- Email: [email protected]
Emergency medical services and the adolescent patient
JOURNAL OF ADOLESCENT HEAJ2-H 1991;12:9.5-100
mergency ical Services a Adolescent Patient JAMES S. SEIDEL,
M.D.,
e
Ph.D.
A study of 10,493 prehospital care report forms from 11 counties in California demonstrated that the adolescent age group (ages 12 to 18 years) accessed prehospital care through the emergency medical service (EMS) system more frequently than other pediatric patients (5978 reports). They did so most commonly for trauma (87.6%), but also for behavioral emergencies such as surcide and psychiatric problems. The most common cause of injury was automobiles, and care rendered wab most commonly wound care and splinting. The most common substances given to adolescents in the prehospital setting were naloxone and 50% dextrose. EMS systems need to Address the need for triage and care of adolescent patients.
KEY WORDS:
Adolescent acute care
EMS prehospital care Adolescent EMS care
Little is known about the utilization of emergency medical services (EMS) by adolescent patients. Because adolescence is a relatively healthy time of life, persons in the age group 12 to 18 years of age may come into contact with health professionals as a result of high-risk behaviors, such as injuries, fighting and violence, suicide, substance abuse, sexually transmitted diseases, and nutritional and eating disorders. Data collected in 1987 from 11,419 eighth and From The California EMSC Project, the Departments Emergency Medicine and Pediatrics, UCLA School of Medicine, Harbor-UCLA Medical Center, Torrance California. Address reprint requests to: James S. Seidel, M.D., Ph.D., Department of Emergency Sewices, UCLA School of Medicine, HarborUCLA Medica! Center, 2000 West Carson Street, D9, Torrance, CA 90509. Manuscript accepted luly 24, 1990.
tenth grade students in 20 states, from The National Adolescent Student Health Survey (NASHS), demonstrated the prevalence of high-risk-taking behavior by teens: 56% of the students rode in vehicles without using seat belts, 32% of eighth grade students reported having ridden in the past month with a driver who was under the influence of alcohol or drugs, 49% percent of the boys and 28% of the girls reported being in at least one fight during the past year, 77% of the eighth gradtrs and 86% of the tenth graders said they had used alcohol, and 15% and 35% of the eighth and tenth graders, respectively, had used drugs (1). These behaviors may lead to injuries and illness that result in the utilization of emergency medical services. There are no available data on the access to health care by adolescent patients through EMS systems. This report will therefore examine the use of EMS by adolescent patients aged 12 through 18 years.
Materials and Methods This study had two parts: Part i is a survey of state EMS agencies, and Part 11is an analysis of data from adolescent EMS calls in 11 California counties. Part I All state Emergency Medical Service provider agencies, as well as those from Los Angeles, San Diego, and Orange Counties in California, were contacted by phone. The agencies were surveyed to determine: the age at which a patient was considered a pediatric or an adult patient; the number of prehospital runs made annually; use of public, private, or volunteer providers; and presence of a trauma care system or pediatric component of the system. The three California counties are included because they represent
0 Society for Adolescent Medicine, 1991 Published by Elsevier Science Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010
95
1054-139x/91/w.LQ
96
SEIDEL
the largest and most organized EMS systems in the country. Data were analyzed using a commercial spread sheet program. Part II Data on EMS runs were abstracted from prehospital care report (PCR) forms of four EMS agencies: Los Angeles County, NorCal EMS Agency (an agency that administer an eight-county area in Northern California), San Luis Obispo County EMS Agency, and Santa Cruz County EMS Agency. A standardized form was used for data collection. EMS runs for patients 12 through 18 years of age, from January 1 through December 31, 1984 were reviewed from NorCal, San Luis Obispo, and Santa Cruz. A 3month period, from September 1 through November 30, 1984, was abstracted from Los Angeles County to correspond with the time period of an existing data set for trauma patients. The 1984 data were selected because they were the only complete data sets available from all the study areas at the time of the study. A small repeat study of data from 1986 showed no statistically sigr:ificant changes. Data were entered into a commercially available software package and outloaded to the UCLA Biomedical Computer Facility for statistical analysis. Data entry was found to be reliable (98%) by analysis of repeated data sets from the PCR forms by the staff of the California EMSC Project. Data included service times; month, day, and time of day of the call; location; type of responding personnei; type of transport; subject’s age and sex; chief complaint(s); mechanism(s) of injury; base hospital contact; physical assessment; field treatment; and disposition. Data were analyzed using Students t-tests, analysis of variance, x2 test, and MannWhitney tests. Only some of the data elements collected will be discussed in this report.
Results Part I: State EMS Survey Data were received by telephone from SO states, three county agencies, and the District of Columbia. The mng&of runs per agency per pear varys widely with a low of 24,000 calls per year b1,:~Wyoming to a high of 1400,080 in New York and an average of 290,552 calls per year. Fourteen state agencies could neither give an exact number or estimate the number of EMS calls per year. The majority of the states (84%) and all of the
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 2
three counties utilize both public and private providers; 13.7% use only private providers, and one state uses only public providers. Many states also use volunteers as first responders for many EMS calls. Only 10 states and two of the three California counties had a written definition of the age of a pediatric patient. Of the 12 agencies having an age definition, five defined the upper limit as 14 years of age, two as 16 years, three as 18 years, and one each as 19 or 21 years of age. Four respondents stated that EMS providers based their assessment on observation in the field. The remainder of the states stated that the designation of a pediatric patient varied from case to case, or that they did not have a poliLy. When asked at what age a patient was considered an adult, 27 states responded with an age. The raxrge of ages varied from 15 years in one agency to 21 years in another, with the majority (19 states) listing 18 years as the age of an adult patient. Only six of the states that defined an age of #anadult patient also had a definition of a pediatric patient. Among the 20 systems with a trauma system in place, eight had an age policy, and others left it up to the provider to make a decision in the field. Of the nine respondents who stated that they had a pediatric system within their EMS system, four did not have an age definition of a pediatric patient and one used clinical arJsessment in the field. Part II: EMS Activities fw the Adolescent Age Group The study areas included 11 counties in California: Los Angeles, San Luis Obispo, Santa CNZ, Butte, Shasta, Modoc, Lassen, Trinity, Tehama, Pulmas, and Siskiyou, which contain large metropolitan centers, urbanized rural areas, and rural and remote areas. Most of these counties have large populations under 18 years of age. Figure 1 contrasts the percentage of adolescents in the general population with that using EMS. The majority (85%) of EMS calls were for patients over 14 years of age (Table 1). A total of 5978 EMS runs sheets for patients between the ages of 12 and 18 years were analyzed; however, not all had complete data. There were 3215 (57%) EMS calls for males and 2450 (43%) for females. Forty-eight percent of the calls took place between Friday afternoon and Sunday evening. Eighteen percent of the calls took place between the hours of 12 PM and 8 AM (Fig. 2). These calls were primarily for trauma due to automobile injuries (87.2%) with other calls for violent acts such as gunshot wounds (8.5%) or stabbing (4%). Ten percent
March 1991
EMF:RGEhCY MEDICAL SERVICES
97
50
40. 30 20 10 0
Qen Pop Urban
Table 1. Age of Adalescents
9 Urban
Using EMS Senices
m
Gm
Pop Rural
in
Urban and Rural AI-&S Age (v)
Urban
Rural
no. (%)
no. (%j
Total no. (‘70)
12-13 14-16 17-18
765 (12.8) 2219 (37.7) 2230 (37.4)
103 (1.7) 335 (5.6) 308 (5.2)
868 (14.6) 2554 (42.8) 2538 (42.6)
Total
5214 (87.5)
746 (12.5)
5960 (100)
of the stabbings and gunshot wounds were in the 12- to 15-year-old age group; 90% were in the 16- to l&year-old group. The most commonly listed chief complaints given by the patients are shown on Fig. 3. More than one complaint was often listed. Most complaints involved trauma with head trauma, abrasions, contusion, laceration!;; and fractures the most common complaints listed. Adolescents were also seen for seizures, ingestions,. and overdoses as well as respiratory distress. Behavioral emergencies such as suicide attempts (34 cases) and psychiatric emergencies (336 cases) were most common in the older age group. Suicide attempts may have been underreported as some of the calls listed as ingestionpoisoning may have been suicide attempts.
The common mechanisms of injury listed on the
PCRsare listed in Fig. 4. Motor vehicles (auto, motorcycle, moped, etc.) were responsible for the majority of injuries in all age groups (2175 cases); however, there were a significant number of falls, ingestions, and contact sport injuries. Violent acts such as gunshot wounds (99 cases) and stab wounds (49 cases) were evident even in the 12- to 13-yearold age group. The most common procedures used in the prehospital setting (field) were splinting and spinal im mobilization (823 times, 13.8% of the calls). Spinal precautions were used for trauma and altered mentai status, and sp!inting for trauma and obvious fractures, Advanced airway management including ,,ndotracheal intubation (5 timesj bag-valve mask ventilation, (1 time), and elder valve use (5 times) were rarely used. Most of the patients receiving drugs ard/or intravenous lines in the field had trauma or altered mental status. Intravenous lines were started on 165 patients. Drugs were given on 110 calls (1.8%), primarily for altered mental status,
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 2
SFJDEL
98
Number
of Patients
so0 400 300
Figure 3. Type of EMS call by age of the patien!.
Number of Patients 600 so0 400 300 200 100 0 12-13 years
14-16 years
17-18 years
Type of Call I
Abrasion
E3
Lacerat ion
m
IngeStiOnWD
0
Seizure
m
Head Trauma
m
Resp Dlsatrsss 0
Fracture Suiclda
March1991
EMERGENCY MEDICAL SERVICES
99
Number of Patients 6ooe
-
14-16 years
12-13 years
Auto Versus m
Contact
Spprtl
m
V-16
Other Vehlclen
F&I
Gun\Stab
Mstorcycle
ingestions, seizures, and behavioral emergencies. The most common substances administered intravenously were naloxone and dextrnsr- 50%.
Discussion About 10% of the prehospital care calls are for patients in the pediatric age group (2). Data from Part I of this study demonstrates that few states have policies that define the age of a pediatric or adult patient. For the purpose of trauma triage criteria, the American College of Surgeons does not clearly define the pediatric trauma patient, but makes mention of some differences in the triage criteria for children under 5 years of age (3). The American Academy of Pediatrins defines the pediatric age group to age 21 years (4). The speci,al needs of adolescents may be overlooked because they appear more like adults than children. Although age does not define a patient’s physiologic status, it would be difficult, if not impossible, to teach emergency medical technicians tn assess a patient’s stage of pubertal development and maturity in the field. Thus, age is often used as a marker for adulthood and for triage to designated trauma centers and other hospital specialty centers in a community (5). The majority of patients under 21 years of age
Figure
4. Mechanism
years
Enges;Zion
sf i+y
EEZ
Bicycle
of ndolescrnts nccessiq
EMS.
utilizing EMS services are in the adolescent age group. This study demonstrates that adclescents utilize the system for medical, behavioral, and surgical emergencies that are often the result of high-risk behavior, such as automobile and other accidents, substance abuse, ingesticns, and suicide attempts. EMS providers may also attend adolescent patients as a result of contact sports injuries. Similar mechanisms of injury were reported for school injuries; adolescents had intentional trauma related to assault, unintentional trauma from sports or playground equipment, and se&nnfhcted injuries (6,7). Part II of the study includes adolescents who access care by prehospital providers. About 25% of the emergency department visits are for patients in the pediatric age group (un+* !d ~I,LYSot age), thus there are many more teens that accc-5s EMS directly through self or famiIv referral to hospital emergency departments and &tics (El). This study demonstrates that adolescents access care through EMS and may not have all of their specific needs addressed because they are considered to be adults, or children, or somewhere in between. The specific needs of adolescent patients,
100
SEIDEL
includingage-appropriatepsychosocialsupport and rehabilitationplanning, shouldbe consideredin the planning of emergency medical service systems. The author would like ‘to thank the following people for their invaluable help with this study: Deborah Parkman Henderson,. R.N., M.A., for her guidance in every aspect of the [email protected] EMSC project; the staff of Santa Cruz County EMS Division; San Luis Obispo EMS Agency; NorCal EMS Agency; LA County EMS Division; and Margaret Emmons, M.A., for her assistance with data collection. This work was funded by a grant from the California State Department of Health, Office of Maternal and Child Health (no. 87-91857) U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Matemal and Child Health (no. MCH-064081-01-3).
References 1. Center for Disease Con!rd. Results from the national adolescent health survey. MMWR iS,OCr, 38~147~50.
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 2
2. Seidel’JS, Hombein M, Yoshiyama K., et al. Emergency medical services and the pediatric patient: Are the needs being met? Pediatrics 1984;73:769-72. 3. American College of Surgeons, Committee on Trauma. Field categorization of trauma patients. ACS Bull 1986;71:17-22. 4. American Academy of Pediatrics, Council on Child an I Adolescent Health. Age limits of pediatrics. Pediatrics 1988; 81:736. 5. San Diego County, Department of Health Services, Division of Emergency Medical Services. County of San Diego Annual Trauma Svstem Renort. 1988. , 6. Sheps SB, Evans dD. Epidemiology of school injuries: A 2year experience in a municipal he&h department. Pediatrics I 987;7!+69-74. 7. Boyce WT, Sprunger L:?, Sebolewski S, Schaefer C. Epidemiology of injuries in a large urban school district. Pediatrics 1984;74:342-49. 8. Ludwig S, Fleisher G, Henretig F, Ruddy R. Pediatric training in emergency medicine residency programs. Ann Emerg Med 1982;11:170-3.
mergency ical Services a Adolescent Patient JAMES S. SEIDEL,
M.D.,
e
Ph.D.
A study of 10,493 prehospital care report forms from 11 counties in California demonstrated that the adolescent age group (ages 12 to 18 years) accessed prehospital care through the emergency medical service (EMS) system more frequently than other pediatric patients (5978 reports). They did so most commonly for trauma (87.6%), but also for behavioral emergencies such as surcide and psychiatric problems. The most common cause of injury was automobiles, and care rendered wab most commonly wound care and splinting. The most common substances given to adolescents in the prehospital setting were naloxone and 50% dextrose. EMS systems need to Address the need for triage and care of adolescent patients.
KEY WORDS:
Adolescent acute care
EMS prehospital care Adolescent EMS care
Little is known about the utilization of emergency medical services (EMS) by adolescent patients. Because adolescence is a relatively healthy time of life, persons in the age group 12 to 18 years of age may come into contact with health professionals as a result of high-risk behaviors, such as injuries, fighting and violence, suicide, substance abuse, sexually transmitted diseases, and nutritional and eating disorders. Data collected in 1987 from 11,419 eighth and From The California EMSC Project, the Departments Emergency Medicine and Pediatrics, UCLA School of Medicine, Harbor-UCLA Medical Center, Torrance California. Address reprint requests to: James S. Seidel, M.D., Ph.D., Department of Emergency Sewices, UCLA School of Medicine, HarborUCLA Medica! Center, 2000 West Carson Street, D9, Torrance, CA 90509. Manuscript accepted luly 24, 1990.
tenth grade students in 20 states, from The National Adolescent Student Health Survey (NASHS), demonstrated the prevalence of high-risk-taking behavior by teens: 56% of the students rode in vehicles without using seat belts, 32% of eighth grade students reported having ridden in the past month with a driver who was under the influence of alcohol or drugs, 49% percent of the boys and 28% of the girls reported being in at least one fight during the past year, 77% of the eighth gradtrs and 86% of the tenth graders said they had used alcohol, and 15% and 35% of the eighth and tenth graders, respectively, had used drugs (1). These behaviors may lead to injuries and illness that result in the utilization of emergency medical services. There are no available data on the access to health care by adolescent patients through EMS systems. This report will therefore examine the use of EMS by adolescent patients aged 12 through 18 years.
Materials and Methods This study had two parts: Part i is a survey of state EMS agencies, and Part 11is an analysis of data from adolescent EMS calls in 11 California counties. Part I All state Emergency Medical Service provider agencies, as well as those from Los Angeles, San Diego, and Orange Counties in California, were contacted by phone. The agencies were surveyed to determine: the age at which a patient was considered a pediatric or an adult patient; the number of prehospital runs made annually; use of public, private, or volunteer providers; and presence of a trauma care system or pediatric component of the system. The three California counties are included because they represent
0 Society for Adolescent Medicine, 1991 Published by Elsevier Science Publishing Co., Inc., 655 Avenue of the Americas, New York, NY 10010
95
1054-139x/91/w.LQ
96
SEIDEL
the largest and most organized EMS systems in the country. Data were analyzed using a commercial spread sheet program. Part II Data on EMS runs were abstracted from prehospital care report (PCR) forms of four EMS agencies: Los Angeles County, NorCal EMS Agency (an agency that administer an eight-county area in Northern California), San Luis Obispo County EMS Agency, and Santa Cruz County EMS Agency. A standardized form was used for data collection. EMS runs for patients 12 through 18 years of age, from January 1 through December 31, 1984 were reviewed from NorCal, San Luis Obispo, and Santa Cruz. A 3month period, from September 1 through November 30, 1984, was abstracted from Los Angeles County to correspond with the time period of an existing data set for trauma patients. The 1984 data were selected because they were the only complete data sets available from all the study areas at the time of the study. A small repeat study of data from 1986 showed no statistically sigr:ificant changes. Data were entered into a commercially available software package and outloaded to the UCLA Biomedical Computer Facility for statistical analysis. Data entry was found to be reliable (98%) by analysis of repeated data sets from the PCR forms by the staff of the California EMSC Project. Data included service times; month, day, and time of day of the call; location; type of responding personnei; type of transport; subject’s age and sex; chief complaint(s); mechanism(s) of injury; base hospital contact; physical assessment; field treatment; and disposition. Data were analyzed using Students t-tests, analysis of variance, x2 test, and MannWhitney tests. Only some of the data elements collected will be discussed in this report.
Results Part I: State EMS Survey Data were received by telephone from SO states, three county agencies, and the District of Columbia. The mng&of runs per agency per pear varys widely with a low of 24,000 calls per year b1,:~Wyoming to a high of 1400,080 in New York and an average of 290,552 calls per year. Fourteen state agencies could neither give an exact number or estimate the number of EMS calls per year. The majority of the states (84%) and all of the
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 2
three counties utilize both public and private providers; 13.7% use only private providers, and one state uses only public providers. Many states also use volunteers as first responders for many EMS calls. Only 10 states and two of the three California counties had a written definition of the age of a pediatric patient. Of the 12 agencies having an age definition, five defined the upper limit as 14 years of age, two as 16 years, three as 18 years, and one each as 19 or 21 years of age. Four respondents stated that EMS providers based their assessment on observation in the field. The remainder of the states stated that the designation of a pediatric patient varied from case to case, or that they did not have a poliLy. When asked at what age a patient was considered an adult, 27 states responded with an age. The raxrge of ages varied from 15 years in one agency to 21 years in another, with the majority (19 states) listing 18 years as the age of an adult patient. Only six of the states that defined an age of #anadult patient also had a definition of a pediatric patient. Among the 20 systems with a trauma system in place, eight had an age policy, and others left it up to the provider to make a decision in the field. Of the nine respondents who stated that they had a pediatric system within their EMS system, four did not have an age definition of a pediatric patient and one used clinical arJsessment in the field. Part II: EMS Activities fw the Adolescent Age Group The study areas included 11 counties in California: Los Angeles, San Luis Obispo, Santa CNZ, Butte, Shasta, Modoc, Lassen, Trinity, Tehama, Pulmas, and Siskiyou, which contain large metropolitan centers, urbanized rural areas, and rural and remote areas. Most of these counties have large populations under 18 years of age. Figure 1 contrasts the percentage of adolescents in the general population with that using EMS. The majority (85%) of EMS calls were for patients over 14 years of age (Table 1). A total of 5978 EMS runs sheets for patients between the ages of 12 and 18 years were analyzed; however, not all had complete data. There were 3215 (57%) EMS calls for males and 2450 (43%) for females. Forty-eight percent of the calls took place between Friday afternoon and Sunday evening. Eighteen percent of the calls took place between the hours of 12 PM and 8 AM (Fig. 2). These calls were primarily for trauma due to automobile injuries (87.2%) with other calls for violent acts such as gunshot wounds (8.5%) or stabbing (4%). Ten percent
March 1991
EMF:RGEhCY MEDICAL SERVICES
97
50
40. 30 20 10 0
Qen Pop Urban
Table 1. Age of Adalescents
9 Urban
Using EMS Senices
m
Gm
Pop Rural
in
Urban and Rural AI-&S Age (v)
Urban
Rural
no. (%)
no. (%j
Total no. (‘70)
12-13 14-16 17-18
765 (12.8) 2219 (37.7) 2230 (37.4)
103 (1.7) 335 (5.6) 308 (5.2)
868 (14.6) 2554 (42.8) 2538 (42.6)
Total
5214 (87.5)
746 (12.5)
5960 (100)
of the stabbings and gunshot wounds were in the 12- to 15-year-old age group; 90% were in the 16- to l&year-old group. The most commonly listed chief complaints given by the patients are shown on Fig. 3. More than one complaint was often listed. Most complaints involved trauma with head trauma, abrasions, contusion, laceration!;; and fractures the most common complaints listed. Adolescents were also seen for seizures, ingestions,. and overdoses as well as respiratory distress. Behavioral emergencies such as suicide attempts (34 cases) and psychiatric emergencies (336 cases) were most common in the older age group. Suicide attempts may have been underreported as some of the calls listed as ingestionpoisoning may have been suicide attempts.
The common mechanisms of injury listed on the
PCRsare listed in Fig. 4. Motor vehicles (auto, motorcycle, moped, etc.) were responsible for the majority of injuries in all age groups (2175 cases); however, there were a significant number of falls, ingestions, and contact sport injuries. Violent acts such as gunshot wounds (99 cases) and stab wounds (49 cases) were evident even in the 12- to 13-yearold age group. The most common procedures used in the prehospital setting (field) were splinting and spinal im mobilization (823 times, 13.8% of the calls). Spinal precautions were used for trauma and altered mentai status, and sp!inting for trauma and obvious fractures, Advanced airway management including ,,ndotracheal intubation (5 timesj bag-valve mask ventilation, (1 time), and elder valve use (5 times) were rarely used. Most of the patients receiving drugs ard/or intravenous lines in the field had trauma or altered mental status. Intravenous lines were started on 165 patients. Drugs were given on 110 calls (1.8%), primarily for altered mental status,
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 2
SFJDEL
98
Number
of Patients
so0 400 300
Figure 3. Type of EMS call by age of the patien!.
Number of Patients 600 so0 400 300 200 100 0 12-13 years
14-16 years
17-18 years
Type of Call I
Abrasion
E3
Lacerat ion
m
IngeStiOnWD
0
Seizure
m
Head Trauma
m
Resp Dlsatrsss 0
Fracture Suiclda
March1991
EMERGENCY MEDICAL SERVICES
99
Number of Patients 6ooe
-
14-16 years
12-13 years
Auto Versus m
Contact
Spprtl
m
V-16
Other Vehlclen
F&I
Gun\Stab
Mstorcycle
ingestions, seizures, and behavioral emergencies. The most common substances administered intravenously were naloxone and dextrnsr- 50%.
Discussion About 10% of the prehospital care calls are for patients in the pediatric age group (2). Data from Part I of this study demonstrates that few states have policies that define the age of a pediatric or adult patient. For the purpose of trauma triage criteria, the American College of Surgeons does not clearly define the pediatric trauma patient, but makes mention of some differences in the triage criteria for children under 5 years of age (3). The American Academy of Pediatrins defines the pediatric age group to age 21 years (4). The speci,al needs of adolescents may be overlooked because they appear more like adults than children. Although age does not define a patient’s physiologic status, it would be difficult, if not impossible, to teach emergency medical technicians tn assess a patient’s stage of pubertal development and maturity in the field. Thus, age is often used as a marker for adulthood and for triage to designated trauma centers and other hospital specialty centers in a community (5). The majority of patients under 21 years of age
Figure
4. Mechanism
years
Enges;Zion
sf i+y
EEZ
Bicycle
of ndolescrnts nccessiq
EMS.
utilizing EMS services are in the adolescent age group. This study demonstrates that adclescents utilize the system for medical, behavioral, and surgical emergencies that are often the result of high-risk behavior, such as automobile and other accidents, substance abuse, ingesticns, and suicide attempts. EMS providers may also attend adolescent patients as a result of contact sports injuries. Similar mechanisms of injury were reported for school injuries; adolescents had intentional trauma related to assault, unintentional trauma from sports or playground equipment, and se&nnfhcted injuries (6,7). Part II of the study includes adolescents who access care by prehospital providers. About 25% of the emergency department visits are for patients in the pediatric age group (un+* !d ~I,LYSot age), thus there are many more teens that accc-5s EMS directly through self or famiIv referral to hospital emergency departments and &tics (El). This study demonstrates that adolescents access care through EMS and may not have all of their specific needs addressed because they are considered to be adults, or children, or somewhere in between. The specific needs of adolescent patients,
100
SEIDEL
includingage-appropriatepsychosocialsupport and rehabilitationplanning, shouldbe consideredin the planning of emergency medical service systems. The author would like ‘to thank the following people for their invaluable help with this study: Deborah Parkman Henderson,. R.N., M.A., for her guidance in every aspect of the [email protected] EMSC project; the staff of Santa Cruz County EMS Division; San Luis Obispo EMS Agency; NorCal EMS Agency; LA County EMS Division; and Margaret Emmons, M.A., for her assistance with data collection. This work was funded by a grant from the California State Department of Health, Office of Maternal and Child Health (no. 87-91857) U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Matemal and Child Health (no. MCH-064081-01-3).
References 1. Center for Disease Con!rd. Results from the national adolescent health survey. MMWR iS,OCr, 38~147~50.
JOURNAL OF ADOLESCENT HEALTH Vol. 12, No. 2
2. Seidel’JS, Hombein M, Yoshiyama K., et al. Emergency medical services and the pediatric patient: Are the needs being met? Pediatrics 1984;73:769-72. 3. American College of Surgeons, Committee on Trauma. Field categorization of trauma patients. ACS Bull 1986;71:17-22. 4. American Academy of Pediatrics, Council on Child an I Adolescent Health. Age limits of pediatrics. Pediatrics 1988; 81:736. 5. San Diego County, Department of Health Services, Division of Emergency Medical Services. County of San Diego Annual Trauma Svstem Renort. 1988. , 6. Sheps SB, Evans dD. Epidemiology of school injuries: A 2year experience in a municipal he&h department. Pediatrics I 987;7!+69-74. 7. Boyce WT, Sprunger L:?, Sebolewski S, Schaefer C. Epidemiology of injuries in a large urban school district. Pediatrics 1984;74:342-49. 8. Ludwig S, Fleisher G, Henretig F, Ruddy R. Pediatric training in emergency medicine residency programs. Ann Emerg Med 1982;11:170-3.