Paramedic initiated non-transport of pediatric patients.
BACKGROUND
In a time of emergency department overcrowding and increased utilization of emergency medical services, a highly functional prehospital system will balance the needs of the individual patient with the global needs of the community. Our community addressed these issues through the development of a multitiered prehospital care system that incorporated EMS initiated non-transport of pediatric patients.


OBJECTIVE
To describe the outcome of pediatric patients accessing a progressive prehospital system that employed EMS initiated non-transport.


METHODS
A prospective observational case series was performed on pediatric patients (< 21 years old) designated EMS initiated non-transport. Patients were designated non-transport after an initial EMS protocol driven, complaint-specific clinical assessment in conjunction with medical oversight affirmation. Telephone follow-up was completed on all consecutively enrolled non-transport patients to collect information about outcome (safety) as well as overall satisfaction with the system. A five-point Likert scale was utilized to rate satisfaction.


RESULTS
There were 5,336 EMS requests during the study period. Seven hundred and four were designated non-transport, of which 74.8% completed phone follow-up. Categories of EMS request included minor; medical illness 43.4%, trauma 55.9%, and other 1.1%. There were 13 admissions (2.4%) to the hospital after EMS initiated non-transport designation. Admissions after non-transport had trends toward younger age (p = 0.002) and medical etiology (p = 0.006). There were no PICU admissions or deaths.


CONCLUSIONS
Our EMS system provides an alternative to traditional protocols, allowing EMS initiated non-transport of pediatric patients, resulting in effective resource utilization with a high level of patient safety and family satisfaction.
Department of Emergency Medicine, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania 19134-1095, USA. chaines911@yahoo.com
Christopher J
CJ
Haines
R Esther
RE
Lutes
Mark
M
Blaser
Norman C
NC
Christopher
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009820:Ohio; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D011446:Prospective Studies; D012449:Safety; D011795:Surveys and Questionnaires; D014187:Transportation of Patients / Q000706:statistics & numerical data*