MEDICALLY UNNECESSARY PEDIATRIC AMBULANCE TRANSPORTS - A MEDICAL TAXISERVICE

Objective: To characterize ambulance utilization in a pediatric popula tion and pediatric emergency physicians' judgment of the medical need for ambulance transport, Methods: A convenience sample of ambulance tr ansports were studied prospectively during a 5-week period. Exclusion criteria included transfer from another medical facility, study physic ian not available, need for immediate resuscitation, or trauma team ac tivation. A questionnaire completed by the physician assessed medical need for the ambulance based on chief complaint, general appearance, v ital signs, and ambulance run sheet information, A separate questionna ire was administered to the parents regarding reasons for ambulance us e and other available means of transportation. Caregivers were contact ed 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 medi cally unnecessary, Interestingly, 40% (37/92) of the subjects had no o ther means of transportation; 86% (32/37) of ambulance transports for this group were judged medically unnecessary, Overall, 86% (79/92) of families had not called their physician, There was no association betw een having spoken with the physician and medical need for an ambulance . Many (82%; 46/56) Medicaid transports were judged medically unnecess ary. Overall, follow-up was achieved for 91% (85/92) of the patients, No patient for whom transport was medically unnecessary had a repeat E D visit for the same complaint or required admission, Most patients (7 4%; 68/92) returned home without any assistance, Among the medically u nnecessary transports, 52% (32/60) of the caregivers cited no other me ans of transportation, yet 34% (11/32) of these patients returned home by private car, Conclusions: Most pediatric ambulance transports in t his sample, which excluded patients requiring immediate resuscitation or trauma team care, were judged to be medically unnecessary, Caregive rs often use an ambulance as a convenience or as the only means of tra nsportation. An alternate, less resource-intensive transportation syst em may be more appropriate for this population.