Use of Emergency Medical Services for Pediatric Interfacility Transports

OBJECTIVE Regionalization of pediatric care may affect interfacility transports (IFTs). We sought to evaluate trends in emergency medical services (EMS) use for IFTs over time and age-based differences in encounter characteristics as there may be implications for emergency department (ED) and EMS training and equipment availability. METHODS We performed a retrospective cross-sectional study using 2018–2023 National EMS Information System data sets, including IFT encounters among children younger than 18 years. We used a time series model and described characteristics by age group. RESULTS We included 4 333 424 pediatric EMS encounters, of which 937 122 (21.6%) were IFTs. From 2018 to 2023, there was an increase from 114 531 to 185 438 encounters, representing a rise of 2014 encounters per year (168/month; 95% CI, 106–230). The middle childhood age group had the largest increase by 32 encounters per month (95% CI, 25.4–38.4). Two primary impressions, systemic states and psychiatric/behavioral/substance use conditions, had the greatest increase among all primary impressions, (39/month [95% CI, 34.8–43.3] and 21/month [95% CI, 13.5–28.4], respectively). Respiratory conditions predominated in younger children, from 24.0% in those aged at least 2 years to younger than 6 years to 32.8% in infants. Most airway procedures were performed in younger children, whereas restraints were more common in adolescents. CONCLUSIONS IFTs account for an increasing number of EMS encounters. We identified differences by age in EMS characteristics, impressions, and interventions. Further investigation into the current state of ED pediatric readiness and IFT clinical indications and dispositions is needed to improve care at primary EDs and efficiently provide care during transport while minimizing unnecessary IFTs.