Use of Emergency Medical Services for Children With Medical Complexity

Area of Science:

• Pediatric Emergency Medicine
• Prehospital Care
• Healthcare Systems Research

Background:

• Children with medical complexity (CMC) are a significant population within emergency medical services (EMS).
• Existing EMS guidelines highlight the priority of caring for CMC in prehospital settings.
• Understanding EMS utilization and outcomes for CMC is crucial for improving pediatric healthcare.

Purpose of the Study:

• To examine the utilization patterns, care provided, and outcomes for children with medical complexity during prehospital transports.
• To identify factors associated with prehospital cardiac arrest and in-hospital mortality in CMC.
• To inform strategies for enhancing the safety and effectiveness of prehospital care for CMC.

Main Methods:

• A multi-center study involving multiple EMS agencies and 17 hospitals within an integrated health system.
• Identification of CMC using encounter-level diagnosis and procedure codes.
• Analysis of prehospital characteristics, cardiac arrest events, and in-hospital mortality.

Main Results:

• Children with medical complexity constituted 19.9% of pediatric EMS encounters.
• Prehospital cardiac arrest occurred in 1.0% of CMC cases, with higher odds associated with cardiovascular, neuromuscular, and neonatal conditions.
• In-hospital mortality was 0.7%, with CMC having 9.55 times higher odds of mortality.

Conclusions:

• CMC represent a substantial portion of pediatric EMS transports, highlighting their vulnerability.
• Findings underscore the need for specialized EMS training and protocols for CMC.
• Integrated prehospital-hospital data systems are essential for improving CMC outcomes.