National Characteristics of Non-Transported Children by Emergency Medical Services in the United States

摘要

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 (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.