44 - Safety of Prehospital Medical Clearance for Pediatric Behavioral Emergencies in Alameda County

Poster Number: 44
Publication Number: 44.103

Nicolaus Glomb, UCSF Benioff Children's Hospital San Francisco, San Mateo, CA, United States; Tarak Trivedi, UCLA, San Jose, CA, United States; Jacqueline Grupp-Phelan, UCSF Benioff Children's Hospital San Francisco, Mill Valley, CA, United States; david L. Schriger, Department of Emergency Medicine, UCLA, Los Angeles, CA, United States; Karl A. Sporer, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States

Background:
Over the past decade there has been an increase in the number of children being seen in emergency departments (EDs) for pediatric behavioral emergencies (BHEs) with a majority arriving via emergency medical services (EMS). EDs spend significant time and resources medically clearing and determining a disposition for stable patients with BHEs leading to significant delays in their psychiatric care.

Objective: Alameda County EMS has implemented a Behavioral Diversion protocol that allows for direct transport to a specialized pediatric psychiatric emergency services (PES) center, bypassing the ED. We examined pediatric patients transported by this protocol to assess safety outcomes associated with direct transportation to PES by EMS.

Design/Methods:
We conducted a retrospective review for all pediatric (age < 18 years) EMS encounters between 2011 to 2016, using Alameda County’s EMS standardized data set. After unique patient identification and linkage to mortality data from Alameda County Vital Statistics, we describe the dataset at the patient level and at the encounter level. Our primary outcome was safety of field medical clearance. First, we identified the proportions of patients who were found to have a concerning medical issue requiring re-transport within 12 hours to a general ED after arriving at the PES. Second, we describe the 30-, 90- and 365-day mortality of all patients after being transported directly for a BHE.  

Results:
There were 38,241 total EMS pediatric encounters, and 20.1% (Nf7,670) were for BHEs, making them the second most common reason for ambulance transport. EMS treated 29,073 unique pediatric patients, of which 208 patients had 5 or more BHE EMS encounters and accounted for 20.8% (Nf1,594) of all BHEs. Among the 4,770 children with BHE, there was a 0.4% mortality compared to a 0.6% (Nf153/24,303) in children without a BHE. One BHE patient died within 90 days of an EMS encounter for BHE. 3,122 (41.3%) BHE encounters met protocol criteria and were transported directly to the pediatric PES. 15 (0.5%) patients had a secondary transport to a general ED within 12 hours of arrival to the PES. None of these re-triaged patients required any critical EMS intervention. 
Conclusion(s):
BHEs are the second most common reason for transport of pediatric patients. Death and adverse clinical outcomes are rare in pediatric patients after the implementation of a Behavioral Diversion protocol for EMS transport. This could significantly improve the care of children in the pre-hospital setting with BHEs.