Pediatric deaths and emergency medical services (EMS) in urban and rural areas

摘要

A total of 1078 pediatric coroners' cases in 11 rural and urban California counties were reviewed as they relate to emergency medical services (EMS). Pediatric coroners' death rates per 100,000 population varied from an average of 21.7 in the rural region to 30.4 in the urban region. Vehicular accidents caused the majority (66percnt;) of the accidental deaths, and firearms caused 61percnt; of the violent deaths. Violent deaths (homicide and suicide) were significantly more common in the urban region (P0.001), and vehicular deaths (excluding auto versus pedestrian) were more common in the rural region (P0.001).EMS provider usage was greater in the urban areas (84 vs 66percnt;,P.001), as was the number of cases receiving advanced life support (97 vs 66percnt;,P0.001). Urban and rural differences in place of death were significant for two places of deathcolon; street and highway, and inhospital deaths. A significantly greater number of children died on the street/highway in rural areas (P0.05). Hospital deaths were more likely to occur on the ward in the rural region, versus the intensive care unit in the urban region (P0.001). Proposed factors which may explain these findings include differences in medical resources and in local transfer policies.The study demonstrates that EMS providers are involved in the care of children who have had a fatal emergency. Further evaluation of rural and urban differences hi prehospital care of the pediatric patient is indicated.