Usage of emergency medical services by children with special health care needs.
OBJECTIVE
To describe the usage of emergency medical services (EMS) by children with special health care needs (CSHCN).


METHODS
All EMS runs and related hospital records for children aged 0-17 years in Utah in 1991-92 were linked. The CSHCN status was determined from ICD-9 diagnoses using three available definitions. The amounts of EMS usage were compared between CSHCN and other children. A pediatric intensive care practitioner determined CSHCN status by chart review for 915 children transported by EMS to a pediatric tertiary care hospital, and his classification was compared with the CSHCN status assigned by the three ICD-9-based definitions.


RESULTS
The three definitions assigned CSHCN status for 2% to 24% of children using EMS. When compared with other children, CSHCN were more likely to be admitted to the hospital, more likely to use EMS for transfer between health care facilities, and more likely to receive prehospital procedures such as intravenous therapy. In the group of children whose charts were reviewed individually, one ICD-9-based definition most closely agreed to determination of CSHCN status by a pediatric intensive care practitioner.


CONCLUSIONS
Children with special health care needs who use EMS are more likely to receive advanced life support service, to receive prehospital procedures, and to be transferred from one health care facility to another. There is need for a specific and measurable definition of CSHCN that can be applied to existing health data.
Suruda
A
A
Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City 84112, USA. asuruda@dfpm.utah.edu
Vernon
D D
DD
Diller
E
E
Dean
J M
JM
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002658:Developmental Disabilities; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008485:Medical Audit; D008498:Medical Record Linkage; D014589:Utah