Unnecessary Use of Red Lights and Sirens in Pediatric Transport

Beech Burns, Matthew Hansen, Stacy Valenzuela, Caitlin Summers, Joshua Van Otterloo, Barbara Skarica, Craig Warden, Jeanne-Marie Guise

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction: Approximately 25.5 million pediatric patients are treated in Emergency Departments around the United States annually. Roughly 7% of these patients are transported by ambulance; of these, approximately 7% arrive in ambulances running red lights and sirens (RLS). Compared to those transporting without RLS, emergency vehicles employing RLS are involved in more accidents and are associated with more fatalities. Objective: To characterize the use of RLS in pediatric transports and identify factors associated with unnecessary use of RLS. Methods: As part of the Children's Safety Initiative (CSI-EMS), a large, multi-phased National Institutes of Health-funded study, we conducted a medical record review of all pediatric RLS transports in an urban EMS system over a 4-year period (2008–11). A standardized chart abstraction tool was adapted for the out-of-hospital setting and pilot tested. Charts were independently reviewed by physicians and paramedics, with disagreements arbitrated by a pediatric emergency physician. Reviewers were asked to judge whether RLS transport was necessary and to provide comments justifying their position. Descriptive statistics were used to measure the frequency of unnecessary transports and logistic regression analysis was employed to identify factors associated with unnecessary use of RLS. Results: Of 490 RLS transports, experts identified 96 (19.6%) as unnecessary use of RLS. Necessary and unnecessary RLS transports had similar patient sex and duration of transport, though unnecessary use of RLS tended to increase with patient age. The call reasons that represented the largest proportion of unnecessary RLS transports were trauma (49.0%), respiratory distress (16.7%), and seizure/altered mental status (11.5%). Compared with necessary RLS transports, unnecessary RLS transports were less likely to require resuscitation, airway management, or medication administration. Univariate analysis revealed that patient vital signs within normal limits were associated with increased risk of unnecessary RLS transport, with the most pronounced effect seen in the normal GCS score group (odds ratio 7.74, p-value 0.001). Conclusions: This analysis identified patient and transport characteristics associated with unnecessary use of RLS. Our results could help serve as the basis for designing and prospectively evaluating protocols for use of RLS, potentially mitigating the risk associated with transport in pediatric patients.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalPrehospital Emergency Care
DOIs
StateAccepted/In press - Jan 21 2016

Fingerprint

Pediatrics
Light
Ambulances
Emergencies
Physicians
Allied Health Personnel
Airway Management
Vital Signs
National Institutes of Health (U.S.)
Resuscitation
Accidents
Medical Records
Hospital Emergency Service
Seizures
Logistic Models
Odds Ratio
Regression Analysis
Safety

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency

Cite this

Unnecessary Use of Red Lights and Sirens in Pediatric Transport. / Burns, Beech; Hansen, Matthew; Valenzuela, Stacy; Summers, Caitlin; Van Otterloo, Joshua; Skarica, Barbara; Warden, Craig; Guise, Jeanne-Marie.

In: Prehospital Emergency Care, 21.01.2016, p. 1-8.

Research output: Contribution to journalArticle

Burns, Beech ; Hansen, Matthew ; Valenzuela, Stacy ; Summers, Caitlin ; Van Otterloo, Joshua ; Skarica, Barbara ; Warden, Craig ; Guise, Jeanne-Marie. / Unnecessary Use of Red Lights and Sirens in Pediatric Transport. In: Prehospital Emergency Care. 2016 ; pp. 1-8.
@article{c71603c8a49a4067842c7349d8f1ed1e,
title = "Unnecessary Use of Red Lights and Sirens in Pediatric Transport",
abstract = "Introduction: Approximately 25.5 million pediatric patients are treated in Emergency Departments around the United States annually. Roughly 7{\%} of these patients are transported by ambulance; of these, approximately 7{\%} arrive in ambulances running red lights and sirens (RLS). Compared to those transporting without RLS, emergency vehicles employing RLS are involved in more accidents and are associated with more fatalities. Objective: To characterize the use of RLS in pediatric transports and identify factors associated with unnecessary use of RLS. Methods: As part of the Children's Safety Initiative (CSI-EMS), a large, multi-phased National Institutes of Health-funded study, we conducted a medical record review of all pediatric RLS transports in an urban EMS system over a 4-year period (2008–11). A standardized chart abstraction tool was adapted for the out-of-hospital setting and pilot tested. Charts were independently reviewed by physicians and paramedics, with disagreements arbitrated by a pediatric emergency physician. Reviewers were asked to judge whether RLS transport was necessary and to provide comments justifying their position. Descriptive statistics were used to measure the frequency of unnecessary transports and logistic regression analysis was employed to identify factors associated with unnecessary use of RLS. Results: Of 490 RLS transports, experts identified 96 (19.6{\%}) as unnecessary use of RLS. Necessary and unnecessary RLS transports had similar patient sex and duration of transport, though unnecessary use of RLS tended to increase with patient age. The call reasons that represented the largest proportion of unnecessary RLS transports were trauma (49.0{\%}), respiratory distress (16.7{\%}), and seizure/altered mental status (11.5{\%}). Compared with necessary RLS transports, unnecessary RLS transports were less likely to require resuscitation, airway management, or medication administration. Univariate analysis revealed that patient vital signs within normal limits were associated with increased risk of unnecessary RLS transport, with the most pronounced effect seen in the normal GCS score group (odds ratio 7.74, p-value 0.001). Conclusions: This analysis identified patient and transport characteristics associated with unnecessary use of RLS. Our results could help serve as the basis for designing and prospectively evaluating protocols for use of RLS, potentially mitigating the risk associated with transport in pediatric patients.",
author = "Beech Burns and Matthew Hansen and Stacy Valenzuela and Caitlin Summers and {Van Otterloo}, Joshua and Barbara Skarica and Craig Warden and Jeanne-Marie Guise",
year = "2016",
month = "1",
day = "21",
doi = "10.3109/10903127.2015.1111477",
language = "English (US)",
pages = "1--8",
journal = "Prehospital Emergency Care",
issn = "1090-3127",
publisher = "Informa Healthcare",

}

TY - JOUR

T1 - Unnecessary Use of Red Lights and Sirens in Pediatric Transport

AU - Burns, Beech

AU - Hansen, Matthew

AU - Valenzuela, Stacy

AU - Summers, Caitlin

AU - Van Otterloo, Joshua

AU - Skarica, Barbara

AU - Warden, Craig

AU - Guise, Jeanne-Marie

PY - 2016/1/21

Y1 - 2016/1/21

N2 - Introduction: Approximately 25.5 million pediatric patients are treated in Emergency Departments around the United States annually. Roughly 7% of these patients are transported by ambulance; of these, approximately 7% arrive in ambulances running red lights and sirens (RLS). Compared to those transporting without RLS, emergency vehicles employing RLS are involved in more accidents and are associated with more fatalities. Objective: To characterize the use of RLS in pediatric transports and identify factors associated with unnecessary use of RLS. Methods: As part of the Children's Safety Initiative (CSI-EMS), a large, multi-phased National Institutes of Health-funded study, we conducted a medical record review of all pediatric RLS transports in an urban EMS system over a 4-year period (2008–11). A standardized chart abstraction tool was adapted for the out-of-hospital setting and pilot tested. Charts were independently reviewed by physicians and paramedics, with disagreements arbitrated by a pediatric emergency physician. Reviewers were asked to judge whether RLS transport was necessary and to provide comments justifying their position. Descriptive statistics were used to measure the frequency of unnecessary transports and logistic regression analysis was employed to identify factors associated with unnecessary use of RLS. Results: Of 490 RLS transports, experts identified 96 (19.6%) as unnecessary use of RLS. Necessary and unnecessary RLS transports had similar patient sex and duration of transport, though unnecessary use of RLS tended to increase with patient age. The call reasons that represented the largest proportion of unnecessary RLS transports were trauma (49.0%), respiratory distress (16.7%), and seizure/altered mental status (11.5%). Compared with necessary RLS transports, unnecessary RLS transports were less likely to require resuscitation, airway management, or medication administration. Univariate analysis revealed that patient vital signs within normal limits were associated with increased risk of unnecessary RLS transport, with the most pronounced effect seen in the normal GCS score group (odds ratio 7.74, p-value 0.001). Conclusions: This analysis identified patient and transport characteristics associated with unnecessary use of RLS. Our results could help serve as the basis for designing and prospectively evaluating protocols for use of RLS, potentially mitigating the risk associated with transport in pediatric patients.

AB - Introduction: Approximately 25.5 million pediatric patients are treated in Emergency Departments around the United States annually. Roughly 7% of these patients are transported by ambulance; of these, approximately 7% arrive in ambulances running red lights and sirens (RLS). Compared to those transporting without RLS, emergency vehicles employing RLS are involved in more accidents and are associated with more fatalities. Objective: To characterize the use of RLS in pediatric transports and identify factors associated with unnecessary use of RLS. Methods: As part of the Children's Safety Initiative (CSI-EMS), a large, multi-phased National Institutes of Health-funded study, we conducted a medical record review of all pediatric RLS transports in an urban EMS system over a 4-year period (2008–11). A standardized chart abstraction tool was adapted for the out-of-hospital setting and pilot tested. Charts were independently reviewed by physicians and paramedics, with disagreements arbitrated by a pediatric emergency physician. Reviewers were asked to judge whether RLS transport was necessary and to provide comments justifying their position. Descriptive statistics were used to measure the frequency of unnecessary transports and logistic regression analysis was employed to identify factors associated with unnecessary use of RLS. Results: Of 490 RLS transports, experts identified 96 (19.6%) as unnecessary use of RLS. Necessary and unnecessary RLS transports had similar patient sex and duration of transport, though unnecessary use of RLS tended to increase with patient age. The call reasons that represented the largest proportion of unnecessary RLS transports were trauma (49.0%), respiratory distress (16.7%), and seizure/altered mental status (11.5%). Compared with necessary RLS transports, unnecessary RLS transports were less likely to require resuscitation, airway management, or medication administration. Univariate analysis revealed that patient vital signs within normal limits were associated with increased risk of unnecessary RLS transport, with the most pronounced effect seen in the normal GCS score group (odds ratio 7.74, p-value 0.001). Conclusions: This analysis identified patient and transport characteristics associated with unnecessary use of RLS. Our results could help serve as the basis for designing and prospectively evaluating protocols for use of RLS, potentially mitigating the risk associated with transport in pediatric patients.

UR - http://www.scopus.com/inward/record.url?scp=84958053186&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958053186&partnerID=8YFLogxK

U2 - 10.3109/10903127.2015.1111477

DO - 10.3109/10903127.2015.1111477

M3 - Article

SP - 1

EP - 8

JO - Prehospital Emergency Care

JF - Prehospital Emergency Care

SN - 1090-3127

ER -