Lights and siren in pediatric 911 ambulance transports: are they being misused?
OBJECTIVE
To evaluate the appropriateness of lights and siren (L&S) in the transport of pediatric patients by ambulance/emergency medical vehicle in a region with no specific guidelines regarding L&S use.


METHODS
We reviewed audiotapes of eligible calls made during a 7-month period to a pediatric medical control center (PMCC) at a children's hospital emergency department in an urban, tertiary care. Level trauma center serving the greater Cincinnati area. We obtained the following information: L&S use, time of day, patient age, chief complaint, vital signs, mental status, and physical examination findings. Final disposition was determined from the corresponding ED charts. We also recorded the level of training of the emergency medical services personnel (basic versus paramedic) and any voluntary comments made by the EMS personnel concerning overall patient stability and their comfort with the situation. Patients were categorized as being in stable condition if all vital signs and mental status were normal, significant abnormalities were absent on examination, and EMS personnel stated they were comfortable with the patient's condition. Inappropriate use of L&S was defined as "running hot" (using L&S) with a stable patient.


RESULTS
We reviewed 622 calls; 504 met inclusion criteria. L&S were used in 312 (62%); of these instances, 123 (39.4%) were classified as involving inappropriate use of L&S. Basic units were more likely to use L&S inappropriately with a patient in stable condition than were paramedic units (P < .015). Inappropriate use was not related to patient age or time of day. Patients transported with inappropriate L&S were more likely to be discharged home than were patients whose transports were marked by appropriate L&S use (74% versus 41%, P < .001). Patients with cardiovascular and respiratory chief complaints were more likely to be transported with appropriate L&S than were those with general medical, trauma, or central nervous system chief complaints.


CONCLUSIONS
In our preliminary study, inappropriate use of L&S in the transport of pediatric patients in stable condition is common Definitive studies are needed to evaluate the risks and benefits of using L&S.
Lacher
M E
ME
Department of Pediatrics, University of Cincinnati College of Medicine, Ohio, USA.
Bausher
J C
JC
D000552:Ambulances; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D006300:Health Services Misuse; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010808:Physical Examination; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods*; D014600:Utilization Review