 28.4% of total EMS transports.
- MBH patients transported by EMS were more likely to be older, female, White, publicly insured, require restraints, and be admitted.
- MBH emergencies constituted 91.8% of police transports, with these patients more likely to be younger, female, and White.
Conclusions:
- The proportion of pediatric EMS transports for MBH emergencies is rising, and they dominate police transports.
- Pediatric MBH patients require significant ED resources, including restraints and admissions, indicating a unique burden on healthcare systems.
Objective:
This study aimed to compare emergency medical services (EMS) and police utilization trends, epidemiology, and emergency department (ED) outcomes between pediatric patients with mental or behavioral health (MBH) emergencies and those with non-MBH concerns transported to a large children's hospital system.
Methods:
This was a retrospective cohort study of patients aged 5 to 18 years transported via EMS and police to two EDs affiliated with a children's hospital from January 2012 through December 2020. Data were abstracted from electronic hospital records. Encounters for MBH emergencies were identified using diagnostic codes and chief complaints. Trends of EMS and police transports of patients with MBH emergencies were examined. Patient demographics and ED outcomes were compared between children presenting with MBH emergencies and those with non-MBH concerns.
Results:
During the 9-year study period, out of 40,663 transports to the EDs, 36,137 (89%) arrived via EMS, and 4,526 (11%) arrived via police. A total of 10,250 (28.4%) EMS transports were for MBH emergencies. The volume of patients transported by EMS for MBH emergencies increased by 1.4% per year ( P < 0.01) with no significant change in total EMS patient volumes. Patients with MBH emergencies transported by EMS were more likely to be older, female, of White race, and publicly insured; require restraint in the ED; and be admitted ( P < 0.001). Of police transports, 4153 (91.8%) were for MBH emergencies, with no statistical change in the proportion of police transports that were for MBH emergencies. Police-transported MBH patients compared to non-MBH police-transported patients were more likely to be younger, female, and of White race ( P < 0.001); 8.7% required mechanical/physical restraints in ED, 6.7% required pharmacologic restraint medications in ED, and 53% were admitted.
Conclusions:
The proportion of pediatric transports for MBH emergencies by EMS is rising and comprises the majority of police transports. Distinct from non-MBH pediatric patients transported, MBH patients necessitate significant ED resources, including ED-administered restraints and admission, highlighting their unique burden on the prehospital and ED systems.
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