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

Pdf Summary

This multicenter study examined Emergency Medical Services (EMS) use, prehospital care, and outcomes for children with medical complexity (CMC) transported from the scene to 17 hospitals in an integrated health system in western Pennsylvania (2014–2023). Using hospital diagnosis/procedure codes and the Complex Chronic Conditions (CCC) algorithm, the authors identified CMC and analyzed factors associated with prehospital cardiac arrest and in-hospital mortality.<br /><br />Among 68,890 pediatric EMS transports, 13,732 encounters (19.9%) involved CMC, with neuromuscular conditions most common (29.7%), followed by respiratory (24.0%) and metabolic (22.8%) conditions. Most CMC encounters involved a single CCC (66.5%), though 15.6% had three or more. Technology dependence was present in 3.2% of all encounters, and tracheostomy/ventilator dependence in 0.4%.<br /><br />Compared with children without medical complexity, CMC had different reasons for transport (notably more neurologic complaints) and more frequent advanced EMS interventions, including vascular access, airway suctioning, positive pressure ventilation, intubation, ventilator management, sedation, and restraint use. CMC were also more likely to be transported to the regional pediatric hospital (77.0%).<br /><br />Outcomes were worse for CMC: 33.0% were admitted, 7.2% required critical care, and in-hospital mortality was 0.7% (vs 0.3% without complexity). Prehospital cardiac arrest occurred in 1.0% of CMC encounters; risk was higher in infants and was associated with cardiovascular, neuromuscular, and neonatal CCC types. After excluding prehospital arrests and ED deaths, CMC had substantially higher adjusted odds of in-hospital mortality (OR 9.55).<br /><br />The authors conclude that CMC account for one-fifth of pediatric EMS transports and have higher acuity, supporting targeted EMS training, technology-specific protocols, and better prehospital–hospital data integration.

Keywords

pediatric EMS transports

children with medical complexity (CMC)

prehospital care interventions

Complex Chronic Conditions (CCC) algorithm

technology dependence (tracheostomy/ventilator)

prehospital cardiac arrest risk

in-hospital mortality outcomes

neuromuscular respiratory metabolic conditions

multicenter integrated health system study

western Pennsylvania 2014–2023