Study on the suitability of ambulance transportation to a paediatric medical emergency department

Objectives: To evaluate the appropriateness of ambulance use as transport to Emergency Medical Services and to determine if ambulance use is associated with preferential attention and to illness severity. Patients and method: All patients attended in a Paediatric Emergency Department during 2008 were included. Two groups were defined: Group 1, patients arriving by ambulance and Group 2, patients arriving by any other means of transport. In order to evaluate the appropriateness of ambulance use, a random sample of 300 patients from the Group 1 was selected; the ''Paediatric Ambulance Need Evaluation tool" was applied to final diagnosis. To assess the preferential attention, the rate of patients with triage evaluation, time to triage and time to medical attention were compared. Finally, to determine differences in the severity of illness, patients with triage level <= 3 and patients needing complementary examinations and/or hospital admission were analysed. Results: A total of 80537 patients were included, of which 2.5% arrived by ambulance. Estimation of the prevalence of inappropriate transport use was 31 % (95 CI%: 26.2-35.8%). Their main diagnoses were: epileptic attack (23-24.7%), panic attack (12-12.9%) and fever (12-12.9%). It was observed that triage evaluation, time to triage and time to medical attention was shorter in Group 1. The proportion of children with triage level <= 3, needing complementary examinations and/or hospital admission was higher in-Group 1. Conclusion: A high number of patients arriving by ambulance could have used another means of transport. However, the greater severity of a significant number of patients justifies the preferential attention given. Triage use in all patients arriving by ambulance would help in the detection of high priority cases and to improve the Emergency Department performance. (C) 2009 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L. All rights reserved.