O0027: Emergency Medical Service (EMS) Provider Perceptions of Pediatric Non-transport

Background: One-third of pediatric EMS calls result in a child being left at the scene. There are, however, very few EMS agencies with protocols to help EMS providers determine when non-transport might be safe. Little is known about how EMS providers currently make non-transport decisions. Our objective was to describe how EMS providers currently make pediatric non-transport decisions and identify enablers and barriers to successfully implementing a pediatric non-transport triage tool.

Methods: We conducted virtual focus groups with EMS providers from the mid-Atlantic region. We used purposive sampling to ensure we captured a diverse sample for individual demographics, clinical experience, and EMS agency type. We refined a semi-structured moderator guide based on key informant interviews. A PhD-trained facilitator then moderated all groups using the final guide. De-identified transcripts were coded using Dedoose. Five study team members independently coded a sample transcript and reviewed it for inter-rater agreement. One team member then completed axial coding of the remaining transcripts until we had reached thematic saturation. Clusters of similar codes were grouped into themes by consensus.

Results: We recruited 50 participants, of whom 70% were Paramedics and 28% EMTs. Participants came from diverse settings with 64% suburban, 24% urban, and 12% rural. Participants had a median of 14 years of clinical experience. EMS providers agreed that caregivers often utilize 911 for low acuity complaints. Sub-themes identified included: (1) lack of access to after-hours primary care, (2) lack of education on what constitutes an emergency, and (3) anxiety amongst first-time parents. EMS providers uniformly described pediatric non-transport as a result of shared decision-making between EMS providers and caregivers. There was widespread agreement that while EMS providers commonly advise whether transport is necessary, caregivers are responsible for making the final decision (and then signing against medical advice (AMA) documentation). Subthemes for how non-transport decisions were made included: (1) individual experience as a caregiver, (2) presence of agency protocols, (3) availability of other healthcare resources, (4) fear of legal liability, and (5) absence of a legal guardian at the scene. Participants identified the following features that would enable successful implementation of an EMS non-transport protocol: (1) user-friendly interface, (2) short completion time, (3) mandatory documentation of vital signs, (4) clear protocol endpoints, (5) and optional online medical control with telemedicine capabilities.

Conclusion: EMS providers believe that a substantial proportion of pediatric EMS calls are for low acuity complaints that do not need emergent transport to the ED. In the absence of pediatric non-transport protocols, EMS providers commonly advise caregivers whether transport is necessary and ask them to sign AMA documentation. EMS providers identified multiple factors that would enable a formal non-transport protocol to be implemented successfully.