National Characteristics of Non-Transported Children by Emergency Medical Services in the United States. (21st June 2022)

• Record Type: Journal Article
• Authors: Ward, Caleb; Zhang, Anqing; Brown, Kathleen; Simpson, Joelle; Chamberlain, James
• Is Part Of: Prehospital emergency care. Volume 26:Number 4(2022)
• Page Start: 537
• Page End: 546
• Publication Date: 2022-06-21
• Subjects: Emergency Medical Services (EMS) -- triage -- pediatric transport; 362.18
• DOI: 10.1080/10903127.2021.1985666
• Languages: English
• ISSNs: 1090-3127

Abstract

Abstract: Study Objective: Most 911 calls result in ambulance transport to an emergency department. In some cases, transport is refused or deemed unnecessary. The frequency of pediatric non-transport is unknown. Our primary objective was to describe the proportion of pediatric EMS activations resulting in non-transport. Our secondary objective was to identify patient, community, and EMS agency factors associated with pediatric non-transport. Methods: We conducted a cross-sectional study using 2019 data from the National EMS Information System registry. We compared non-transport rates for children (<18 y/o), adults (18 − 60 y/o) and elderly (>60 y/o) patients. We then used generalized estimating equations to identify factors associated with pediatric non-transport while accounting for geographical clustering. Results: There were 21, 931, 490 EMS activations, including 1, 403, 454 pediatric 911 responses. 30% of pediatric 911 responses resulted in non-transport. Non-transport was less likely for adults (19%, OR 0.54 [0.54, 0.55]) and elderly patients (13%, OR 0.35 [0.35, 0.36]). The most common pediatric non-transport dispositions were: refused evaluation/care, and treated/released. Non-transport was associated with: pulmonary (aOR 3.84 [3.30, 4.48]) and musculoskeletal chief complaints (aOR 3.75 [3.22, 4.36]). Non-transport was more likely for: rural EMS calls (aOR 1.28 [1.24, 1.32]); calls classified by EMS as Lower Acuity (aOR 7.88 [5.98, 10.38]); and Tribal EMS agencies (aOR 3.49 [3.09, 3.94]). Conclusion: Almost one-third of pediatric 911 activations result in non-transport. Although very few children have been included in pilots of alternate transport processes to date, non-transport is actually more common in children than adults. More work is needed to understand better the patient safety and economic implications of this practice.