362 - Characteristics of pediatric behavioral health emergencies in the prehospital setting

Poster Number: 362
Publication Number: 362.21

Julia Walczak, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Vishal Naik, Northwestern University / Lurie Children's Hospital, Chicago, IL, United States; Kenshata Watkins, University of California, San Francisco, School of Medicine, Oakland, CA, United States; Sriram Ramgopal, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Jennifer A. Hoffmann, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States

Background: Approximately 10% of emergency medical services (EMS) encounters in the United States are behavioral health-related. However, pediatric behavioral health EMS encounters have not been well characterized.

Objective: To describe demographic, clinical, and EMS-system characteristics of pediatric behavioral health EMS encounters across the United States and to evaluate factors associated with sedative medication administration or physical restraint use during these encounters.

Design/Methods: We conducted a retrospective cross-sectional study of behavioral health EMS encounters for children under 18 years of age from 2019-2020 using the National Emergency Medical Services Information System. Behavioral health encounters were defined using primary or secondary impression codes. We used multivariable logistic regression to identify factors associated with sedative medication administration or physical restraint use.

Results: We identified 309,442 pediatric behavioral health EMS encounters (85.2% 12 to 17-years, 57.3% female, 86.6% urban). Sedative medications and physical restraints were used in 2.1% and in 3.0% of encounters, respectively. There were higher adjusted odds of using sedative medications in the Western relative to the Southern region of the US (adjusted odds ratio [aOR] 1.51, 95% CI 1.40-1.64) and among EMS encounters in children with developmental, communication, or physical disabilities relative to their absence (aOR 3.36, 95% CI 2.90-3.89). There were higher adjusted odds of using physical restraint with an age of 6-11 years relative to 12-17 years (aOR 1.38, 95% CI 1.30-1.47); among EMS counters in the Western relative to the Southern region of the US (aOR 3.44, 95% CI 3.22, 3.68); and in private, nonhospital EMS systems relative to fire departments (aOR 3.41, 95% CI 3.20, 3.63).

Conclusion(s): In pediatric prehospital behavioral health EMS encounters, the use of sedative medications and physical restraints varies by EMS-system and patient characteristics, notably in patients with developmental, communication, or physical disabilities. Significant regional variation suggests the need for standardization of care and implies that opportunities may be available to reduce the use of restrictive interventions.