Pediatric Rural Interfacility Transfers by Emergency Medical Services

Interfacility transports (IFTs) are critical for the care of pediatric patients in the United States (US), particularly in rural areas that may have limited pediatric specialty resources. Given the paucity of data describing rural pediatric IFTs, we aimed to characterize pediatric rural IFTs in the US.

We conducted a retrospective, observational study using the 2023 National Emergency Medical Services Information System dataset. Rural IFTs involving patients aged >1 day to <18 years were included and stratified into the following age groups: infant (1 day to <1 year), toddler (1-2 years), preschooler (3-5 years), young child (6-11 years), and teenager (12 to <18 years). Using descriptive statistics, we analyzed patient demographics, clinical characteristics, emergency medical services (EMS) transport characteristics, medications, procedures, and transport time intervals.

We identified 29,992 rural pediatric IFTs (median age: 8 years [IQR: 2-14 years]; 52.9% male). Teenagers represented the largest age group transferred (38.8%). Respiratory diseases (12.3%) were the most common primary impression overall, whereas psychiatric and behavioral health conditions predominated among teenagers. Ground transport accounted for most IFTs (79.4%), and advanced life support units were the most common transport level of care (62.7%). Infants demonstrated the highest proportion of specialty critical care transports (32.1%) and longer median response and total call intervals across transport modalities compared with older age groups. Younger children more commonly received respiratory-focused medications and procedures, whereas teenagers more frequently received pain management and sedative medications.

Nearly 30,000 pediatric rural IFTs occurred in 2023, with substantial age-related differences in clinical presentations, transport characteristics, and EMS interventions. Infants more frequently required specialty critical care transport and experienced longer transport intervals, whereas psychiatric and behavioral health conditions represented a substantial proportion of adolescent transfers. These findings underscore the importance of pediatric-focused EMS preparedness, transport readiness, and clinical training initiatives to support safe rural pediatric interfacility care.