Pre-hospital emergency medical services: a population based study of pediatric utilization

Suruda, Anthony; Vernon, Donald D.; Reading, James C.; Cook, Lawrence J.; Nechodom, P.; Leonard, Daniel; Dean, Jonathan

doi:10.1136/ip.5.4.294

Cited by 23 publications

(20 citation statements)

References 14 publications

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“…look closer at the effect of age, we adjusted for specific insurance types and found that older children without insurance have increased odds of ambulance use, similar to adult studies. One possible explanation for the difference in use by age is the higher incidence of injuries, poisoning and mental health problems in the older age group; all of which are associated with higher rates of ambulance use [15,20,25].…”

Section: Resultsmentioning

confidence: 99%

“…Most pediatric ambulance studies have utilized data from individual hospitals or statewide databases and very few have examined the effect of insurance on ambulance use [13][14][15][16]. Some studies that focus on adults have suggested that those patients without insurance or public insurance view the ambulance as a "taxi service" since they do not see a bill Other studies that focus on adults suggest that the utilization pattern is multifactorial [8,9,[17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The role of health insurance in pediatric ambulance use: are children just small adults?

Bober¹,

Stefanov²,

Paladino³

et al. 2017

Trauma Emerg Care

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Objective: Rapidly rising healthcare costs require a thorough analysis of all the components of care. Multiple studies of adult patients with public insurance or without private insurance have shown that they are more likely than those with private insurance to use the ambulance. Multiple studies of pediatric ambulance use have been limited in generalizability because they rely on individual hospital or single statewide databases and do not specifically look at insurance. The purpose of this study was to describe pediatric ambulance use and its association with specific health insurances using the National Hospital Ambulatory Medical Survey (NHAMCS) database.Methods: NHAMCS data between 2008 to 2010 for all pediatric (age <19 years) visits were analyzed. Multivariate logistic regression was used to model ambulance utilization on insurance status while controlling for variability in demographics and severity levels.Outcomes Measured: A total of 25,215 pediatric ED visits were included representing a national sample of approximately 97,341,191 million ED visits between 2008-2010. Non-insured (9.9%) compared to privately insured (6.6%) children had significantly higher rates of ambulance use. No significant difference in ambulance utilization was noted between those with Medicaid/State Children's Health Insurance Program (SCHIP) (5.8%) versus private (6.6%) insurance. Even after controlling for demographic and severity variables the adjusted odds ratio (1.66, 95% CI 1.30-2.13, p<0.0001) identified those visits without insurance as an independent predictor of ambulance utilization. In addition, older children (12-18 years), those of black race and residing in urban areas or the Northeast also had significantly higher odds of ambulance utilization. Visits by older children, specifically those without insurance, had increased odds of ratio of ambulance utilization (1.83, CI: 1.36-2.45, p<0.0001). Conclusions:Similar to adult patients, non-uninsured versus insured visits by pediatric patients have increased ambulance utilization. Different from the adults, public the type of insurance public versus private did not affect pediatric ambulance use. Health policies that facilitate continuous insurance coverage for children may be one way to maximize resource utilization in regards to ambulance use.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The role of health insurance in pediatric ambulance use: are children just small adults?

Bober¹,

Stefanov²,

Paladino³

et al. 2017

Trauma Emerg Care

View full text Add to dashboard Cite

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“…EMTparamedics generally respond to more calls in a typical week (18.4 calls versus 4.2 calls for EMT-basics) [29], which may further explain the contribution of practice level to the experience of violence among EMTs. Additionally, EMTparamedics treat more severely injured patients [30,31] and have the opportunity to support law enforcement personnel during dangerous deployments such as hostage situations and drug raids [32]. These situations may also increase the likelihood of EMT-paramedics experiencing violence.…”

Section: Discussionmentioning

confidence: 99%

Workplace Violence: A Survey of Nationally Registered Emergency Medical Services Professionals

Oliver

Levine

2015

Epidemiology Research International

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Previous studies on violence against prehospital personnel have mainly reported on "verbal" and "physical" violence. This study explored how provider demographic and work-related characteristics were associated with five different forms of workplace violence (being cursed or threatened; being punched, slapped, or scratched; being spat upon; being stabbed/stabbing attempt; and being shot/shooting attempt). A cohort of nationally registered United States Emergency Medical Services professionals was surveyed to determine the experience of each of these types of patient initiated violence by these providers and their partners. Multivariable logistic regression analyses indicated gender was significantly associated with both being cursed/threatened and being stabbed or experiencing a stabbing attempt (odds ratio (OR) = 0.65, CI = 0.44-0.96; OR = 0.27, CI = 0.09-0.75, resp.). Level of EMT practice was significantly associated with being cursed/threatened, being spat upon, and being punched, slapped, or scratched (OR = 0.17, OR = 0.30, OR = 0.31, resp.). Both community size and experience were significantly associated with all the types of violence investigated. EMS workplace violence research is at its infancy; thus this study adds to a limited but growing body of knowledge.

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“…When children younger than 5 years are cared for in the EMS system, they are less likely to receive appropriate interventions, such as splinting or cervical spine immobilization. 3 According to the 2000 US Census,* 42% of the population lives in nonmetropolitan areas, 25% of which are rural 4 ; 41% of community hospitals are considered rural by the American Hospital Guide. 5 Additionally, certain populations such as Native Americans disproportionately live in rural areas.…”

Section: Introductionmentioning

confidence: 99%

The Role of the Pediatrician in Rural Emergency Medical Services for Children

Krug¹,

Bojko²,

Dolan³

et al. 2012

Pediatrics

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In rural America, pediatricians can play a key role in the development, implementation, and ongoing supervision of emergency medical services for children (EMSC). Pediatricians may represent the only source of pediatric expertise for a large region and are a vital resource for rural physicians (eg, general and family practice, emergency medicine) and other rural health care professionals (physician assistants, nurse practitioners, and emergency medical technicians), providing education about management and prevention of pediatric illness and injury; appropriate equipment for the acutely ill or injured child; and acute, chronic, and rehabilitative care. In addition to providing clinical expertise, the pediatrician may be involved in quality assurance, clinical protocol development, and advocacy, and may serve as a liaison between emergency medical services and other entities working with children (eg, school nurses, child care centers, athletic programs, and programs for children with special health care needs). Pediatrics 2012;130:978-982 INTRODUCTIONTen percent of prehospital emergency responses 1 and 37% of emergency department (ED) visits are for patients 24 years and younger. 2 Children, in general, have been shown to use emergency medical services (EMS) less frequently than adults. When children younger than 5 years are cared for in the EMS system, they are less likely to receive appropriate interventions, such as splinting or cervical spine immobilization. 3 According to the 2000 US Census,* 42% of the population lives in nonmetropolitan areas, 25% of which are rural 4 ; 41% of community hospitals are considered rural by the American Hospital Guide. 5 Additionally, certain populations such as Native Americans disproportionately live in rural areas. Depending on the state, one-fourth to one-third of the population resides in rural or frontier areas 6 ; rural is defined as fewer than 1000 people per square mile, and frontier is defined as 6 to 8 people per square mile. Rural areas vary widely, however, by environment, terrain, resources, and needs. Additionally, rural and frontier areas are common vacation destinations, with Because of occupational and lifestyle exposure to work-and play-related vehicles, hazardous structures, and animals (eg, farm machinery, pickup trucks, all-terrain vehicles, grain silos, and horses) and environmental threats (eg, weather, terrain, and toxins), children in rural areas have unique medical and surgical emergency needs. Children in rural areas have increased risk of disability and death from injury, trauma and medical diseases largely because of long transport times to definitive care. 7 It has also been reported that the quality of care rendered to children in rural EDs is not of a level equal to the quality of care in urban facilities. 8 Additionally, there may be a higher risk of medication errors for children treated in rural EDs. 9,10 Finally, in a survey study, remote and rural EDs were not as well prepared as urban EDs were to care for children. 11 Because def...

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Pre-hospital emergency medical services: a population based study of pediatric utilization

Cited by 23 publications

References 14 publications

The role of health insurance in pediatric ambulance use: are children just small adults?

The role of health insurance in pediatric ambulance use: are children just small adults?

Workplace Violence: A Survey of Nationally Registered Emergency Medical Services Professionals

The Role of the Pediatrician in Rural Emergency Medical Services for Children

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