Pediatric Clinical Interventions and Adverse Safety Events Among Emergency Medical Services Encounters in Agencies With and Without a Pediatric Emergency Care Coordinator: An Observational Study

OBJECTIVES The purpose of this study was to compare the frequency and types of adverse safety events (ASEs) and potential harm in a diverse population of pediatric emergency medical services (EMS) encounters. As a secondary aim we evaluated the association between prehospital pediatric emergency care coordinators (PECCs) in EMS agencies on the frequency, type and harm severity of ASEs.METHODS This was a cross-sectional study of EMS and hospital records for children <18 years who received care from 15 EMS agencies from 2019 to 2023, using a validated ASE chart review tool. Frequency and types of ASEs associated with three different categories of clinical interventions (procedures, medication, and fluid administration) were captured. ASEs were assigned to three severities of harm: Harm Unlikely, Mild Temporary Harm, or Permanent/Severe Harm. EMS Physicians verified ASEs and harm severity.RESULTS There were 2219 records included in the analysis, 995 from PECC agencies (44.8%). Median patient age was 12.5 years (IQR 6-15). In total, 551 (55.4%; CI: 52.3, 58.5) PECC agency patients had a procedure compared to 328 patients of agencies without a PECC (26.8%; CI: 24.3, 29.3; p < 0.001). Compared to non-PECC agency patients, PECC agency patients were more likely to receive medications (23.4% vs 7.7%, p< 0.001) and receive intravenous fluids (12.9% vs 4.6%, p< 0.001). In total, 290 ASEs were identified, the most frequent of which was the failure to perform a procedure or administer a medication or fluids (43.1%, CI: 37.4, 48.8). There were differences between PECC and non-PECC agencies in the frequency of ASEs in procedures (13.7% vs, 20.0%, p = 0.003). The assigned severity of ASE Mild Temporary and Permanent/Severe Harm was lower for procedures in PECC versus non-PECC agencies, respectively (28.6%, CI: 29.5, 48.5 and 63.3%, 95% CI: 69.6, 88.4, p < 0.001).CONCLUSIONS Compared to non-PECC agency care, pediatric care by PECC agencies was associated with more procedures, medication and fluid administration, but fewer ASEs for procedures and lower severity of harm when an ASE occurred. These results indicate that the PECC role may be associated with increased interventions and a reduction in harm associated with procedural care.