217 - Utilization of emergency medical services for pediatric interfacility transports

Poster Number: 217
Publication Number: 217.1854

Background: Children who require interfacility transport (IFT) may be of higher acuity or have unique needs compared to children encountered at a scene by emergency medical services (EMS). Indications for pediatric IFTs and interventions performed during IFTs are not well characterized, may vary by age, and may have implications for improving pediatric ED readiness and EMS training initiatives for children.

Objective: To evaluate age-based differences in impression, EMS level of care, and procedural needs of pediatric IFTs.

Design/Methods: We performed a retrospective descriptive study using the 2018-2022 National EMS Information System datasets, including children ( < 18 years) encountered for an IFT. We stratified encounters by age: neonate (birth to 27d), infant (28d to < 13mo), toddler (13mo to < 2y), early child (2 to < 6y), middle child (6 to < 12y), and adolescent (12 to < 18y). We described overall trends in IFTs over time and described EMS characteristics, primary impression, and procedural interventions by age group.

Results: We included 5,989,519 pediatric EMS encounters, of which 1,369,704 (22.9%) were IFTs. The proportion of all EMS encounters classified as IFTs increased from 20.8% in 2018 to 23.6% in 2022, with the greatest gain in IFTs observed among adolescents between 2019 and 2020 (Spearman’s rho=1; Figure 1). Respiratory conditions predominated in the neonate through early childhood age groups, while a higher proportion of IFTs during the middle childhood group were for trauma. Psychiatric/behavioral conditions were most common among adolescents and represented 28.7% of all IFTs in this age group (Table 1). Most basic and advanced airway procedures were performed among younger children, whereas restraints were more common in adolescents (Figure 2). Neonates and infant IFTs comprised half of IFT encounters that required critical care transport (30.8% and 19.1%, respectively). Over half of middle childhood and adolescent IFTs were cared for by advanced life support personnel.

Conclusion(s): IFTs have accounted for an increasing proportion of EMS encounters over time, with differences noted by age with impression, level of care, and procedures performed. Most notably, adolescents had the largest proportional increase in IFTs, of which one fourth were for psychiatric/behavioral health indications. More research is required to evaluate institutional elements related to both pediatric readiness in emergency settings and EMS IFT provider training, particularly for behavioral health conditions.