UMEM Educational Pearls

Category: Misc

Title: What do caregivers think of alternate EMS dispositions for pediatric patients?

Keywords: EMS, Alternate destinations, pediatric, EMS, reduce transport times (PubMed Search)

Posted: 5/17/2023 by Jennifer Guyther, MD (Updated: 6/16/2024)
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Pediatric patients represent up to 10% of EMS transports, but studies suggest that between 10-60% of these patients can be safely transported by alternate means.  Many EMS agencies have begun to implement alternate destination programs for adult patients - including transport to an urgent care center, using a taxi service instead of an ambulance, or utilizing telehealth services.  One of the first steps in being able to expand these program into the pediatric population involves determining the caregivers perspectives on the concept of not being taken directly to an emergency department when 911 is called.
 
This study conducted focus groups in English and Spanish which included a total of 38 participants in the Washington DC area.  Key take away points include:
1) The reasons for calling 911 for a non emergent reason were multifactorial and included lack of transportation, lack of health insurance, uncertainty about the severity of the patient's complaint and difficulty with after hours primary care access.
2) Most participants were not familiar with alternate EMS disposition programs.
3) Most caregivers preferred telemedicine over telecommunication.
4) Caregivers worried that there would be a delay in care if their child had a genuine medical emergency or decompensation.  They were also concerned that there would not be pediatric resources and expertise at the alternate destination requiring a second transport.  Also, there were concerns about the coordination between 911, clinics and EMS.  Concerns about transportation included vehicle cleanliness and hygiene and provision of appropriate car seats.
 
Bottom line: Alternate destination for EMS is possible with pediatric patients, but the programs need to take into consideration the above parental concerns in order to be successful. 

References

Ward CE, Singletary J, Campanella V, Page C, Simpson JN. Caregiver Perspectives on Including Children in Alternative Emergency Medical Services Disposition Programs: A Qualitative Study [published online ahead of print, 2023 May 5]. Prehosp Emerg Care. 2023;1-9. doi:10.1080/10903127.2023.2206480