Emergency Medical Services Utilization Research Articles

Utilization of Emergency Medical Services for Pediatric Interfacility Transports

OBJECTIVE Regionalization of pediatric care may affect interfacility transports (IFTs). We sought to evaluate trends in EMS use for IFTs over time and age-based differences in encounter characteristics as there may be implications for emergency department (ED) and emergency medical services (EMS) training and equipment availability. METHODS We performed a retrospective cross-sectional study using 2018-2023 National EMS Information System datasets, including IFT encounters among children <18 years old. We used a time series model and described characteristics by age group. RESULTS We included 4,333,424 pediatric EMS encounters, of which 937,122 (21.6%) were IFTs. From 2018 to 2023, there was an increase from 114,531 to 185,438 encounters, representing a rise of 2014 encounters/year (168/month, 95% CI, 106, 230). The middle childhood age group had the largest increase by 32 encounters/month (95% CI, 25.4, 38.4). Two primary impressions: systemic states and psychiatric/behavioral/substance abuse conditions, had the greatest increase among all primary impressions, (39/month [95% CI, 34.8, 43.3] and 21/month [95% CI, 13.5, 28.4], respectively). Respiratory conditions predominated in younger children, from 24.0% in ages ≥2 to <6 years to 32.8% in infants Most airway procedures were performed in younger children, whereas restraints were more common in adolescents. CONCLUSIONS IFTs account for an increasing number of EMS encounters. We identified differences by age in EMS characteristics, impressions, and interventions. Further investigation into the current state of ED pediatric readiness and IFT clinical indications and dispositions is needed to improve care at primary EDs and efficiently provide care during transport while minimizing unnecessary IFTs.

Characteristics and outcomes of out-of-hospital-cardiac-arrest in rural and suburban areas of Sindh, Pakistan: A cross-sectional study.

Despite extensive research on OHCA in urban centres worldwide, there is a significant gap in knowledge regarding these events in less urbanized regions, especially in Low-Middle-Income Countries (LMICs). To determine the characteristics and outcomes of adult out-of-hospital cardiac arrest (OHCA) in rural and suburban districts of Sindh, Pakistan. Data of OHCA patients (>18years) was collected retrospectively from January 2020 to December 2022, from the medical records of district and tehsil hospitals of the province of Sindh. Data analysis was performed using the Statistical Package Software for the Social Sciences (SPSS) Statistics 29. Out of 139 OHCA patients, 75.5% were males, and 24.5% were females, with a mean age of 52.78±13.1years. Most cardiac arrests occurred at home (54.75%). Only 0.7% of patients were transported by emergency medical services (EMS), while 59% arrived via private transport, such as cars or vans. An additional 4.3% were brought by other ambulance services, including private and philanthropic organizations, and for 36% of patients, the mode of transportation was undocumented. Cardiac arrests were witnessed in 43.2% of cases. CPR (either in-hospital or pre-hospital) was performed on 59% of patients, but only 6.1% received pre-hospital CPR (Bystander: 1.22%, Ambulance Staff: 2.44%, Family Member: 2.44%). Return of spontaneous circulation (ROSC) was achieved in 14.63% of patients, while 4.88% were alive at hospital admission. This study highlights significant gaps in the chain of survival for OHCA patients in rural and suburban Sindh, Pakistan, including inadequate EMS utilization, low bystander CPR rates, and delayed hospital care, contributing to poor outcomes. The findings may underestimate true rates due to missing and inconsistent data, emphasizing the need for improved documentation and prospective studies.

‘It overwhelms the system’: examining EMS provision in a South Texas border community

ObjectiveExamine how the characteristics of border communities along the US southern land border impact Emergency Medical Services (EMS) personnel in these border communities.DesignUsing phenomenological approach, we conducted face-to-face, one-on-one interviews...

Take care of the patient: Pharmacists should advocate for overdose prevention centers as harm reduction

Overdose prevention centers (OPCs) are places where people can bring previously obtained substances to use under the supervision of trained health care professionals who are prepared to intervene in the event of an overdose. Health care professionals, counselors, and peer support provide services including naloxone distribution, provision of sterile injection equipment, counseling services, referrals to necessary providers, and above all a safe and compassionate space for people to get the care they need. This is a method of harm reduction that has been used worldwide for decades and is now gaining traction in the United States. Pharmacists play a vital role in harm reduction for patients, and they should support the legalization and establishment of OPCs across the country to extend this essential service. A compelling body of evidence shows that OPCs reduce overdose deaths, emergency department visits for overdoses and wounds relating to injection drug use, and emergency medical service utilization in the area surrounding the centers. They also reduce drug use and discarded hazardous drug paraphernalia in public areas. OPCs also provide wrap-around services that aid in the holistic care of the person, including referrals to inpatient substance use treatment, detoxification, primary care, transportation, and housing. It is the responsibility of pharmacists to advocate for the needs of patients, and OPCs will provide an effective avenue for pharmacists to deliver counseling and medication management services as part of care of the individual.

COVID-19 pandemic effects on the emergency medical services utilization: A systematic review protocol.

To the best of our knowledge, to date, there is no comprehensive review study that has explored the effects and impacts of the COVID-19 pandemic on emergency medical services (EMS) systems. Therefore, this systematic review will be conducted to investigate the effects of the COVID-19 pandemic on the delivery of pre-hospital emergency care services in EMS agencies. To achieve the study aims, electronic databases such as PubMed, Scopus, Web of Science, and Google Scholar will be searched for related studies. It seems that reviewing the effects of the COVID-19 pandemic on EMS systems, play an important role in identifying and solving the main challenges of EMS in future pandemics.

Abstract 383: Racial Disparities in Stroke Care: Differences in Dispatch Pathways and Patient Location

Introduction Racial and ethnic disparities in stroke treatment are well‐documented, with Non‐Hispanic Black (NHB) and Hispanic patients often experiencing longer delays in care compared to Non‐Hispanic White (NHW) patients. This study evaluates differences in pre‐hospital metrics (dispatch pathway and dispatch location), both of which have potential to influence racial disparities in stroke management. Methods This retrospective cross‐sectional study included patients with acute stroke symptoms enrolled in BEST MSU, a cluster randomized trial with patients treated in Mobile Stroke Units (MSUs) or Emergency Medical Services (EMS) from August 2014 to August 2020. Patients were evaluated by EMS or MSU in alternating weeks. Data on race, ethnicity, education, insurance status, dispatch pathways (direct dispatch via patient/family via 911, on‐scene first responder, MSU monitoring EMS ratios and adding themselves onto call) dispatch locations (home, public area, chronic healthcare facility, and outpatient healthcare setting) were collected. We focused comparisons on NHB, NHW, and Hispanic patients. Variables were described using frequency and percentages. Results A total of 1,420 ischemic stroke patients were analyzed: NHW (n=557), NHB (n=277), and Hispanic (n=586). Hispanic patients had the highest uninsured rates (26.9% MSU, 37.9% EMS), followed by NHB patients (14.6% MSU, 13.2% EMS), while NHW patients had the lowest (3.4% MSU, 3.8% EMS). Hispanic patients also had the lowest educational attainment, with over 50% having less than a high school education, compared to 19.5% of NHB and 6.6% of NHW patients. NHW patients were the oldest group (median age: 74.0 MSU, 71.0 EMS), while NHB and Hispanic patients were younger (median age: 63 MSU, 63.5 EMS). Direct dispatch of MSU was more likely for NHW (54.8), compared to NHB (36.5) and Hispanic (43.5) patients (p<0.001). In contrast, NHB (50.2) and Hispanic (43.5) patients were more dependent on on‐scene first responders for MSU dispatch compared to NHW (34.6) patients. Regarding dispatch location, EMS/MSU was more likely to be called from “home” for NHW patients (48.3), and Hispanic patients (47.8%) compared to NHB (43.7%) patients. Dispatches for NHB patients most often came from public areas (49.5%). Conclusion Racial and ethnic differences in dispatch pathway and dispatch location exist. In BEST MSU, NHW patients were more likely to have direct dispatch of MSU to the home location. For NHB and Hispanic patients, MSU was dispatched by first responders. Finally, NHB patients enrolled in BEST MSU were more likely to be identified in public areas compared to home. More studies are needed to understand the possible reasons for these findings including differences in baseline demographic and social factors, disparities in stroke knowledge, or disparities in EMS utilization in BEST MSU. Further investigation is needed to understand whether these differences contribute to racial and ethnic disparities in treatment metrics and thrombolytic therapy utilization and to design targeted interventions to address these disparities.

Emergency Medical Services and Police Utilization for Pediatric Mental and Behavioral Health Concerns Within a Large Hospital System.

This study aimed to compare emergency medical services (EMS) and police utilization trends, epidemiology, and emergency department (ED) outcomes between pediatric patients with mental or behavioral health (MBH) emergencies and those with non-MBH concerns transported to a large children's hospital system. This was a retrospective cohort study of patients aged 5 to 18 years transported via EMS and police to two EDs affiliated with a children's hospital from January 2012 through December 2020. Data were abstracted from electronic hospital records. Encounters for MBH emergencies were identified using diagnostic codes and chief complaints. Trends of EMS and police transports of patients with MBH emergencies were examined. Patient demographics and ED outcomes were compared between children presenting with MBH emergencies and those with non-MBH concerns. During the 9-year study period, out of 40,663 transports to the EDs, 36,137 (89%) arrived via EMS, and 4,526 (11%) arrived via police. A total of 10,250 (28.4%) EMS transports were for MBH emergencies. The volume of patients transported by EMS for MBH emergencies increased by 1.4% per year (P < 0.01) with no significant change in total EMS patient volumes. Patients with MBH emergencies transported by EMS were more likely to be older, female, of White race, and publicly insured; require restraint in the ED; and be admitted (P < 0.001). Of police transports, 4153 (91.8%) were for MBH emergencies, with no statistical change in the proportion of police transports that were for MBH emergencies. Police-transported MBH patients compared to non-MBH police-transported patients were more likely to be younger, female, and of White race (P < 0.001); 8.7% required mechanical/physical restraints in ED, 6.7% required pharmacologic restraint medications in ED, and 53% were admitted. The proportion of pediatric transports for MBH emergencies by EMS is rising and comprises the majority of police transports. Distinct from non-MBH pediatric patients transported, MBH patients necessitate significant ED resources, including ED-administered restraints and admission, highlighting their unique burden on the prehospital and ED systems.

A Survey of Patient Utilization and Trust of Emergency Medical Services

Little is known about patients’ decisions to come to the Emergency Department (ED) via emergency medical services (EMS) versus privately owned vehicle (POV); this is problematic as trust in EMS systems impacts patient care decisions. Furthermore, no studies exist that evaluate patients’ trust of the EMS system as it relates to a patient’s race. Patients completed a multi-method survey during their ED stay. Quantitative data included: patient demographics (age, gender, race) income, insurance status, previous medical training, highest level of education, self-reported medical and social history, number of ED visits in the past three months, and two scales assessing trust and empathy: the Group-Based Medical Mistrust Scale and the Jefferson Scale. Characteristics of patients who came to the ED via EMS versus POV were shown. A Wilcoxon signed rank test described differences in EMS trust scales by race. Logistic regression showed which factors contribute to the decision of EMS or POV. Qualitative comments described patients’ rationale for EMS versus POV. 23/72 (31.94%) patients utilized EMS transport and 49/72 (68.06%) utilized POV. 59.09% of patients self-identified as Black and 40.91% self-identified as White. The Group-Based Medical Mistrust Scale found Black patients had less trust in the EMS system (p=0.0001), while the Jefferson Scale of Patient Perception of Physician Empathy showed no significant difference in patient perceptions of EMS provider empathy (p=0.608). Logistic regression indicated that age predicted the use of EMS over POV (p&lt;0.001). Lack of access to POV, physical limitations, cost, speed, perception of emergency, and fear were identified as reasons that supportg patients’ decision to use EMS or POV. Many factors can influence patients’ transportation decisions and this study highlights trust, age, and other social and economic factors. These findings could inform policy decisions and ensure emergency care systems that are accessible for all patients.

186 Emergency Medical Service Clinicians' Perceptions and Utilization of Resources for People Experiencing Homelessness

186 Emergency Medical Service Clinicians' Perceptions and Utilization of Resources for People Experiencing Homelessness

Regional differences, repeated use, and costs of emergency medical services in Germany.

Little is known about regional differences regarding the utilization and costs of emergency medical services (EMS) in Germany. Evidence on characteristics of repeated use of EMS is also scarce. To compare German federal states regarding the utilization and costs of EMS and to analyze characteristics of repeated EMS use. We used BARMER health insurance data on more than 1.4million German EMS cases in 2022. We estimated EMS use rates (per 1000 inhabitants) and median reimbursements and costs by EMS type (ground transport with/without emergency physician (EP); helicopter emergency medical services), hospitalization status, and federal state. We applied Poisson regression to estimate incidence rate ratios (IRRs) with 95% confidence intervals (95% CI), capturing relationships between repeated use of EMS and individual characteristics, including care degree and income level. Ground transport EMS use rates varied between federal states by more than 2.6-fold without EP (Bavaria: 84.6; Berlin: 223.2) and 2.1-fold with EP (Bremen: 19.1; Saxony: 41.3). Median reimbursement of ground transport with EP was 132% higher in Schleswig-Holstein (€ 1530) compared with Berlin (€ 660). Approximately one-third of all persons used EMS more than once and accounted for two-thirds of all EMS cases. Repeated EMS use was strongly related to care degree (IRR of care degree5: 3084; 95% CI 3.012-3.158) and low income (IRR: 1.174; 95% CI 1.161-1.189). The substantial regional heterogeneity in terms of utilization and costs of EMS calls for anationwide, consistent regulation of EMS in Germany. Additionally, (outpatient) primary nursing care of persons with severe health impairments and health literacy should be strengthened.

Global, regional, and national burden of stroke attributable to diet high in sodium from 1990 to 2019: a systematic analysis from the global burden of disease study 2019.

Given the increasing occurrence of stroke and high-sodium diets (DHIS) over the past 30 years, it is crucial to assess the global, national, and regional impact of DHIS on the burden of stroke. The Global Burden of Diseases Study 2019 provided the study's data. We used the Bayesian meta-regression tool DisMod-MR 2.1 to evaluate the burden of stroke attributable to DHIS. Age-standardized disability-adjusted life years (ASDR) and age-standardized mortality rate (ASMR) were used to quantify the burden. We perform correlation analysis utilizing the Spearman rank-order correlation method, and we calculate the estimated annual percentage change (EAPC) to evaluate temporal trends. Globally, DHIS accounts for 17,673.33 thousand disability-adjusted life years (DALYs) and 700.98 thousand deaths of stroke in 2019. The burden of stroke attributable to DHIS has declined between 1990 and 2019 globally and in the majority of regions, with the largest declines seen in regions with high sociodemographic indexes (SDI). Both ASMR and ASDR were higher regionally in regions with moderate SDI than those in developed regions. Furthermore, the absolute values of EAPC, reflecting the rate of decrease, were notably lower in these regions compared to developed nations. High-income North America, categorized within the SDI regions, notably witnessed the smallest decline in ASDR over the last three decades. Additionally, from 1990 to 2019, males consistently bore a larger burden of stroke attributable to DHIS. The burden of stroke attributable to DHIS remained a major concern despite advancements in public knowledge of stroke and their utilization of emergency medical services. Over the past 30 years, more burden has been placed on males and regions with moderate SDI values; in males, higher EAPC values for both ASMR and ASDR have been found. This underscores the urgent need for effective interventions to alleviate the burden of stroke associated with DHIS.

Utilization of Emergency Medical Services by Culturally and Linguistically Diverse Patients: A Population-Based Retrospective Study

Objectives To compare emergency medical services (EMS) utilization between culturally and linguistically diverse (CALD) and non-CALD patients in Victoria, Australia. Methods A retrospective study of EMS attendances and transports in Victoria from January 2015 to June 2019, utilizing linked EMS, hospital emergency and admissions data. The CALD and non-CALD patients who received EMS care and transport to a Victorian public emergency department were included. The incidence of EMS use for CALD and non-CALD patients based on the 2016 Census population and expressed per 100,000 person-years. Results In 1,261,167 included patients, there were 272,100 (21.6%) CALD and 989,067 (78.4%) non-CALD patients. Before adjustment for age and sex, EMS utilization for CALD patients was 13% lower than non-CALD patients (incidence rate ratio [IRR] 0.87, 95% CI: 0.87–0.87). When stratified by age groups, CALD patients aged under 70 years had significantly lower rates of EMS utilization than non-CALD patients, while CALD patients aged 75 years or older were more likely than non-CALD patients to use EMS (IRR 1.08, 95% CI: 1.07–1.09). The CALD patients were less likely to utilize EMS for trauma/external injury (IRR = 0.67, 95% CI: 0.66–0.68) and mental health/alcohol/drug problems (IRR = 0.39, 95% CI: 0.38–0.40). After adjustment for differences in the age and sex distribution of CALD and non-CALD populations, CALD patients were 51% less likely to utilize EMS than non-CALD patients (IRR 0.49, 95% CI: 0.42–0.56). Conclusions The CALD patients used EMS less frequently than non-CALD patients with significant variation observed across age groups, countries of birth, and clinical presentation. Further research is needed to understand the factors that may be contributing to these disparities.

Prior emergency medical services utilization is a risk factor for in-hospital death among patients with substance misuse: a retrospective cohort study

BackgroundSubstance misuse poses a significant public health challenge, characterized by premature morbidity and mortality, and heightened healthcare utilization. While studies have demonstrated that previous hospitalizations and emergency department visits are associated with increased mortality in patients with substance misuse, it is unknown whether prior utilization of emergency medical service (EMS) is similarly associated with poor outcomes among this population. The objective of this study is to determine the association between EMS utilization in the 30 days before a hospitalization or emergency department visit and in-hospital outcomes among patients with substance misuse.MethodsWe conducted a retrospective analysis of adult emergency department visits and hospitalizations (referred to as a hospital encounter) between 2017 and 2021 within the Substance Misuse Data Commons, which maintains electronic health records from substance misuse patients seen at two University of Wisconsin hospitals, linked with state agency, claims, and socioeconomic datasets. Using regression models, we examined the association between EMS use and the outcomes of in-hospital death, hospital length of stay, intensive care unit (ICU) admission, and critical illness events, defined by invasive mechanical ventilation or vasoactive drug administration. Models were adjusted for age, comorbidities, initial severity of illness, substance misuse type, and socioeconomic status.ResultsAmong 19,402 encounters, individuals with substance misuse who had at least one EMS incident within 30 days of a hospital encounter experienced a higher likelihood of in-hospital mortality (OR 1.52, 95% CI [1.05 – 2.14]) compared to those without prior EMS use, after adjusting for confounders. Using EMS in the 30 days prior to an encounter was associated with a small increase in hospital length of stay but was not associated with ICU admission or critical illness events.ConclusionsIndividuals with substance misuse who have used EMS in the month preceding a hospital encounter are at an increased risk of in-hospital mortality. Enhanced monitoring of EMS users in this population could improve overall patient outcomes.

Effect of COVID-19 Pandemic Lockdown on Emergency Medical Service Utilisation, and Percutaneous Coronary Intervention Volume—An Australian Perspective

Acute coronary syndrome (ACS) admissions and percutaneous coronary intervention (PCI) volume declined during periods of COVID-19 lockdown internationally in 2020. The effect of lockdown on emergency medical service (EMS) utilisation, and PCI volume during the initial phase of the pandemic in Australia has not been well described. We analysed data from the Victorian Cardiac Outcomes Registry (VCOR), a state-wide PCI registry, linked with the Ambulance Victoria EMS registry. PCI volume, 30-day major adverse cardiovascular and cerebrovascular events (MACCE; composite of mortality, myocardial infarction, stent thrombosis, unplanned revascularisation, and stroke), and EMS utilisation were compared over four time periods: lockdown (26 Mar 2020-12 May 2020); pre-lockdown (26 Feb 2020-25 Mar 2020); post-lockdown (13 May 2020-10 Jul 2020); and the year prior (26 Mar 2019-12 May 2019). Interrupted time series analysis was performed to assess PCI trends within and between consecutive periods. The EMS utilisation for ACS during lockdown was higher compared with other periods: lockdown 39.4% vs pre-lockdown 29.7%; vs post-lockdown 33.6%; vs year prior 27.1%; all p<0.01. Median daily PCI cases were similar: 31 (IQR 10, 38) during lockdown; 39 (15, 49) pre-lockdown; 39.5 (11, 44) post-lockdown; and, 42 (10, 49) the year prior; all p>0.05. Median door-to-procedure time for ACS indication during lockdown was shorter at 3 hours (1.2, 20.6) vs pre-lockdown 3.9 (1.7, 21); vs post-lockdown 3.5 (1.5, 21.26); and, the year prior 3.5 (1.5, 23.7); all p<0.05. Lockdown period was associated with lower odds for 30-day MACCE compared to pre-lockdown (odds ratio [OR] 0.55 [0.33-0.93]; p=0.026); post-lockdown (OR 0.66; [0.40-1.06]; p=0.087); and the year prior (OR 0.55 [0.33-0.93]; p=0.026). Contrary to international trends, EMS utilisation for ACS increased during lockdown but PCI volumes remained similar throughout the initial stages of the pandemic in Victoria, with no observed adverse effect on 30-day MACCE during lockdown. These data suggest that the public health response in Victoria was not associated with poorer quality cardiovascular care in patients receiving PCI.

Emergency medical services in Armenia: national call trends and future directions.

Emergency medical services (EMS) are paramount to boosting health indices in lower-middle income countries (LMICs); however, lack of uniform data collection and analysis hinders system improvement efforts. In the present study, we describe patterns of EMS utilization in the Republic of Armenia and provide key insight into the quality of digital data collection methods. For calls logged in the capital city, Yerevan, the majority had at least one missing field. The predominant complaint was high blood pressure among adults (34.4%) and fever among pediatrics (65.9%). A majority of patients were female (57.6%), adults (90.2%), and not transported to a hospital (85.0%). In the rural provinces, the data was largely intact. The predominant complaints were unspecified acute condition (27.4%) and high blood pressure (26.2%) among adults, and fever (43.9%) and unspecified acute condition (22.1%) among pediatrics. A majority of patients were female (57.1%), adults (94.2%), and not transported to a hospital (78.9%). Our study reveals that the majority of calls to the EMS system are for concerns not needing in-hospital treatment and for acute exacerbation of chronic conditions. Our study also provides a critical foundation for the improvement of EMS systems in Armenia and in other nations in transition. The Locator software has the potential to be a valuable tool to the MoH if it is improved for surveillance purposes, and future synchronization of digital systems would provide easy access to critical information on population health needs and the effectiveness of public health interventions.

Emergency Department Pediatric Mental and Behavioral Health Patients Transported by Emergency Medical Services and Police: Trends and Interventions

ObjectiveWe aimed to understand transport utilization trends, demographics, emergency department (ED) interventions, and outcomes of pediatric mental and behavioral health (MBH) patients transported by emergency medical services (EMS), police, or self-transported. MethodsThis retrospective cohort study utilized electronic health record data from patients aged 5 to 18 years presenting with acute MBH conditions at 2 affiliated pediatric EDs from January 2012 to December 2020. Data included demographics, ED interventions for aggression/agitation, Brief Rating of Aggression by Children and Adolescents (BRACHA) scores, and ED dispositions. Descriptive statistics and comparative analyses were conducted using chi-square, Wilcoxon rank sum tests, and multivariable logistic regression. Linear regression analyzed trends. ResultsOf 440,302 ED encounters, 70,557 (16%) were for acute MBH concerns, with 14.6% transported by EMS and 5.9% by police. The proportion of MBH visits increased from 9.9% in 2012 to 19.8% in 2020 (95% (confidence interval) CI [0.7, 1.7], P = 0.0009), with a concurrent 0.4% annual increase in those transported by EMS (95% CI [0.2, 0.6], P = 0.006). MBH patients transported by EMS and police had significantly higher odds of requiring restraint in the ED and were more likely to have higher BRACHA scores and to be admitted compared to self-transported patients (all comparisons, P < 0.001). ConclusionsPediatric MBH ED visits and EMS utilization are increasing. MBH patients transported by EMS and police may represent a more aggressive ED population. Given the rising encounters within this high-risk population, our EDs, EMS, and police need support and resources for safe pediatric MBH patient management.

Strengthening care for emergencies: what is the level of awareness and utilization of Emergency Medical Services (EMS) in FCT, Nigeria?

BackgroundAs part of the Federal Government of Nigeria’s desire to increase medical coverage among the citizenry, the National Emergency Medical Service and Ambulance Scheme (NEMSAS) was set up and piloted in the FCT in 2022. To gauge the progress so far, this study sought to assess the level and determinants of public awareness and utilization of Emergency Medical Services (EMS) among residents of the Federal Capital Territory, Abuja.MethodsA cross-sectional study was conducted in June 2023 among 1177 respondents residing in FCT Abuja at the time of the survey. Data was collected by trained research assistants using an interviewer-administered questionnaire and purposive sampling was adopted. The level of awareness and the socio-demographic determinants of the level of awareness in the FCT were assessed. Logistic regression was used to find predictors of EMS awareness and utilization.Results57.8% of respondents are aware of EMS, while 42.2% are not. 62.7% are uncertain about the source of information for EMS with only a minority relying on word of mouth (17.7%), traditional media (11.1%), or social media (8.5%). 91.4% have not accessed or utilized EMS via the toll-free emergency line, while only 8.6% reported doing so. There are median EMS awareness and utilization differences across gender, age, location, and employment status of the respondents. Additionally, the multivariate logistic regression showed that age, location, and employment status are significant predictors of EMS awareness and utilization. Males have lower odds of awareness and utilization of EMS compared to females. Furthermore, there was a significant relationship between EMS access and utilization (Chi-square = 80.748, p < 0.001). However, awareness did not necessarily translate to utilization.ConclusionThe relationship between EMS awareness and utilization and the unmasked predictors in this paper should be factored into the design of interventions to increase access and utilization of EMS in Nigeria.

Adherence to dietary guidelines associated with lower medical service utilization in preschoolers: a longitudinal study

ObjectiveWe aimed to evaluate the association between dietary guideline adherence and overall, outpatient, and emergency medical service utilization in Taiwanese preschoolers.MethodsWe selected 614 preschoolers (2–6 years) who had one day of 24-h dietary recall data from the 2013–2016 Nutrition and Health Survey in Taiwan. The Taiwanese Children Healthy Eating Index (TCHEI) was developed on the basis of Taiwanese Food-Based Dietary Guidelines; it assesses dietary adequacy and eating behavior. Data on the participants’ outpatient and emergency medical service utilization were obtained for 2013–2018 from the National Health Insurance Research Database. A multivariable generalized linear model was used to evaluate the association between the TCHEI and medical service utilization for all disease and respiratory diseases.ResultsAfter adjustment for confounding factors, children aged 2–3 years in the Tertile (T) 2 and T3 groups of the TCHEI exhibited 25% (95% CI 0.69–0.83) and 16% (95% CI 0.77–0.92) lower overall medical visits, respectively. The same pattern was noted in the outpatient and emergency visits for all diseases and respiratory diseases. The children aged 4–6 years in the T2 group exhibited 15% (95% CI 0.80–0.91) and 11% (95% CI 0.82–0.97) lower overall visits and visits for respiratory diseases, respectively. Moreover, preschoolers in the T2 group exhibited lower overall medical expenditures than did those in the T1 group.ConclusionsTCHEI score was positively correlated with better nutritional status. Optimal dietary intake associated with lower medical service utilization among Taiwan preschoolers.

Pediatric Utilization of Emergency Medical Services from Outpatient Offices and Urgent Care Centers

ObjectiveNational 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 these settings. We aimed to characterize emergency medical services (EMS) utilization from outpatient offices and urgent care centers to better understand pediatric readiness needs. MethodsWe 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. ResultsOf 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. ConclusionsEMS 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.

The impact of the COVID-19 pandemic on treatment for domestic violence injuries: evidence from medical claims

AbstractPrevious studies have observed heterogeneous changes in domestic violence-related 911 calls, police incident reports, and arrests at the onset of the COVID-19 pandemic. In this study, we use a large-scale medical claims database with coverage of over 100 million patients to examine the impact on domestic violence victims’ use of emergency department care for their injuries in the early weeks of the pandemic compared to the corresponding weeks in previous years. We find a 23–35% decrease in utilization of emergency medical services by domestic violence victims between March and June of 2020. Based on this finding, it is essential to use caution when using medical claims to measure domestic violence in future research covering this time period. Decreases in care utilization also have important implications for the detection, screening, and treatment of domestic violence injuries during future public health crises.