Journal article
Preferences for emergency medical service transport after childhood injury: An emergency department-based multi-methods study
Injury, Vol.51(9), pp.1961-1969
09/2020
DOI: 10.1016/j.injury.2020.04.036
PMCID: PMC7508417
PMID: 32507453
Abstract
•Multiple factors drive parental decisions to seek emergency care following child injury.•Decision-making after child injury is related to characteristics of the nearby parent or guardian.•Parental decision-making factors after injury differ from emergency medical service decision-making criteria.
Pre-hospital emergency medical services (EMS) transport can be associated with benefits following pediatric injury. However, many pediatric trauma patients do not use EMS. The objective of this study was to elucidate guardians’ decision factors for pre-hospital transport for children after injury.
This is a multi-methods study of pediatric trauma patients (≤14 years) and their guardians presenting to the ED of a Level I Pediatric Trauma Center via both EMS and non-EMS modalities. Demographic information and injury characteristics were collected. Semi-structured interviews were conducted, and qualitative codes were identified and assigned into themes.
(Quantitative): Of the 29 child-guardian pairs, five participants initially presented by EMS, 18 were admitted, and the majority (66%) sustained mild injuries. Guardians’ assessment of their child's injury severity did not correlate with Injury Severity Score (ISS). Neither EMS status (did or did not use EMS to transport to first hospital) nor rurality status of participants’ place of residence were associated with disparate management in any of the three scenarios.
Five themes emerged, which informed guardians’ transport decisions: Factors Related to the Nature of the Patient's Injury, Guardian Attributes and Prior Experiences, Access and Availability of EMS, Perceived Risks and Benefits of EMS and Hospital, and Collaborative Decision-Making. Injury characteristics and contextual factors, like perceived EMS response times and advice from family or medical providers, were considered in choices about EMS utilization and hospital selection. Despite the view that EMS response times were important in determining what to do following injury, both EMS and non-EMS users were largely unfamiliar with the capabilities of EMS in their area. Finally, guardians described cost to be a theoretical risk of EMS use, and a few cited this as a factor contributing to their decision-making.
Guardians used a variety of considerations to make transport decisions, including the five themes identified above. Future studies could explore modalities to disseminate information about pre-hospital decision-making for guardians and determine the relationship between EMS utilization and patient outcomes.
Details
- Title: Subtitle
- Preferences for emergency medical service transport after childhood injury: An emergency department-based multi-methods study
- Creators
- Rob Thinnes - Roy J. and Lucille A. Carver College of MedicineMorgan B. Swanson - Roy J. and Lucille A. Carver College of MedicineKristel Wetjen - University of IowaKarisa K. Harland - Roy J. and Lucille A. Carver College of MedicineNicholas M. Mohr - Roy J. and Lucille A. Carver College of Medicine
- Resource Type
- Journal article
- Publication Details
- Injury, Vol.51(9), pp.1961-1969
- DOI
- 10.1016/j.injury.2020.04.036
- PMID
- 32507453
- PMCID
- PMC7508417
- NLM abbreviation
- Injury
- ISSN
- 0020-1383
- eISSN
- 1879-0267
- Publisher
- Elsevier Ltd
- Language
- English
- Date published
- 09/2020
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center; Law Faculty
- Record Identifier
- 9984296146102771
Metrics
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