84 - Pediatric Outcomes after Emergency Medical Service (EMS) Non-Transport during the COVID-19 Pandemic

Poster Number: 84
Publication Number: 84.106

Lori Pandya, University of Texas Southwestern Medical School, Dallas, TX, United States; Brandon Morshedi, Baptist Health System, Little Rock, AR, United States; Brian Miller, University of Texas Southwestern Medical School, Dallas, TX, United States; Halim Hennes, University of Texas Southwestern Medical School, Frisco, TX, United States; Mohamed Badawy, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: Pediatric patients account for up to 10% of emergency medical service (EMS) activations in the United States. Up to 28% of these children are not transported to an emergency department (ED). Adult literature shows that non-transport is associated with up to a 16% hospitalization rate and in some cases serious complications. Outcomes of pediatric non-transport are largely unknown. 

Objective: Our primary aim was to determine pediatric outcomes of non-transport within our large urban EMS system during the COVID-19 pandemic. Outcomes included: repeat EMS activation within 72 hours, ED visits within 72 hours, and hospital admissions within 72 hours. Our secondary aim was to learn about reasons for non-transport.

Design/Methods: This was a descriptive pilot study of children age 0-17 years who activated City of Dallas EMS in 2020 and did not receive EMS transport to an ED. September 2020 (9/2020) was randomly picked for analysis as a representation of COVID pandemic and compared to September 2019 (9/2019) as a pre-pandemic representation. Records were analyzed and matched for any repeated activations within 72 hours. Our large health system records were queried for ED visits and hospital admissions within 72 hours for these subjects.

Results: In 2019, Dallas EMS had 12663 pediatric activations and 10429 activations in 2020. 640 (58.7%) of 1089 EMS activations in 9/2019 and 418 (54%) of 780 EMS activations in 9/2020 were not transported to ED. EMS was reactivated within 72 hours for 9 (1.4%) of 640 and 6 (1.4%) of 418 (p=0.51). 55 (8.5%) of 640 and 45 (10.7%) of 418 were evaluated in ED within 72 hours (p=0.11). 10 (1.5%) of 640 and 5 (1.1%) of 418 got admitted to the hospital within 72 hours (p=0.68). Reason for non-transport was filed for 354 (55%) of 640 EMS activations as follows: chief complaint resolved (24.9%), feels ambulance not necessary (47.7%), transport by private vehicle (20%), other 3.1 %, and 207 (49.5%) of 418 activations: chief complaint resolved (15.5%), feels ambulance not necessary (57.5%), transport by private vehicle (22.2%) and other (4.8%).Conclusion(s): Pediatric EMS activations decreased since COVID-19 with over 50 % non-transport to ED. Children not transported to ED did well pre-pandemic and during pandemic with only up to 1.5% admissions to the hospital within 72 hours. These findings highlight the role of EMS providers, who with guided protocols may decrease burden on EMS resources and ED visits, especially during pandemic times.