Paramedic initiated non-transport of pediatric patients

Prehosp Emerg Care. 2006 Apr-Jun;10(2):213-9. doi: 10.1080/10903120500541308.

Abstract

Introduction: In a time of emergency department overcrowding and increased utilization of emergency medical services, a highly functional prehospital system will balance the needs of the individual patient with the global needs of the community. Our community addressed these issues through the development of a multitiered prehospital care system that incorporated EMS initiated non-transport of pediatric patients.

Objective: To describe the outcome of pediatric patients accessing a progressive prehospital system that employed EMS initiated non-transport.

Methods: A prospective observational case series was performed on pediatric patients (< 21 years old) designated EMS initiated non-transport. Patients were designated non-transport after an initial EMS protocol driven, complaint-specific clinical assessment in conjunction with medical oversight affirmation. Telephone follow-up was completed on all consecutively enrolled non-transport patients to collect information about outcome (safety) as well as overall satisfaction with the system. A five-point Likert scale was utilized to rate satisfaction.

Results: There were 5,336 EMS requests during the study period. Seven hundred and four were designated non-transport, of which 74.8% completed phone follow-up. Categories of EMS request included minor; medical illness 43.4%, trauma 55.9%, and other 1.1%. There were 13 admissions (2.4%) to the hospital after EMS initiated non-transport designation. Admissions after non-transport had trends toward younger age (p = 0.002) and medical etiology (p = 0.006). There were no PICU admissions or deaths.

Conclusion: Our EMS system provides an alternative to traditional protocols, allowing EMS initiated non-transport of pediatric patients, resulting in effective resource utilization with a high level of patient safety and family satisfaction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Emergency Medical Technicians*
  • Female
  • Humans
  • Infant
  • Male
  • Ohio
  • Outcome Assessment, Health Care
  • Pediatrics*
  • Prospective Studies
  • Safety
  • Surveys and Questionnaires
  • Transportation of Patients / statistics & numerical data*