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Emergency Care for Children: Growing Pains
ies, covering four states, found that most pediatric calls were for boys (56 percent), and most occurred in the evening and daylight hours. Children were transported in 89 percent of the cases, and care was refused by the patient or parents in approximately 8 percent of cases (Joyce et al., 1996). Data from one EMS agency indicate that utilization rates of EMS vary by pediatric age group. In a study of children under age 15 who used the Kansas City, Missouri, EMS system between 1993 and 1995, researchers found that infants under age 1 had the highest rate of use (47.4 children transported per 1,000 persons), followed by those aged 1–4 (26.2), 10–14 (17.5), and 5–9 (17.3) (Murdock et al., 1999).
Approximately half of pediatric prehospital runs are for injury; the rest are for a wide range of medical problems. A 1991 analysis of 10,493 pediatric calls in four California EMS agencies found that 57 percent were for injuries. The most common injuries included head trauma (19 percent of calls), lacerations (16 percent), and contusions (14 percent). Medical calls accounted for the remaining 43 percent, which included knee pain (12 percent), seizures (8.5 percent), neck or back pain (9 percent), ingestions (7 percent), respiratory distress (5 percent), and abdominal pain (5 percent) (Seidel et al., 1991).
However, these statistics mask important differences in prehospital calls across different pediatric age groups. A study of nearly 18,000 transports of children under age 21 in Albuquerque, New Mexico, showed that the most prevalent chief complaints varied by age. Medical complaints predominated in children under 5, while the leading cause of transports among children aged 5–10 was motor vehicle crashes. Assault was a leading cause for transport among patients over age 11 (Sapien et al., 1999).
A number of small studies have investigated the appropriateness of pediatric ambulance transports. Results of these studies generally reveal that the majority of pediatric prehospital runs are not for critical cases (Hamilton et al., 2003) although in general, they are appropriate transports. Foltin and colleagues (1998) developed a tool for evaluating the appropriateness of pediatric ambulance utilization. Applying this tool to patients arriving at two New York City hospitals, they found that the majority of requests for ambulances were appropriate and that dispatchers called for the proper level of care the majority of the time (Foltin et al., 1998).
Still, many pediatric ambulance transports are unnecessary. A study of pediatric transports in Delaware found that they were unnecessary for 28 percent of patients. Of the unnecessary transports, 60 percent were covered by Medicaid. In fact, several studies have shown that children covered by Medicaid have higher rates of EMS transport than other children (Murdock et al., 1999) and higher rates of inappropriate EMS transport (Kost and Arruda, 1999). A study of pediatric ambulance transports in Cleveland that excluded patients needing immediate resuscitation or trauma care found