Medically unnecessary emergency medical services (EMS) transports among children ages 0 to 17 years.
OBJECTIVE
Estimate the prevalence of medically unnecessary Emergency Medical Services (EMS) transports among children.


METHODS
We linked EMS and emergency department (ED) billing records for all EMS-to-hospital transports of children originating in three counties in South Carolina between January 1, 2001 and March 31, 2003. EMS responses resulting in no transport, transports to destinations other than the ED, or multiple trips for the same child in a single day could not be linked to ED data and were excluded. Medically unnecessary transports were identified with an algorithm using pre-hospital impressions, ED diagnoses and ED procedures. After exclusions, 5,693 transports of children between 0 and 17 years were available for study.


RESULTS
Sixteen percent (16.4%) of all transports were medically unnecessary. Among children through age 12, upper respiratory and viral problems were the most common diagnoses associated with medically unnecessary transports; among older children, behavioral problems such as conduct disturbance or drug abuse were common. In multivariable analysis, the odds of an unnecessary transport were higher among younger children, non-white children, rural children, and children insured by Medicaid.


CONCLUSIONS
The proportion of EMS transports which may be medically unnecessary is relatively modest compared to previous studies. However, many questions remain for future research. Further investigation should include examination of primary care availability and occurrence of unnecessary EMS use, existence of race-based disparities, and transports involving conduct disturbance and other behavioral conditions among children.
Patterson
P Daniel
PD
Cecil G Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr., Blvd., CB# 7590, Chapel Hill, NC 27599, USA. dpatterson@schsr.unc.edu
Baxley
Elizabeth G
EG
Probst
Janice C
JC
Hussey
James R
JR
Moore
Charity G
CG
D000293:Adolescent; D016497:Adolescent Health Services / Q000191:economics / Q000706:statistics & numerical data*; D000465:Algorithms; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004630:Emergencies / Q000145:classification; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012959:Socioeconomic Factors; D013022:South Carolina; D014187:Transportation of Patients / Q000191:economics / Q000706:statistics & numerical data