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Abstract
Background Children represent fewer than 10% of emergency medical services (EMS) encounters in the USA. We evaluated whether agency-level paediatric volume is associated with the quality of prehospital care provided.
Methods We conducted a retrospective analysis of 7104 agencies that contributed data consistently to the 2022–2023 National Emergency Medical Services Information System database, including children (<18 years) from an out-of-hospital EMS encounter. We assessed outcomes based on adherence to paediatric-specific quality benchmarks using mixed-effects models.
Results We identified 3 403 925 paediatric encounters (median age 10 years; IQR 3–15). The annual paediatric volumes serviced by the study agencies per year ranged from 0.5 to 62 443. Six measures had a positive association with EMS volume, one measure had a negative association with EMS volume and four measures had no association with EMS volume. Higher volumes were associated with beta agonist administration for asthma/wheeze (adjusted OR (aOR) 1.08 per twofold increase in volume, 95% CI 1.06 to 1.11), epinephrine for anaphylaxis (aOR 1.09, 95% CI 1.05 to 1.08), vital signs assessment in trauma (aOR 1.05, 95% CI 1.04 to 1.07), benzodiazepines for status epilepticus (aOR 1.21, 95% CI 1.17 to 1.25), oxygen or positive pressure ventilation for hypoxia (aOR 1.06, 95% CI 1.04 to 1.09) and naloxone for opioid overdose (aOR 1.08, 95% CI 1.02 to 1.14). Higher paediatric volume was negatively associated with improvement of pain status in trauma (aOR 0.96, 95% CI 0.95 to 0.97). Paediatric volume was not associated with management of hypoglycaemia (aOR 1.01, 95% CI 0.97 to 1.06) or hypotension (aOR 0.98, 95% CI 0.92 to 1.04), or analgesia (0.99, 95% CI 0.97 to 1.01) and pain assessment (aOR 1.01, 95% CI 0.99 to 1.04) in trauma.
Conclusion Higher paediatric volume EMS agencies had better adherence to some paediatric care quality measures but showed no association or an inverse association with others. Efforts to improve prehospital paediatric care quality should pay special attention to low-volume agencies.
- Emergency department
- Paediatrics
- Prehospital care
- Quality improvement
Data availability statement
Data are available in a public, open access repository. Data are available upon request from the National Emergency Medical Services Information System (https://nemsis.org/).
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Data availability statement
Data are available in a public, open access repository. Data are available upon request from the National Emergency Medical Services Information System (https://nemsis.org/).
Footnotes
Contributors SR conceptualised and designed the study, carried out the initial analyses and drafted the initial manuscript. CEW, RC and CM-G conceptualised and designed the study and critically reviewed and revised the manuscript. KAM conceptualised and designed the study, carried out the initial analyses and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted. SR is the guarantor of the present work.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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