Emergency Medical Services Utilization by Children.

OBJECTIVE: The aim of this study was to compare demographic and clinical features of children (0-14 years old) who arrived at general emergency departments (EDs) by emergency medical services (EMS) to those who arrived by private vehicles and other means in a rural, 3-county region of northern California. METHODS: We reviewed 507 ED records of children who arrived at EDs by EMS and those who arrived by other means in 2013. We also analyzed prehospital procedures performed on all children transported to an area hospital by EMS. RESULTS: Children arriving by EMS were older (9.0 vs 6.0 years; P < 0.001), more ill (mean Severity Classification Score, 2.9 vs 2.4; P < 0.001), and had longer lengths of stay (3.6 vs 2.1 hours; P < 0.001) compared with children who were transported to the EDs by other means. Children transported by EMS received more subspecialty consultations (18.7% vs 6.9%; P < 0.05) and had more diagnostic testing, including laboratory testing (22.9% vs 10.6%; P < 0.001), radiography (39.7% vs 20.8%; P < 0.001), and computed tomography scans (16.8% vs 2.9%; P < 0.001). Children arriving by EMS were transferred more frequently (8.8% vs 1.6%; P < 0.001) and had higher mean Severity Classification Scores compared with children arriving by other transportation even after adjusting for age and sex (ß = 0.48; 95% confidence interval, 0.35-0.61; P < 0.001). Older children received more prehospital procedures compared with younger children, and these were of greater complexity and a wider spectrum. CONCLUSIONS: Children transported to rural EDs via EMS are more ill and use more medical resources compared with those who arrive to the ED by other means of transportation.

Nuclear/radiological terrorism: emergency department management of radiation casualties.

Recent world events have increased concern that hospitals must be prepared for radiological emergencies. Emergency departments (EDs) must be ready to treat patients suffering from injuries in combination with radiation exposure or contamination with radioactive material. Every hospital should have a Radiological Emergency Medical Response Plan, tested through periodic drills, which will allow effective handling of contaminated and injured patients. Treatment of life-threatening or severe traumatic injuries must take priority over radiation-related issues. The risk to ED staff from radioactive contamination is minimal if universal precautions are used. The likelihood of significant radiation exposure to staff under most circumstances is small. Educating medical staff on the magnitude of the radiological hazards allows them to promptly and confidently provide the necessary patient care. Measures must be taken to prevent the "worried well" and uninjured people with radioactive contamination from overwhelming the ED.