The Epidemiology of Pediatric Ambulance Transport in Ontario, Canada

Background: Trauma is one of the most frequent requests for ambulance services. However, little is known about the mechanism of injury sustained by pediatric patients seen by a paramedic. There are few studies comparing ambulance transport to private transport in pediatric patients and none within the Canadian context.

Methods: This dissertation consists of three studies that describe the epidemiology of pediatric ambulance transport in Ontario, Canada. Study 1 focuses on creating a profile of children <19 years who were seen by Toronto Paramedic Services. Study 2 examines the difference in all-cause-mortality, hospitalization, ICU admission, and severe injury between ambulance transport and private transport to the emergency department [ED] in children in the province of Ontario. Study 3 examines differences in all-cause-mortality, hospitalization, ICU admission, and severe injury between ambulance transport and private transport in motor vehicle collisions for children in Ontario.

Results: In Manuscript 1, the most common mechanism of injuries were falls, transport related injuries, assault/gunshot injuries, injuries involving choking or foreign bodies, and burn/scald injuries. In Manuscript 2, there were 1,872,519 patients who sustained an injury in Ontario with 129,577 (6.9%) transported to the ED via ambulance. The adjusted OR for all cause mortality was 154.88 (95% CI: 101.11-237.23), the adjusted OR for ICU admission was 19.17 (95% CI: 18.01-20.41), the adjusted OR for hospitalization was 13.27 (95% CI: 12.97-13.57) and the adjusted OR for severe injury was 1.88 (95% CI: 1.78-1.98). In Manuscript 3, There were 32,025 patients who sustained an injury in an MVC with 13,995 (43.7%) transported to the ED via ambulance. The adjusted OR for mortality in an MVC was 33.05 (95% CI: 8.05-135.79), the adjusted OR for ICU admission was 17.14 (95% CI: 11.57-25.39), the adjusted OR for hospitalization was 13.30 (95% CI: 11.05-16.01), and the adjusted OR for severe injury was 2.22 (95% CI: 1.45-3.39).

Conclusions: The majority of injuries seen by TPS were fall related, transport-related, gunshots/assaults, choking/foreign body, and burn/scald injuries. Ambulance transport amongst pediatric patients who sustained an injury and patients who were injured in an MVC in Ontario is associated with increased odds of mortality and morbidity outcomes.