Assessment of pediatric patients by emergency medical technicians-basic.
OBJECTIVE
To determine whether emergency medical technicians-basic can accurately assess children and whether this ability varies with the patient's age or diagnosis. This determination is important for educational program design for emergency medical technicians in pediatrics and for evaluation of the possibility of expanding their scope of practice.


METHODS
Retrospective chart review.


METHODS
Pediatric emergency department in a large, urban hospital.


METHODS
Patients (n = 2430) presenting to the pediatric emergency department via basic life support ambulance during a 12-month period.


METHODS
Data collected were name, age, field assessment (FA), and emergency department (ED) diagnosis. Patient's ages were organized into five groups: infant (0-1 y), toddler (1-3 y), preschool (3-6 y), school-aged (6-11 y), and adolescent (> 11 y), and the ED diagnoses were divided into seven categories. The accuracy of the FA was compared with the ED diagnosis. We then analyzed FA accuracy by patient's age and type of diagnosis. The chi(2) contingency table analysis was used for dichotomous variables (P < 0.05). In addition, logistic regression and stratified analysis were used. Both ambulance and hospital charts were available for 2064 patients. Age ranged from birth to 19 years with a bimodal distribution at the extremes of patient age and a mean age of 8.25 (SD, 5.64). The distribution was 11.7% (241) infants, 14.7% (303) toddlers, 14.9% (307) preschool, 21.2% (437) school-aged, and 37.6% (776) adolescents.


RESULTS
Overall emergency medical technician-basic assessment was accurate 81.5% (1683) of the time. There was a statistically significant variation in accuracy with both age group (chi(2) = 40.07, P < 0.05) and diagnostic category (chi(2) = 185.7, P < 0.05). By age group, the accuracy of field assessment was 69.7% (168) infants, 75.9% (230) toddlers, 82.7% (254) preschool, 86.7% (379) school-aged, and 84.0% (652) adolescents. By category of diagnosis, the accuracy of the field assessment was 92.4% (292) major trauma, 91.4% (478) minor trauma, 88.9% (112) psychologic and social, 85.1% (229) major medical, 81.1% (180) wheezing-associated respiratory illness, 65.4% (350) minor medical, and 57.5% (42) non-wheezing-associated respiratory illness.


CONCLUSIONS
Emergency medical technicians-basic were highly successful in assessing children with wheezing, serious illness, injuries, and psychologic and social conditions. Consideration should be given to expanding their scope of practice in these areas. They were less successful in assessing minor medical conditions and respiratory emergencies other than wheezing. They require additional training in these areas.
Foltin
George
G
Department of Pediatrics, Bellevue Hospital Center, New York University School of Medicine, New York, New York 10016, USA. gf16@nyu.edu
Markenson
David
D
Tunik
Michael
M
Wellborn
Charles
C
Treiber
Marsha
M
Cooper
Arthur
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards; D003937:Diagnosis, Differential; D004632:Emergency Medical Services / Q000592:standards; D004634:Emergency Medical Technicians / Q000193:education* / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D005791:Patient Care / Q000592:standards*; D012189:Retrospective Studies; D014481:United States; D014505:Urban Population; D000078329:Workforce