Objective-To describe the epidemiology of repeat ambulance use by a pediatric population.

Methods- A database for the primary transporting Advanced Life Support prehospital service for a metropolitan area was analyzed for patients less than 21 years of age for the years 1992-5. Chief complaint (the primary reason for transport) by age category, gender and billing status were analyzed and compared for those patients transported once verses those transported more than once.

Results- There were 17,722 transports involving 15,168 patients. Of these, 1691 children were transported two or more times, 55 were transported more than six times and one child was transported 34 times. The proportion of transports for traumatic chief complaints did not differ by gender. The frequency of males transported for trauma increased with increasing age and the rate of increase was higher among patients transported repeatedly than among patients transported only once. Respiratory complaints were the most common chief complaints among children <1 year old and seizure in those aged 1-10 years for both the singly and repeatedly transported groups. In the 11-16 year old age group, repeat ambulance users had a higher proportion of transports (7.3%) for drug overdose than those transported only once (4.5%; O.R.=1.68, 95% CI=1.28,2.20). In this age group transports for trauma were less prevalent among repeat users (49.7%) than among those transported once (67.6%; p<0.0001). The 17-20 year olds who were transported repeatedly had a higher proportion of transports (6.0%) due to drug overdose than adolescents in the same age group transported only once(5.0%; O.R.=1.22, CI=0.97,1.53). The payment source for repeatedly transported patients was primarily self pay and Medicaid. The proportion of transports funded by Medicaid among repeat users (37.6%) was twice that of singly transported patients (18.4%; p<0.0001).

Conclusions-Pediatric patients who use the EMS system repeatedly are different from those children transported once. Respiratory disorders and seizures are areas in which age-specific case management for infants and children could decrease repeat ambulance transports. This may be especially effective in the Medicaid reimbursed population. For the older age groups, the impact of substance abuse on repeat ambulance transports is an area for possible intervention.