Medically unnecessary pediatric ambulance transports

A medical taxi service?

Karen Camasso-Richardson, James A Wilde, Emory M. Petrack

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objective: To characterize ambulance utilization in a pediatric population and pediatric emergency physicians' judgment of the medical need for ambulance transport. Methods: A convenience sample of ambulance transports were studied prospectively during a 5-week period. Exclusion criteria included transfer from another medical facility, study physician not available, need for immediate resuscitation, or trauma team activation. A questionnaire completed by the physician assessed medical need for the ambulance based on chief complaint, general appearance, vital signs, and ambulance run sheet information. A separate questionnaire was administered to the parents regarding reasons for ambulance use and other available means of transportation. Caregivers were contacted by telephone 2-3 days later to determine the mode of transportation home and the clinical outcome. Results: Of 172 eligible patients, 92 (53%) were enrolled. Most (61%; 56/92) transports were considered medically unnecessary. Interestingly, 40% (37/92) of the subjects had no other means of transportation; 86% (32/37) of ambulance transports for this group were judged medically unnecessary. Overall, 86% (79/92) of families bad not called their physician. There was no association between having spoken with the physician and medical need for an ambulance. Many (82%; 46/56) Medicaid transports were judged medically unnecessary. Overall, follow-up was achieved for 91% (85/92) of the patients. No patient for whom transport was medically unnecessary had a repeat ED visit for the same complaint or required admission. Most patients (74%; 68/92) returned home without any assistance. Among the medically unnecessary transports, 52% (32/60) of the caregivers cited no other means of transportation, yet 34% (11/32) of these patients returned home by private car. Conclusions: Most pediatric ambulance transports in this sample, which excluded patients requiring immediate resuscitation or trauma team care, were judged to be medically unnecessary. Caregivers often use an ambulance as a convenience or as the only means of transportation. An alternate, less resource-intensive transportation system may be more appropriate for this population.

Original languageEnglish (US)
Pages (from-to)1137-1141
Number of pages5
JournalAcademic Emergency Medicine
Volume4
Issue number12
DOIs
StatePublished - Jan 1 1997

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Ambulances
Pediatrics
Physicians
Caregivers
Resuscitation
Vital Signs
Medicaid
Wounds and Injuries
Telephone
Population
Emergencies
Parents

Keywords

  • Ambulances
  • EMS
  • Emergency medical services
  • Medical necessity
  • Pediatrics

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Medically unnecessary pediatric ambulance transports : A medical taxi service? / Camasso-Richardson, Karen; Wilde, James A; Petrack, Emory M.

In: Academic Emergency Medicine, Vol. 4, No. 12, 01.01.1997, p. 1137-1141.

Research output: Contribution to journalArticle

Camasso-Richardson, Karen ; Wilde, James A ; Petrack, Emory M. / Medically unnecessary pediatric ambulance transports : A medical taxi service?. In: Academic Emergency Medicine. 1997 ; Vol. 4, No. 12. pp. 1137-1141.
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abstract = "Objective: To characterize ambulance utilization in a pediatric population and pediatric emergency physicians' judgment of the medical need for ambulance transport. Methods: A convenience sample of ambulance transports were studied prospectively during a 5-week period. Exclusion criteria included transfer from another medical facility, study physician not available, need for immediate resuscitation, or trauma team activation. A questionnaire completed by the physician assessed medical need for the ambulance based on chief complaint, general appearance, vital signs, and ambulance run sheet information. A separate questionnaire was administered to the parents regarding reasons for ambulance use and other available means of transportation. Caregivers were contacted by telephone 2-3 days later to determine the mode of transportation home and the clinical outcome. Results: Of 172 eligible patients, 92 (53{\%}) were enrolled. Most (61{\%}; 56/92) transports were considered medically unnecessary. Interestingly, 40{\%} (37/92) of the subjects had no other means of transportation; 86{\%} (32/37) of ambulance transports for this group were judged medically unnecessary. Overall, 86{\%} (79/92) of families bad not called their physician. There was no association between having spoken with the physician and medical need for an ambulance. Many (82{\%}; 46/56) Medicaid transports were judged medically unnecessary. Overall, follow-up was achieved for 91{\%} (85/92) of the patients. No patient for whom transport was medically unnecessary had a repeat ED visit for the same complaint or required admission. Most patients (74{\%}; 68/92) returned home without any assistance. Among the medically unnecessary transports, 52{\%} (32/60) of the caregivers cited no other means of transportation, yet 34{\%} (11/32) of these patients returned home by private car. Conclusions: Most pediatric ambulance transports in this sample, which excluded patients requiring immediate resuscitation or trauma team care, were judged to be medically unnecessary. Caregivers often use an ambulance as a convenience or as the only means of transportation. An alternate, less resource-intensive transportation system may be more appropriate for this population.",
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