Route less travelled? Ambulance use for children with high‐acuity acute illness

Hopgood, Timothy; Shepherd, Michael

doi:10.1111/jpc.12465

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…Based on limited previously published data, the rates of pediatric ED admission by ambulance worldwide were 14% for all children and 5.3% for those under 15 years of age 9 . These rates vary based on geographical characteristics: 5.2%, 7%, and 13% in South Korea, New York, and Canada, respectively 10–12 . The rate of patients brought to the ED by ambulance in this study was 0.55%, and it was quite low when compared to the literature.…”

Section: Discussioncontrasting

confidence: 49%

“…9 These rates vary based on geographical characteristics: 5.2%, 7%, and 13% in South Korea, New York, and Canada, respectively. [10][11][12] The rate of patients brought to the ED by ambulance in this study was 0.55%, and it was quite low when compared to the literature. One explanation for this difference may be that Turkish parents or caregivers may prefer to come with their own cars or by commercial taxi, believing that the ambulance would be delayed.…”

Section: Discussionmentioning

confidence: 64%

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The first national data of Turkish pre-hospital emergency care for children: Epidemiology, clinical characteristics, and outcomes

Turan

Saz

Anıl

et al. 2019

Hong Kong Journal of Emergency Medicine

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Background and Objectives: The emergency medical service system is designed to ensure rapid identification and transport of patients from the field to emergency departments. This study aims to examine pediatric patients’ clinical characteristics and reasons for ambulance use in Turkey. Life-saving interventions and non-life-saving interventions performed during transport and patients’ outcomes following transport were also investigated. Methods: This is a prospective-multicentric study conducted at four metropolitan cities and nine tertiary pediatric emergency departments. This survey-based study evaluated all children brought by ambulance to emergency departments. Patient demographics, clinical features, triage levels, procedures performed in the ambulance or emergency department, and final outcomes were sought. Results: A total of 2094 patients were transported during the study period. Only a minority of ambulances were physician staffed (16.5%), and 72% of the patients were delivered to pediatric emergency departments without notification calls. Although notification calls were more likely given for particularly critically ill children, for non-urgent conditions transfer calls were less common (60.8% vs 23.5%, respectively; p < 0.001). A majority of transports were performed for trauma patients (20.5%), neurological issues (20%), and toxicological emergencies (13.8%). While parents prefer using the ambulances for medical emergencies, physicians prefer it for mainly traumatic and toxicological emergencies. In total, 65% of the patients received at least one intervention, and 18 patients needed immediate life-saving interventions (intubation, cardiopulmonary resuscitation, etc.) but they did not receive it. Mortality occurred in nine patients. If the health care providers were paramedics, they were more likely avoided by performing any intervention in critically ill children ( p < 0.001). A majority of the procedures performed in children were older than 12 months ( p < 0.001). Conclusion: This study presents comprehensive epidemiological and outcome data for pediatric patients transported by the national emergency medical service system in Turkey. Non-urgent calls were more likely made by parents, physicians avoided making NCs, and paramedics also avoided performing any intervention when they were transporting children.

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 64%

The first national data of Turkish pre-hospital emergency care for children: Epidemiology, clinical characteristics, and outcomes

Turan

Saz

Anıl

et al. 2019

Hong Kong Journal of Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…Moderately to severely injured children have been shown to benefit from ambulance transport,10 but there are no evidence-based guidelines to direct non-transport decision-making in out-of-hospital medical emergencies. Accordingly, paediatric transport decisions are suboptimal; ambulances are possibly being used as a taxi service for non-critical or non-medical transport,11 whereas critically ill children often arrive to the ED by means other than ambulance 12 13…”

Section: Introductionmentioning

confidence: 99%

Outcomes in children evaluated but not transported by ambulance personnel: retrospective cohort study

Oulasvirta

Salmi

Kuisma

et al. 2019

bmjpo

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BackgroundNot all children with an out-of-hospital emergency medical contact are transported by ambulance to the emergency department (ED). Non-transport means that after on-scene evaluation and possible treatment, ambulance personnel may advise the patient to monitor the situation at home or may refer the patient to seek medical attention by other means of transport. As selecting the right patients for ambulance transport is critical for optimising patient safety and resource use, we studied outcomes in non-transported children to identify possible risk groups that could benefit from ambulance transport.MethodsIn a population-based retrospective cohort study of all children aged 0–15 years encountered but not transported by ambulance in Helsinki, Finland, between 1 January 2014 and 31 December 2016, we evaluated (1) 12-month mortality, (2) intensive care admissions, (3) unscheduled ED contacts within the following 96 hours after the non-transport decision and (4) the clinical status of the child on presentation to ED in the case of a secondary ED visit.ResultsOf all children encountered by out-of-hospital emergency medical services, 3579/7765 (46%) were not transported to ED by ambulance. There was no mortality or intensive care admissions related to the non-transport. The risk factors for an unscheduled secondary ED visit after a non-transport decision were young age (p=0.001), non-transport decision during the early morning hours (p<0.001) and certain dispatch codes, including ‘dyspnoea’ (p<0.001), ‘vomiting/diarrhoea’ (p=0.030) and ‘mental illness’ (p=0.019). We did not detect deterioration in patients’ clinical presentation at ED traceable to non-transport decisions.ConclusionsNot transporting all children by ambulance after an out-of-hospital emergency medical contact was not associated with deaths, intensive care admissions or significant deterioration in general condition in our study population and healthcare system. Special attention and a formal non-transport protocol are warranted in certain subgroups, including infants.

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Mode of Transport and Trauma Activation Status in Admitted Pediatric Trauma Patients

Rubens

Ahmed

Yenokyan

et al. 2020

Journal of Surgical Research

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Route less travelled? Ambulance use for children with high‐acuity acute illness

Cited by 4 publications

References 11 publications

The first national data of Turkish pre-hospital emergency care for children: Epidemiology, clinical characteristics, and outcomes

The first national data of Turkish pre-hospital emergency care for children: Epidemiology, clinical characteristics, and outcomes

Outcomes in children evaluated but not transported by ambulance personnel: retrospective cohort study

Mode of Transport and Trauma Activation Status in Admitted Pediatric Trauma Patients

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