title: Emergency Medical Services Provider Pediatric Adverse Event Rate Varies by Call Origin.
abstract: OBJECTIVE
  Emergency medical services providers may be called to a variety of sites to transport pediatric patients, whether it be a scene call for initial evaluation and care, a clinic for transportation of a patient who has been assessed by medical providers, or a hospital where assessment and stabilization have already begun. We hypothesize that there may be a direct relationship between adverse event rates and adverse event severity in transports from less medically stabilizing origins.
  
  
  METHODS
  Emergency medical services records of all critical pediatric transports in an urban Oregon county in 2011 were reviewed and abstracted using a standardized tool. From this, UNSEMs (unintended injury, near miss, suboptimal action, error, management complication) were determined, and the potential severity of the issue was assessed. Then, UNSEMs were compared with the origin of transport using logistic regression.
  
  
  RESULTS
  Four hundred ninety records were abstracted: 59 hospital transports, 48 clinic transports, and 384 scene transports. Furthermore, UNSEMs were noted in 24 hospital transports (40.7%), 33 clinic transports (68.8%), and 263 scene transports (68.5%). Severe UNSEMs were reported on 0 hospital transports (0.0%), 12 clinic transports (25.0%), and 65 scene transports (16.9%). The odds ratio of UNSEM occurrence from a hospital compared with nonmedical scenes was 0.35 (95% confidence interval, 0.20-0.60), and the odds ratio of a severe UNSEM from a hospital compared with nonmedical scenes was 0.09 (95% confidence interval, 0.01-0.63).
  
  
  CONCLUSIONS
  In conclusion, UNSEMs involving the emergency medical services care of children are more likely to occur when transport originates from a clinic or scene compared with a hospital.
authors.affiliation: From the Departments of Emergency Medicine.
authors.forename: David
authors.initials: D
authors.lastname: Jones
authors.affiliation: From the Departments of Emergency Medicine.
authors.forename: Matt
authors.initials: M
authors.lastname: Hansen
authors.affiliation: Obstetrics and Gynecology.
authors.forename: Josh
authors.initials: J
authors.lastname: Van Otterloo
authors.forename: Caitlin
authors.initials: C
authors.lastname: Dickinson
authors.forename: Jeanne-Marie
authors.initials: JM
authors.lastname: Guise
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D009922:Oregon; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000706:statistics & numerical data*