{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T03:35:50Z","timestamp":1784345750480,"version":"3.55.0"},"reference-count":53,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["5K12HS026385\u201003"],"award-info":[{"award-number":["5K12HS026385\u201003"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Approximately 10% of emergency medical services (EMS) encounters in the United States are behavioral health related, but pediatric behavioral health EMS encounters have not been well characterized. We sought to describe demographic, clinical, and EMS system characteristics of pediatric behavioral health EMS encounters across the United States and to evaluate factors associated with sedative medication administration and physical restraint use during these encounters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective cross\u2010sectional study of pediatric (&lt;18\u2009years old) behavioral health EMS encounters from 2019 to 2020 using the National Emergency Medical Services Information System. Behavioral health encounters were defined using primary or secondary impression codes. We used multivariable logistic regression to identify factors associated with sedative medication administration and physical restraint use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 2,740,271 pediatric EMS encounters, 309,442 (11.3%) were for behavioral health. Of pediatric behavioral health EMS encounters, 85.2% of patients were 12\u201317\u2009years old, 57.3% of patients were female, and 86.6% of encounters occurred in urban areas. Sedative medications and physical restraints were used in 2.2% and 3.0% of pediatric behavioral health EMS encounters, respectively. Sedative medication use was associated with the presence of developmental, communication, or physical disabilities relative to their absence (adjusted odds ratio [aOR] 3.38, 95% confidence interval [CI] 2.93\u20133.91) and with encounters in the West relative to the South (aOR 1.23, 95% CI 1.16\u20131.32). Physical restraint use was associated with encounters by patients 6\u201311\u2009years old relative to those 12\u201317\u2009years old (aOR 1.35, 95% CI 1.27\u20131.44), the West relative to the South (aOR 3.49, 95% CI 3.27\u20133.72), and private nonhospital EMS systems relative to fire departments (aOR 3.39, 95% CI 3.18\u20133.61).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among pediatric prehospital behavioral health EMS encounters, the use of sedative medications and physical restraint varies by demographic, clinical, and EMS system characteristics. Regional variation suggests opportunities may be available to standardize documentation and care practices during pediatric behavioral health EMS encounters.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14833","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T09:59:45Z","timestamp":1699610385000},"page":"129-139","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Characteristics of pediatric behavioral health emergencies in the prehospital setting"],"prefix":"10.1111","volume":"31","author":[{"given":"Julia H.","family":"Wnorowska","sequence":"first","affiliation":[{"name":"Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal","family":"Naik","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"Division of Emergency Medicine, Department of Pediatrics Ann &amp; Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1389-5726","authenticated-orcid":false,"given":"Sriram","family":"Ramgopal","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"Division of Emergency Medicine, Department of Pediatrics Ann &amp; Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenshata","family":"Watkins","sequence":"additional","affiliation":[{"name":"Divison of Pediatric Emergency Medicine University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1653-363X","authenticated-orcid":false,"given":"Jennifer A.","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"Division of Emergency Medicine, Department of Pediatrics Ann &amp; Robert H. Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,27]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"1","article-title":"Methods and implementation of the 2019 EMS practice analysis","volume":"26","author":"Panchal AR","year":"2021","journal-title":"Prehosp Emerg Care"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2021.1973626"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e3181bec82f"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-2192"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7108e1"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.38840"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2021.1917736"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2019.1.41344"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.13431"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2023.04.028"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000002510"},{"key":"e_1_2_10_13_1","unstructured":"The Business Case for Preventing and Reducing Restraint and Seclusion Use. HHS Publication No. (SMA) 11\u20104632. Substance Abuse and Mental Health Services Administration.2011."},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2011.640767"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14515"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2018.1542473"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2019.1566423"},{"key":"e_1_2_10_18_1","unstructured":"NASEMSO Data Managers Council Mann NC. NEMSIS V3 Suggested List \u2013 eSituation.11 \u2013 Provider's Primary Impression.2016. Accessed October 17 2023https:\/\/nemsis.org\/media\/nemsis_v3\/master\/SuggestedLists\/NEMSIS_V3_Suggested_List_eSituation.11.pdf"},{"key":"e_1_2_10_19_1","unstructured":"What is NEMSIS. National EMS Information System (NEMSIS). Accessed December 21 2022https:\/\/nemsis.org\/what\u2010is\u2010nemsis\/"},{"key":"e_1_2_10_20_1","unstructured":"Mental Health Disorder Codes.2019. Accessed June 29 2023.https:\/\/www.childrenshospitals.org\/content\/analytics\/toolkit\/mental\u2010health\u2010disorder\u2010codes"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2020.0037"},{"key":"e_1_2_10_22_1","unstructured":"Extended Data Definitions (NEMSIS) Version 3.5. NASEMSO.2020. Accessed October 17 2023.https:\/\/nasemso.org\/wp\u2010content\/uploads\/NEMSIS\u2010Extended\u2010Data\u2010Definitions_v3.5.0.pdf"},{"key":"e_1_2_10_23_1","unstructured":"National Association of State EMS Officials.National EMS Scope of Practice Model 2019: Including Change Notices 1.0 and 2.0. Report No. DOT HS 813 151. National Highway Traffic Safety Administration.2021."},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2021.3348"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.pec.0000195758.12447.69"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-056667"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2021.10.002"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2021.03.027"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2019.08.184"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.13016"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1177\/1367493520937152"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/jclp.20772"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-002-0274-2"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2020-000273"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/PTS.0000000000000915"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e3182767d96"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1177\/01632787211003972"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-003939"},{"key":"e_1_2_10_39_1","volume-title":"National EMS Scope of Practice Model 2019: Including Change Notices 1.0 and 2.0 (Report No, DOT HS 813 151)","author":"National Association of State EMS Officials","year":"2021"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2014.964891"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2022.2079779"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12245-021-00343-y"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1080\/01460860701366658"},{"key":"e_1_2_10_44_1","volume-title":"What Children Tell us about their Experiences of Being Physically Restrained in Inpatient Child and Adolescent Mental Health Services: an Interpretative Phenomenological Analysis","author":"Nielson S","year":"2022"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.31038\/IMROJ.2016124"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/26.8.491"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-0522"},{"key":"e_1_2_10_48_1","unstructured":"Critical crossroads: pediatric mental health care in the emergency department. U.S. Department of Health and Human Services Health Resources and Services Administration Maternal and Child Health Bureau. A Care Pathway Resource Toolkit.2019."},{"key":"e_1_2_10_49_1","unstructured":"National Model EMS Clinical Guidelines Version 3.0.NASEMSO;2022."},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000139"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2013.6.17848"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41077-020-00139-9"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2015.8.26220"},{"key":"e_1_2_10_54_1","unstructured":"ButlerSM SheriffN.Innovative solutions to address the mental health crisis: shifting away from police as first responders. Brookings.2020. Accessed January 26 2023.https:\/\/www.brookings.edu\/research\/innovative\u2010solutions\u2010to\u2010address\u2010the\u2010mental\u2010health\u2010crisis\u2010shifting\u2010away\u2010from\u2010police\u2010as\u2010first\u2010responders\/"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.14833","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T12:39:11Z","timestamp":1708691951000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.14833"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,27]]},"references-count":53,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1111\/acem.14833"],"URL":"https:\/\/doi.org\/10.1111\/acem.14833","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,27]]},"assertion":[{"value":"2023-07-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-27","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}