Examining the Link Between Emergency Department Arrival Mode, Social Determinants of Health, and Social Service Needs in Pediatric Emergency Medicine: A Cross-Sectional Study
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Background
Unmet social needs can increase the risk of adverse health outcomes in children. Emergency medical services (EMS) utilization is higher among families facing challenges with certain social determinants of health (SDoH). Understanding service needs among families seeking emergency care may inform interventions designed to support better health outcomes.
Methods
We conducted a cross-sectional survey of caregivers and EMS clinicians presenting to a pediatric emergency department (ED) via EMS or private vehicle (POV). Participants completed a survey reporting access to transportation, food, housing, healthcare, mental healthcare, and financial support. We evaluated differences in self-reported SDoH and service needs by arrival mode and differences in caregiver-reported needs with those perceived by EMS clinicians using Pearson’s chi-squared and Fisher’s exact tests.
Results
A total of 159 caregivers (111 POV, 48 EMS) and 17 EMS clinicians were enrolled. Caregiver demographics were similar between groups. Overall, 67 (42%) caregivers reported at least one service need with few differences between groups. Difficulty seeking healthcare, childcare, and mental health support were most frequently reported. EMS arrivals were more likely to report difficulty seeking child healthcare (p=.02); POV arrivals were more likely to report personal mental health needs (p<.01). There was no difference in requests for child mental health treatment (p>.90).
Conclusions
Service needs are common in pediatric emergency care. Difficulty accessing child healthcare and mental healthcare were common in our population. Screening pediatric caregivers during emergency care including during EMS activations may identify families in need of support services.
KEY MESSAGE STATEMENT
Social Determinants of Health (SDoH) have important health implications in children. In pediatric emergency care, caregivers and children arriving via Emergency Medical Services (EMS) are more likely to have social needs. There is a paucity of research on the specific needs of this population compared to private vehicle arrives and if EMS clinicians are aware of these needs. This study compares the SDoH of caregivers in the ED between arrival type and assesses if EMS clinicians recognize the needs of the people they transport. These results may be useful in improving EMS clinician curricula and addressing SDoH in families with young children.
