Exclusion criteria included transfer from another medical facility, study physician not .... Were you wormed chat your child may die wichour calling for an arnbulancc? ..... Applebaum D. Advanced prehospital care for pediatric emergencies.
Pediatric Ambulance Transports, Camasso-Richardson et al.
Medically Unnecessary Pediatric Ambulance Transports: A Medical Taxi Service? Karen Camasso-Richardson, M D , James A. Wilde, M D , Emory M . Petrack, MD, M P H
Objective: To characterize ambulance utilization i n a pediatric population and pediatric emergency physicians' judgment of the medical need for ambulance transport. Methods: A convenience sample of ambulance transports were studied prospectively during a 5-week period. Exclusion criteria included transfer from another medical facility, study physician not available, need for immediate resuscitation, or trauma team activation. A questionnaire completed by the physician assessed medical need for the ambulance based on chief complaint, general appearance, vital signs, and ambulance run sheet information. A separate questionnaire was administered to the parents regarding reasons for ambulance use and other available means of transportation. Caregivers were contacted by telephone 2-3 days later to determine the mode of transportation home and the clinical outcome. Results: Of 172 eligible patients, 92 (53%) were enrolled. Most (61 %; 56/92) transports were considered medically unnecessary. Interestingly, 40% (37/92) of the subjects had no other means of transportation; 86% (32/37) of ambulance transports for this group were judged medically unnecessary. Overall, 86% (79/92) of families had not called their physician. There was no association between having spoken with the physician and medical need for an ambulance. Many (82%; 46/56) Medicaid transports were judged medically unnecessary. Overall, follow-up was achieved for 91% (85/92) of the patients. No patient for whom transport was medically unnecessary bad a repeat ED visit for the same complaint or required admission. Most patients (74%; 68/92) returned home without any assistance. Among the medically unnecessary transports, 52% (32/ 60) of the caregivers cited no other means of transportation, yet 34% (1 1/32) of these patients returned home by private car. Conclusions: Most pediatric ambulance transports in this sample, which excluded patients requiring immediate resuscitation or trauma team care, were judged to be medically unnecessary. Caregivers often use an ambulance as a convenience or as the only means of transportation. An alternate, less resource-intensive transportation system may be more appropriate for this population. Key words: pediatrics; ambulances; emergency medical services; EMS; medical necessity. Acad. Emerg. Med. 1997; 4:1137-1141.
I The advent of managed care has prompted the American health care system to redesign itself, with a particular focus on cost-effectiveness and efficiency. One aspect of this reorganization concerns the use of emergency medical services (EMS)-based ambulance transportation. Although pediatric out-of-hospital care has received increased published pediatric ambulance utilization studies are few and tend to be retrospective.'-' Pediatric patients transported by EMS personnel often may have
From Case Wesrern Reserve University, Rainbow Babies and Childrens Hospitaal, Cleveland, OH, Departnrent of Pediatrics (KCR,JAW, EMP).
serious injuries or i l l n e s s e ~ ~however, .~; it is estimated that 30-90% of transports may be medically unnecessary and may reflect overutilization of a costly r e s o u ~ c e . ' ~A- 're~ cent multisite survey of general EDs evaluated ambulance transports and found medically unnecessary ambulance use correlated most strongly with age