Maternal and Child Health Journal

, Volume 10, Issue 6, pp 527–536 | Cite as

Medically Unnecessary Emergency Medical Services (EMS) Transports Among Children Ages 0 to 17 Years

  • P. Daniel PattersonEmail author
  • Elizabeth G. Baxley
  • Janice C. Probst
  • James R. Hussey
  • Charity G. Moore
Original Paper


Objectives: Estimate the prevalence of medically unnecessary Emergency Medical Services (EMS) transports among children. Methods: We linked EMS and emergency department (ED) billing records for all EMS-to-hospital transports of children originating in three counties in South Carolina between January 1, 2001 and March 31, 2003. EMS responses resulting in no transport, transports to destinations other than the ED, or multiple trips for the same child in a single day could not be linked to ED data and were excluded. Medically unnecessary transports were identified with an algorithm using pre-hospital impressions, ED diagnoses and ED procedures. After exclusions, 5,693 transports of children between 0 and 17 years were available for study. Results: Sixteen percent (16.4%) of all transports were medically unnecessary. Among children through age 12, upper respiratory and viral problems were the most common diagnoses associated with medically unnecessary transports; among older children, behavioral problems such as conduct disturbance or drug abuse were common. In multivariable analysis, the odds of an unnecessary transport were higher among younger children, non-white children, rural children, and children insured by Medicaid. Conclusions: The proportion of EMS transports which may be medically unnecessary is relatively modest compared to previous studies. However, many questions remain for future research. Further investigation should include examination of primary care availability and occurrence of unnecessary EMS use, existence of race-based disparities, and transports involving conduct disturbance and other behavioral conditions among children.


Emergency medical services Medically unnecessary transports Children 



This research was supported in part by a National Research Service Award Post-Doctoral Traineeship from the Agency for Healthcare Research and Quality sponsored by the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Grant No. T32-HS000032.


  1. 1.
    McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary (Report No 340). Hyattsville, Maryland: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Care Statistics, 2004.Google Scholar
  2. 2.
    Johnston C, King WD. Pediatric prehospital care in a southern regional emergency medical service system. South Med J 1988;81(12):1473–6.PubMedGoogle Scholar
  3. 3.
    Tsai A, Kallsen G. Epidemiology of pediatric prehospital care. Ann Emerg Med 1987;16(3):284–92.CrossRefPubMedGoogle Scholar
  4. 4.
    Haddy RI, Schmaler ME, Epting RJ. Nonemergency emergency room use in patients with and without primary care physicians. J Fam Pract 1987;24(4):389–92.PubMedGoogle Scholar
  5. 5.
    Camasso-Richardson K, Wilde JA, Petrack EM. Medically unnecessary pediatric ambulance transports: a medical taxi service? Acad Emerg Med 1997;4(12):1137–41.PubMedGoogle Scholar
  6. 6.
    Doobinin KA, Heidt-Davis PE, Gross TK, Isaacman DJ. Nonurgent pediatric emergency department visits: Care-seeking behavior and parental knowledge of insurance. Pediatr Emerg Care 2003;19(1):10–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Mann N, Schmidt T, Cone D. Defining research criteria to characterize medical necessity in emergency medical services: A consensus among experts at the neely conference. Prehosp Emerg Care 2004;8(2):138–53.CrossRefPubMedGoogle Scholar
  8. 8.
    Office of Inspector General & Department of Health and Human Services Medicare payments for ambulance transports (Report No OEI-05-02-00590). Washington, DC: 2006.Google Scholar
  9. 9.
    Bamezai A, Melnick G, Nawathe A. The cost of an emergency department visit and its relationship to emergency department volume. Ann Emerg Med 2005;45(5):483–90.CrossRefPubMedGoogle Scholar
  10. 10.
    Selig M, Borton D. Keeping volunteers in EMS* (*emergency medical services). Volunt Action Leadersh 1989;Fall:18–20.Google Scholar
  11. 11.
    Derlet RW. Overcrowding in emergency departments: increased demand and decreased capacity. Ann Emerg Med 2002;39(4):430–2.CrossRefPubMedGoogle Scholar
  12. 12.
    McKonkey K. 911 services sometimes used frivolousy. The Kinston Free Press; 2005.Google Scholar
  13. 13.
    Smith T. 911 calls may not yield siren: Local test project may free up ambulances if it’s not an emergency. Richmond Times-Dispatch; 2005.Google Scholar
  14. 14.
    Gonzalez M. Plan will limit firefighters to emergencies only. Daily Press; 2005.Google Scholar
  15. 15.
    Harris L, Bombin M, Chi F, deBortoli T, Long J. Use of the emergency room in Elliot Lake, a rural community of Northern Ontario, Canada. Rural Remote Health 2004;4(1):1–12.Google Scholar
  16. 16.
    Grossman LK, Rich LN, Johnson C. Decreasing nonurgent emergency department utilization by medicaid children. Pediatrics 1998;102(1):20–4.CrossRefPubMedGoogle Scholar
  17. 17.
    Piehl MD, Clemens CJ, Joines JD. Narrowing the Gap: Decreasing emergency department use by children enrolled in the medicaid program by improving access to primary care. Arch Pediatr Adolesc Med 2000;154(8):791–5.PubMedGoogle Scholar
  18. 18.
    Dale J, Williams S, Foster T, Higgins J, Snooks H, Crouch R et al. Safety of telephone consultation for “non-serious” emergency ambulance service patients. Qual Saf Health Care 2004;13(5):363–73.CrossRefPubMedGoogle Scholar
  19. 19.
    Chan T, Vilke G, Smith S, Sparrow W, Dunford J. Impact of an after-hours on-call emergency physician on ambulance transports from a county jail. Prehosp Emerg Care 2003;7(3):327–31.PubMedGoogle Scholar
  20. 20.
    Billittier A, Moscati R, Janicke D, Lerner EB, Seymour J, Olsson D. A multisite survey of factors contributing to medically unnecessary ambulance transports. Acad Emerg Med 1996;3(11):1046–52.PubMedGoogle Scholar
  21. 21.
    Kost S, Arruda J. Appropriateness of ambulance transportation to a suburban pediatric emergency department. Prehosp Emerg Care 1999;3(3):187–90.PubMedGoogle Scholar
  22. 22.
    Coid DR. Measurement for management: report of a pilot project to quantify ambulance misuse for managers of a Fife hospital. Health Serv Manage Res 1989;2(3):213–6.PubMedGoogle Scholar
  23. 23.
    Brady WJ, Hennes H, Wolf A, Hall KN, Davis M. Pattern of basic life support ambulance use in an urban pediatric population. Am J Emerg Med 1996;14(3):250–3.CrossRefPubMedGoogle Scholar
  24. 24.
    Rosenberg N, Knazik S, Cohen S, Simpson P. Use of Emergency Medical Service transport system in medical patients up to 36 months of age. Pediatr Emerg Care 1998;14(3):191–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Gratton M, Ellison S, Hunt J, Ma O. Prospective determination of medical necessity for ambulance transport by paramedics. Prehosp Emerg Care 2003;7(4):466–9.PubMedCrossRefGoogle Scholar
  26. 26.
    O’Leary C, Bury G, McCabe M, Kelly C, McGoldrick F, Ward F. Ambulance-user analysis in an accident and emergency department. Ir Med J 1987;80(12):422–3.PubMedGoogle Scholar
  27. 27.
    Carroll V. [Abstract] The impact of EMS system over-utilization on a large urban EMS service. Prehosp Emerg Care 2006;10(1):122.Google Scholar
  28. 28.
    Patterson PD, Moore CG. [Abstract] Inter-rater agreement using one component of the Neely Conference Criteria for determining medical necessity of EMS transports. Prehosp Emerg Care 2006;10(1):121–2.Google Scholar
  29. 29.
    South Carolina Budget and Control Board, Office of Research and Statistics. [On-line]. Available:, 2004Google Scholar
  30. 30.
    Lowy A, Kohler B, Nicholl J. Attendance at accident and emergency departments: unnecessary or inappropriate? J Public Health Med 1994;16(2):134–40.PubMedGoogle Scholar
  31. 31.
    Lowe RA, Bindman A. Judging who needs emergency department care: a prerequisite for policy-making. Am J Emerg Med 1997;15(2):133–6.CrossRefPubMedGoogle Scholar
  32. 32.
    South Carolina Office of Research and Statistics. South Carolina Community Profiles. http://www.sccommunityprofiles. org/zip_profile.asp [On-line]. Available: http://www., 2003Google Scholar
  33. 33.
    Eagle DJ, Rideout E, Price P, McCann C, Wonnacott E. Misuse of the emergency department by the elderly population: myth or reality? J Emerg Nurs 1993;19(3):212–8.PubMedGoogle Scholar
  34. 34.
    Asplin B. Undertriage, overtriage, or no triage? In search of the unnecessary emergency department visit. Ann Emerg Med 2001;38(3):282–5.CrossRefPubMedGoogle Scholar
  35. 35.
    Zachariah BS. The problem of ambulance misuse: whose problem is it, anyway? Acad Emerg Med 1999;6(1):2–5.PubMedGoogle Scholar
  36. 36.
    Newacheck PW, Pearl M, Hughes DC, Halfon N. The role of Medicaid in ensuring children’s access to care. JAMA: J Am Med Assoc 1998;280(20):1789–93.CrossRefGoogle Scholar
  37. 37.
    Newacheck PW, Stoddard JJ, Hughes DC, Pearl M. Health insurance and access to primary care for children. New Engl J Med 1998;338(8):513–9.CrossRefPubMedGoogle Scholar
  38. 38.
    O’Brien GM, Stein MD, Zierler S, Shapiro M, O’Sullivan P, Woolard R. Use of the ED as a regular source of care: associated factors beyond lack of health insurance. Ann Emerg Med 1997;30(3):286–91.CrossRefPubMedGoogle Scholar
  39. 39.
    Kingdom DN. Welcome to the World: Process evaluation of a paramedic-delivered home safety intervention. Chapel Hill: MPH University of North Carolina; 2003.Google Scholar
  40. 40.
    American College of Emergency Physicians. Ear Infections: How You Can Avoid an Emergency. http://www. Pediatrics/FeatureColumnEar±InfectionsHowYouCanAvoidan Emergency.htm [On-line]. Available: http:// www. aceporg/ webportal/ PatientsConsumers/ HealthSubjectsByTopic/ Pediatrics/ FeatureColumnEar± InfectionsHowYouCanAvoidanEmergency. htm, 2005.Google Scholar
  41. 41.
    Alternate ambulance transportation and destination–National Association of EMS Physicians/American College of Emergency Physicians Joint Position Paper. Prehosp Emerg Care 2001;5(3):289.Google Scholar
  42. 42.
    Medical condition list and appropriate use of air medical transport–Position statement of the Air Medical Physician Association. Prehosp Emerg Care 2002;6(4):464–70.Google Scholar
  43. 43.
    Schmidt T, Neely(*) K, Adams A, Newgard C, Wittwer L, Muhr M et al. Is it possible to safely triage callers to EMS dispatch centers to alternative resources? Prehosp Emerg Care 2003;7(3):368–74.Google Scholar
  44. 44.
    Hauswald M. Can paramedics safely decide which patients do not need ambulance transport or emergency department care? Prehosp Emerg Care 2002;6(4):383–6.PubMedGoogle Scholar
  45. 45.
    Silvestri S, Rothrock S, Kennedy D, Ladde J, Bryant M, Pagane J. Can paramedics accurately identify patients who do not require emergency department care? Prehosp Emerg Care 2002;6(4):387–90.PubMedGoogle Scholar
  46. 46.
    Ames JR, Baer LD, Bird DC, Bolda EJ, Casey MM, Clark SJ, et al. Rural Health in the United States. New York, NY: Oxford University Press, Inc.; 1999.Google Scholar
  47. 47.
    Davis CO, Bauer C, Arnold J, Shah MN. Emergency Medical Services for Nonurgent Pediatric Patients: Parents’ Opinions of Alternatives. Acad Emerg Med 2006;13(5_suppl_1):S86.CrossRefGoogle Scholar
  48. 48.
    Foldes S, Fischer L, Kaminsky K. What Is an Emergency? The Judgments of Two Physicians. Ann Emerg Med 1994;23(4):833–40.PubMedGoogle Scholar
  49. 49.
    O’Brien GM, Shapiro MJ, Woolard RW, O’Sullivan PS, Stein MD. “Inappropriate” emergency department use: a comparison of three methodologies for identification. Acad Emerg Med 1996;3(3):252–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Pointer J, Levitt M, Young J, Promes S, Messana B, Ader M. Can paramedics using guidelines accurately triage patients? Ann Emerg Med 2001;38(3):268–77.CrossRefPubMedGoogle Scholar
  51. 51.
    Sasser SM, Brokaw M, Blackwell TH. Paramedic vs emergency physician decisions regarding the need for emergency department evaluation [abstract]. Acad Emerg Med 1998;5(5):391.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • P. Daniel Patterson
    • 1
    Email author
  • Elizabeth G. Baxley
    • 2
  • Janice C. Probst
    • 3
  • James R. Hussey
    • 4
  • Charity G. Moore
    • 1
    • 5
  1. 1.Cecil G Sheps Center for Health Services ResearchThe University of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Family and Preventive MedicineUniversity of South Carolina School of MedicineColumbiaUSA
  3. 3.Department of Health Services Policy and Management, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  4. 4.Department of Epidemiology and Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  5. 5.Departments of Medicine & Biostatistics, Division of General Medicine and EpidemiologyUniversity of North Carolina at Chapel HillChapel HillUSA

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