Document Type

Conference Proceeding

Publication Date


Publication Title

Prehospital emergency care


Study Objectives: The COVID-19 pandemic has significantly decreased pediatric emergency department (ED) utilization. The objective of this study was to quantify the characteristics of pediatric EMS utilization both before and during the COVID-19 pandemic in a metropolitan health care system.

Methods: We performed a multi-center, retrospective observational study of all pediatric ED visits between 1/1/2018 and 12/31/2021, that presented to one of nine EDs within our health system. The data were sorted by mode of arrival; children arriving to the ED via EMS, or arrival by other means. Data collection included a variety of demographic and clinical variables. We compared overall pediatric ED patients’ arrival methods as well as ED and EMS volumes by year using a binomial test with a null hypothesis that the population proportion equals 50%. Analysis compared ED mode of arrival, admission rate, and Emergency Severity Index (ESI) triage scores using chi-square tests.

Results: There were 201,313 pediatric ED encounters for 118,744 unique patients meeting the inclusion criteria. There were 8,815 (4.38%) children who arrived via EMS compared to 192,498 (95.62%) children who arrived by other means (p < 0.0001). Children who arrived via EMS had a higher admission rate of 22.27% (1963) compared to 5.9% (11,351, p < 0.0001). ESI among children arriving via EMS was higher, with 44.3% (3847) having ESI 1 or 2 triage scores compared to 8.8% (16,790) for children arriving by other means (p < 0.0001). Overall pediatric ED mortality was 0.03% (61 deaths), with 86.9% (53) of those children arriving via EMS (p < 0.0001). Pediatric ED and EMS volumes in 2018 and 2019 pre-pandemic were 127,652 ED visits and 5,306 EMS visits, respectively, compared to 73,661 and 3,509 visits in 2020 and 2021. This represents a 42.3% overall reduction in pediatric ED visits (p < 0.0001) and a 33.9% reduction in pediatric EMS visits (p < 0.0001).

Conclusion: Approximately 5% of pediatric ED encounters in our health system arrived via EMS. These children appeared to have higher acuity presentations and required inpatient services more often than children who arrived by other means. Pediatric ED and EMS encounters have decreased substantially since the onset of the pandemic.




Sup 1

First Page




To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.