Related Experiment Video
Updated: Mar 25, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Use of Emergency Medical Services for Children With Medical Complexity
Sriram Ramgopal1,2, Carolyn Foster2,3, Michelle L Macy1,2
1Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Insights
Children with medical complexity (CMC) represent nearly 20% of pediatric emergency medical services (EMS) encounters. These children face higher risks, including cardiac arrest and in-hospital mortality, necessitating improved prehospital care.
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.
Objective:
The care of children with medical complexity (CMC) in the prehospital setting is recognized as a priority in consensus-based Emergency Medical Services (EMS) guidelines. We examined EMS use, care patterns, and outcomes for CMC, including cardiac arrest and mortality.
Methods:
We performed a multi-EMS agency and multicenter study of pediatric transports, from the scene to the hospital, to 1 of 17 hospitals within an integrated health system. We identified CMC based on encounter-level diagnosis and procedure codes. We described prehospital characteristics and identified which factors were associated with prehospital cardiac arrest and which factors were associated with in-hospital mortality.
Results:
Of 68 890 pediatric encounters, 13 732 (19.9%) involved CMC, most commonly owing to neuromuscular conditions (29.7%). Among EMS encounters for CMC, 33.0% resulted in hospital admission, and 7.2% required critical care. Prehospital cardiac arrest occurred in 1.0% of cases, and in-hospital mortality was 0.7%. Among CMC, the presence of prehospital cardiac arrest was associated with cardiovascular (odds ratio [OR] 3.10, 95% CI: 2.08-4.62), neuromuscular (OR 2.71, 95% CI: 1.82-4.03), and neonatal (OR 2.71, 95% CI: 1.65-4.44) conditions. The presence of medical complexity was associated with a 9.55-times higher odds of in-hospital mortality (95% CI: 6.01-15.18).
Conclusions:
CMC account for one-fifth of EMS of pediatric encounters transported to the hospital. Our findings support targeted EMS training, technology-specific protocols, and integrated prehospital-hospital data systems to improve the safety and outcomes of CMC.
More Related Videos
07:20Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
09:57Author Spotlight: Advancing Pediatric Epilepsy Surgery in Children Through Novel Biomarkers and Enhanced Localization
Published on: September 20, 2024
Related Concept Videos
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:30Specialized Care Centers and Settings-I
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...
01:11Secondary Healthcare System
01:22Standards of Care I
01:30Methods of Documentation VII: EMR
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion