131 - Outcomes of Children After Non-transport by Emergency Medical Services (EMS)

Publication Number: 131.5634

Jessica Williams, Children's National Health System, Silver Spring, MD, United States; Trang Ha, Children's National Health System, Hyattsville, MD, United States; James Chamberlain, Children's National Health System, Washington, DC, United States; Caleb Ward, Children's National Hospital; The George Washington University School of Medicine and Health Sciences, Washington, DC, United States

Background: Children constitute 7% of all Emergency Medical Services (EMS) calls in the U.S., with 30% of pediatric calls resulting in non-transport. Little is known about the clinical outcomes for children who are not transported. European studies suggest that adverse outcomes after pediatric non-transport are rare, but U.S. data is limited to small single center studies with poor follow up.

Objective: To determine the proportion of non-transported children who subsequently reactivate EMS within 3 days and are transported to an emergency department (ED). Our secondary objective was to determine whether patient demographic or clinical characteristics are associated with EMS reactivation and transport.

Design/Methods: This is a retrospective case control study of patients aged 0-17 years captured in the 2018 - 2022 ESO Data Collaborative research dataset. ESO is a national convenience sample of U.S. patients evaluated by EMS. We used descriptive statistics to compare cases (non-transported children with EMS reactivation and transport within 3 days) to controls (those without EMS reactivation or with EMS reactivation and non-transport). To evaluate the association between patient demographic factors and EMS reactivation, we performed logistic regression and adjusted for main categories of chief complaint, characteristics of EMS agency, time of call and completion of vital signs.

Results: There were 1,849,925 pediatric EMS activations, of which 737,337 (~40%) were not transported by EMS. Within 3 days, 7,526 (1%) had EMS reactivation with transport to the ED. EMS reactivation was associated with young age (age 0-11 months and 1-4 years), Black race, male sex, calls originating in areas with a very low child opportunity index (COI), calls during out of office hours, and neurologic chief complaints (Table 1). A sensitivity analysis using a longer 7-day follow up window did not significantly change the results. Of the 913 (12%) of the patients with hospital-linked data, 814 (89%) were discharged from the ED, 74 (8%) were hospitalized, and two (0.2%) died.

Conclusion(s): Non-transport of children by EMS is common, but only 1% of these encounters result in EMS reactivation and transport to the ED. Hospitalization and death were rare after non-transport. EMS reactivation and transport were associated with young age, Black race, very low COI and neurologic complaints. This is the first national study to evaluate repeat calls after pediatric non-transport by EMS. These results will help inform the development of safe non-transport protocols.

Characteristics and Factors Associated with Children Initially Non-transported by Emergency Medical Services who had an EMS Reactivation Resulting in Transport to the Emergency Department within 3 days


Characteristics and Factors Associated with Children Initially Non-transported by Emergency Medical Services who had an EMS Reactivation Resulting in Transport to the Emergency Department within 3 days