Available online 16 March 2024

Author links open overlay panel, , , AbstractObjective

National efforts have highlighted the need for pediatric emergency readiness across all settings where children receive care. Outpatient offices and urgent care centers are frequent starting points for acutely injured and ill children, emphasizing the need to maintain pediatric readiness in this setting. We aimed to characterize emergency medical services (EMS) utilization from outpatient offices and urgent care centers to better understand pediatric readiness needs.

Methods

We performed a retrospective cross-sectional analysis of EMS encounters using the National Emergency Medical Services Information System, a nationally representative EMS registry (2019-2022). We included four years of EMS encounters of children (<18 years old) that originated from an outpatient office or urgent care center. We described characteristics, including patient demographics, prehospital clinician impression, therapies, and procedures performed.

Results

Of 179,854,336 EMS encounters during the study period, 164,387 pediatric encounters originated at an outpatient setting. Most EMS encounters originated from outpatient offices. Evening and weekend EMS encounters more frequently originated from urgent care centers. The most common impressions were respiratory distress (n=60,716), systemic illness (n=23,583), and psychiatric/behavioral health (n=13,273). Ninety-four percent of EMS encounters resulted in transportation to a hospital.

Conclusions

EMS encounters from outpatient settings most commonly originate from outpatient offices, relative to urgent care settings, where pediatric emergency readiness may be limited. It is important that outpatient settings and providers are ready for varied emergencies, including those occurring for a behavioral health concern, and that readiness guidelines are updated to address these needs.

What’s New

In this analysis of US emergency medical services agency data, pediatric emergencies originating in outpatient offices and urgent care centers were common. We characterized common types of emergencies and the interventions performed in efforts to further improve outpatient readiness.

Section snippetsBackground

Outpatient settings, including primary care offices and urgent care (UC) centers, are a frequent starting point of acute care for children.1, 2 Problem based sick visits constitute a greater number of pediatric primary care visits compared to preventative visits.3 Readiness is important in primary care, with 5% of children having a primary care visit prior to arriving to the emergency department (ED).4 A 52-practice survey study found most pediatric offices encounter one emergency per month.5

Data source

We performed a retrospective cross-sectional analysis of EMS encounters from the National Emergency Medical Services Information System (NEMSIS). NEMSIS is a national EMS registry that includes standardized patient care records submitted prospectively by US EMS agencies. The number of states and territories submitting data to NEMSIS increased during the study years from 47 to 54. The dataset is estimated to include greater than 92% of all 911-intiated EMS activations in the United States

Sample inclusion

The four years of NEMSIS data included 179,854,336 EMS records. After applying initial exclusions (Figure 1), we identified 6,186,663 pediatric encounters by a ground EMS service from the scene. A location was not available in 320,445 (5.2%) of these encounters. Among children with a listed location, 128,638 (2.2%) originated from an outpatient office and 35,749 (0.6%) originated from an UC center.

Demographics of children transported from outpatient settings (Table 1)

The median age of children transported from outpatient offices and UCs was similar (4 and 5 years,

Discussion

We analyzed four years of EMS data from a nationally representative sample to evaluate utilization of EMS from outpatient offices or UC centers and to identify common reasons for EMS contact. About 100,000 pediatric EMS encounters had an origin location in the outpatient setting, with the majority originating at an outpatient office. While there was substantial overlap in types of conditions presenting from outpatient offices and UC centers, a greater proportion of behavioral health emergency

Funding Source

None

Conflict of Interest

The authors have indicated they have no potential conflicts of interest to disclose.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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