Paediatric medical emergency calls to a Danish Emergency Medical Dispatch Centre: a retrospective, observational study

Managing High Frequency of Ambulance Calls in Hospitals: A Systematic Review

Background

This study addresses the critical issue of high-volume emergency calls in hospitals, focusing on the strain caused by frequent caller patients on ambulance services. The aim was to synthesize various management methods for handling high-frequency hospital calls.

Methods

The systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines and guided by the Cochrane Handbook for systematic reviews. Inclusion criteria encompassed studies focusing on the management of emergency departments in hospitals, exploring various medical conditions requiring ambulance attention, and reporting on the impact of a high volume of ambulance calls on hospitals. Databases including PubMed, Web of Science, and Google Scholar were searched from January 1, 2005, to May 1, 2022. The quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) Checklist.

Results

Out of 2390 identified citations, 18 studies met the inclusion criteria. These studies, from 12 countries, presented diverse methods categorized into country policy-based management, modeling approaches, and general strategies. Key findings included the effectiveness of risk stratification models and community-based interventions in managing high call frequencies and improving patient care. Our review identified effective strategies such as risk stratification models and community-based interventions, which have shown significant impacts in managing high call frequencies, aligning closely with our objective. These approaches have been pivotal in reducing the burden on emergency services and improving patient care.

Conclusion

The study synthesizes effective management methods for high-frequency ambulance calls, including predictive modeling and community interventions. It highlights the need for multi-faceted management strategies in different healthcare settings and underscores the importance of continued research and implementation of these methods to improve emergency service efficiency.

Outcomes of Pediatric Patients in Secondary Transport to Tertiary Hospital: A Retrospective Observational Study

OBJECTIVES

Emergency medical service (EMS) providers play an important role in determining which hospital to choose. To date, there is no evidence-based guideline to support their decisions, except for major trauma cases. Secondary transport is considered when a patient needs further investigation or treatment after primary transport, but this can delay treatment and put patients at unnecessary risk. The objective of this study was to investigate the outcomes of pediatric secondary transport patients to tertiary hospitals.

METHODS

This was a citywide population-based observational study conducted in Kobe, Japan. We reviewed the EMS registry to identify secondary transport patients younger than 19 years and investigated their clinical characteristics. We excluded cases of unknown hospital destinations, nontransported cases, and major trauma patients who followed a different protocol for a hospital destination. The primary endpoint was the hospital outcome 12 hours after transport. Because there was no link between the EMS patient transport data and the hospital medical records, a probabilistic linkage was performed to obtain the hospital outcomes. Patients who required secondary transport were compared with patients transported directly to tertiary hospitals.

RESULTS

A total of 13,720 pediatric patients were transported from the field by Kobe EMS between January 2013 and December 2015. Among them, 81 pediatric patients (0.6%) required secondary transport to tertiary hospitals within 24 hours of the primary transport, whereas a total of 3673 patients (27%) were transported directly to tertiary hospitals. Despite no apparent difference in prehospital severity, secondary transport patients were associated with higher hospitalization rates and a need for critical care compared with those who had direct transport. Seizure was the most common reason for the use of secondary transport, and 89% of the seizure patients were hospitalized after undergoing secondary transport; minor trauma was the second most common reason for the use of secondary transport, and 53% of the patients were hospitalized.

CONCLUSIONS

In this study, the characteristics of the secondary transport patients and hospital outcomes revealed a heterogeneity in pediatric prehospital transport. It is recommended that the development of pediatric EMS destination guidelines cover children's diverse conditions. Further studies are required, and linkages between prehospital and hospital data will help promote a better understanding of appropriate hospital destinations.

Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study

Background

The challenges encountered in emergency medical services (EMS) contacts with children are likely most pronounced in infants, but little is known about their out-of-hospital care. Our primary aim was to describe the characteristics of EMS contacts with infants. The secondary aims were to examine the symptom-based dispatch system for nonverbal infants, and to observe the association of unfavorable patient outcomes with patient and EMS mission characteristics.

Methods

In a population-based 5-year retrospective cohort of all 1712 EMS responses for infants (age < 1 year) in Helsinki, Finland (population 643,000, < 1-year old population 6548), we studied 1) the characteristics of EMS missions with infants; 2) mortality within 12 months; 3) pediatric intensive care unit (PICU) admissions; 4) medical state of the infant upon presentation to the emergency department (ED); 5) any medication or respiratory support given at the ED; 6) hospitalization; and 7) surgical procedures during the same hospital visit.

Results

1712 infants with a median age of 6.7 months were encountered, comprising 0.4% of all EMS missions. The most common complaints were dyspnea, low-energy falls, and choking. Two infants died on-scene. The EMS transported 683 (39.9%) infants. One (0.1%) infant died during the 12-month follow-up period. Ninety-one infants had abnormal clinical examination upon arrival at the ED. PICU admissions (n = 28) were associated with young age (P < 0.01), a history of prematurity or problems in the neonatal period (P = 0.01), and previous EMS contacts within 72 h (P = 0.04). The adult-derived dispatch codes did not associate with the final diagnoses of the infants.

Conclusions

Infants form a small but distinct group in pediatric EMS care, with specific characteristics differing from the overall pediatric population. Many EMS contacts with infants were nonurgent or medically unjustified, possibly reflecting an unmet need for other family services. The use of adult-derived symptom codes for dispatching is not optimal for infants. Unfavorable patient outcomes were rare. Risk factors for such outcomes include quickly renewed contacts, young age and health problems in the neonatal period.

Progression of vital signs during ambulance transport categorised by a paediatric triage model: a population-based historical cohort study

OBJECTIVES

To examine the severity and progression of acute illness or injury in children using vital signs obtained during ambulance transport and categorised according to a paediatric triage model.

DESIGN

A population-based historical cohort study using data from prehospital patient medical records linked to a national civil registration database.

SETTING

Emergency medical services providing ground-level transport in a mixed urban-rural region with three hospitals in Denmark.

PARTICIPANTS

25 039 events with patients aged <18 years attended by emergency medical services dispatched after a 1-1-2 emergency call during the years 2006-2018.

PRIMARY AND SECONDARY OUTCOME MEASURES

Distribution of the first observed vital signs according to a paediatric triage model: heart rate, Glasgow Coma Score, respiratory rate, oxygen saturation and oxygen treatment, and proportion of patients progressing to a triage score with a lower level of urgency during ambulance transport.

RESULTS

The proportion of patients with the first observed vital signs outside the normal age-specific range was as follows: 33.6% for heart rate, 15.3% for Glasgow Coma Score, 17.4% for respiratory rate and 37.4% for oxygen saturation regardless of oxygen treatment. The proportion of patients progressing to a triage score with a lower level of urgency during transport varied with age: 146/354 (41.2%) for age 0-2 months, 440/986 (44.6%) for age 3-11 months, 1278/3212 (39.8%) for age 1-2 years, 967/2814 (34.4%) for age 3-7 years and 4029/13 864 (29.1%) for age 8-17 years (p<0.001). One-day mortality was 3.05 deaths per 1000 patient-days (95% CI 2.43 to 3.83).

CONCLUSIONS

One third of the patients' condition progressed to a triage score with a lower level of urgency during ambulance transport. Vital sign documentation in paediatric patients was incomplete, and educational initiatives should be taken to increase documentation of vital signs, especially in patients aged ≤2 years.