Unnecessary Use of Red Lights and Sirens in Pediatric Transport

Abstract

Introduction Approximately 25.5 million pediatric patients are treated in Emergency Departments around the United States annually. Roughly 7% of these patients are transported by ambulance; of these, about 7% arrive in ambulances running red lights and sirens (RLS). Compared to those transporting without RLS, emergency vehicles employing RLS are involved in more accidents and are associated with more fatalities. Objective To characterize the use of RLS in pediatric transports and identify factors associated with unnecessary use of RLS. Methods As part of the Children’s Safety Initiative (CSI-EMS), a large, multi-phased National Institutes of Health-funded study, we conducted a medical record review of all pediatric RLS transports in an urban EMS system over a 4-year period (2008–2011). A standardized chart abstraction tool was adapted for the out-of-hospital setting and pilot tested. Charts were independently reviewed by physicians and paramedics, with disagreements arbitrated by a pediatric emergency physician. Reviewers were asked to judge whether RLS transport was necessary and to provide comments justifying their position. Descriptive statistics were used to measure the frequency of unnecessary transports and logistic regression analysis was employed to identify factors associated with unnecessary use of RLS. Results Of 490 RLS transports, experts identified 96 (19.6%) as unnecessary use of RLS. Necessary and unnecessary RLS transports had similar patient sex and duration of transport, though unnecessary use of RLS tended to increase with patient age. The call reasons that represented the largest proportion of unnecessary RLS transports were trauma (49.0%), respiratory distress (16.7%), and seizure/altered mental status (11.5%). Compared with necessary RLS transports, unnecessary RLS transports were less likely to require resuscitation, airway management, or medication administration. Univariate analysis revealed that patient vital signs within normal limits were associated with increased risk of unnecessary RLS transport, with the most pronounced effect seen in the normal GCS score group (odds ratio 7.74, p-value 0.001). Conclusions This analysis identified patient and transport characteristics associated with unnecessary use of RLS. Our results could help serve as the basis for designing and prospectively evaluating protocols for use of RLS, potentially mitigating the risk associated with transport in pediatric patients.

Safety events in pediatric out-of-hospital cardiac arrest

“…Overall, the CSI-EMS is a study with several components that have been described elsewhere. 8–14 This portion of the study consisted of a medical records review of lights and sirens (“Code 3”) pediatric transports from an urban county in Oregon. The study was approved by the IRB of Oregon Health & Science University.…”

The performance of the EMS triage (RETTS-p) and the agreement between the field assessment and final hospital diagnosis: a prospective observational study among children < 16 years

“…Paramedics’ ability to predict hospital admission and the aetiology of the condition in adults has been shown to be moderate in several studies [35–37]. In one study, 19% of the paediatric transports with lights and sirens were later identified as unnecessary [38]. In a study of adults from Ireland, advanced paramedics showed agreement in 70% of the cases when the field diagnosis and the ED physicians’ working diagnosis were compared.…”

Emergency Medical Services Clinicians’ Pediatric Destination Decision-Making: A Qualitative Study

“…For pediatrics, the transport destination determined by the EMS clinician is a particularly important aspect of the child's overall emergency care. If a child is transported to a hospital that is not capable of providing definitive care, they must undergo interfacility transport (IFT) to another facility ("secondary transport") which both prolongs care and is associated with patient harms [4][5][6][7][8][9].…”