STARS Train the Trainer Class (TtT) - Beta-AAP - Use of Emergency Medical Services for Children with Medical Complexity

AAP - Use of Emergency Medical Services for Children with Medical Complexity

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This multicenter, multi–EMS agency study examined how often Emergency Medical Services (EMS) are used for children with medical complexity (CMC), what care they receive prehospital, and how they fare after hospital arrival. Using linked EMS and hospital records from an integrated health system in western Pennsylvania (2014–2023), the authors identified CMC via hospital-assigned diagnosis/procedure codes using the Complex Chronic Conditions (CCC) algorithm.<br /><br />Among 68,890 pediatric EMS transports to 17 hospitals, 13,732 encounters (19.9%) involved CMC. Neuromuscular conditions were the most common CCC category (29.7%), followed by respiratory (24.0%) and metabolic (22.8%); 16.5% had technology dependence, and 0.4% were tracheostomy- and ventilator-dependent. One CCC was present in two-thirds of CMC encounters, but 15.6% had three or more. CMC had different transport patterns, with more neurologic complaints (24.3% vs 15.7% in non-CMC).<br /><br />CMC more frequently required EMS interventions than other children, including IV access (26.0% vs 19.6%), suctioning (1.8% vs 0.5%), intubation (1.1% vs 0.4%), positive pressure ventilation (2.0% vs 0.6%), ventilator management (0.9% vs 0.2%), and sedation (3.2% vs 1.1%). Prehospital cardiac arrest occurred in 1.0% of CMC encounters (vs 0.5%); within CMC, arrest risk was higher with cardiovascular, neuromuscular, and neonatal CCCs, and lower in older age groups versus infants.<br /><br />After hospital arrival, 33.0% of CMC were admitted and 7.2% required critical care (vs 1.3%). In-hospital mortality was 0.7% for CMC (vs 0.3%). Adjusted analyses showed CMC had 9.55 times higher odds of in-hospital death. The authors conclude that CMC comprise a substantial share of pediatric EMS transports and support targeted EMS training, technology-specific protocols, and better integrated prehospital–hospital data systems to improve safety and outcomes.

Keywords

pediatric emergency medical services

children with medical complexity

complex chronic conditions algorithm

prehospital interventions

technology dependence

tracheostomy ventilator dependent

neuromuscular conditions

prehospital cardiac arrest risk

hospital admission and critical care

in-hospital mortality odds