406 - Prehospital Interventions by EMS in Pediatric Patients with Psychiatric Emergencies

Poster Number: 406
Publication Number: 406.315

Caroline E. Cummings, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Lynn Babcock, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Wendy Pomerantz, Cincinnati Children's Hospital, Cincinnati, OH, United States; Olga Semenova, Cincinnati Children's Hospital Medical Center, Loveland, OH, United States

Background: There has been a marked increase in Emergency Department (ED) encounters for pediatric psychiatric and behavioral health in recent years. Most arrive to the ED via self-transport, yet a significant number arrive via emergency medical services (EMS). EMS utilization by pediatric mental health (MH) patients is not well-studied.

Objective: To characterize the EMS transport to a pediatric ED for a subset of children with MH conditions and to determine how often physical restraint or psychiatric medication was needed.

Design/Methods: This was a retrospective cohort study of a randomly selected 10% of EMS patients with MH conditions, ages 5-18 years, who were transported to two pediatric EDs between 1 January 2012 and 31 December 2020. EMS run sheets were manually reviewed. Demographic variables and EMS transport variables were collected. Intervention studied was psychiatric medication or physical restraint administration by an EMS provider. Frequencies were used to characterize the population. Chi-square test and Fisher’s exact test were used to analyze categorical and continuous variables, respectively.

Results: During the study period, 36,534 patients were transported via EMS to the 2 EDs of which 10,264 were MH patients. Of the 1,400 randomly selected records, 768 were available for analysis. Patients were more frequently female (n=405, 52.7%), white (n=480, 62.5%), publicly insured (n=478, 61.9%), and of adolescent age (mean age 13.6 years). Sixty-three patients (8%) received a psychiatric medication, and 69 (9%) were physically restrained. As shown in the Table, those who received a field intervention were younger (13.7 vs 13.0 years, p=0.006), more likely male (21.5% vs 10.6%, p=0.006), and more likely to be picked up from school (26.4% vs 14.4%) or a street/road (6.6% vs 4.3%) [p=0.008].Conclusion(s): Pediatric patients with psychiatric conditions transported by EMS were more likely female, white, publicly insured, and of adolescent age. Most pediatric patients brought to the ED by EMS for psychiatric emergencies do not receive physical restraints or psychiatric medications, those who do are more likely to be younger, male, and picked up at school or from a street/road.
Caroline Cummings CVCummings CV 01.04.22 .pdf