Social Vulnerability and Pediatric EMS Behavioral Health Activations: Trends in Utilization and Sedation Practices

Objectives: Despite the growing instances of pediatric patients presenting to emergency medical services (EMS) with a behavioral health emergency (BHE), these encounters remain an understudied phenomenon from a medical and social perspective. This study aims to characterize pediatric BHEs and to understand how social determinants of health impact BHE Frequency and sedation rates. Methods: We conducted a retrospective observational analysis of the National Emergency Medical Services Information System (NEMSIS) database and the Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) between 2018 and 2021. Pediatric EMS encounters were filtered based on age (<18 years old) and behavioral health International Classification of Diseases-10 (ICD-10) codes. Descriptive statistics and Poisson regression assessed the association between SVI scores and BHE frequency and sedation rates. Results: Our study analyzed 344,896 BHE activations out of 3,382,719 total pediatric EMS calls. The SVI score was inversely correlated with both BHE rates and sedative medication administration, conveying that higher levels of social vulnerability were associated with lower BHE rates and lower sedative medication administration. Census tracts with an SVI score in the 1st quartile (least vulnerable) had a pediatric BHE activation rate of 15.79% whereas the 4th quartile (most vulnerable) was 11.51% (OR: 1.443 (95% CI: 1.427–1.459), p < 0.0001). For sedation rates, census tracts with an SVI score in the 1st quartile had a sedative administration rate of 2.53% whereas the 4th quartile was 1.90% (OR: 1.345 (95% CI: 1.254–1.442), p < 0.0001). Conclusions: The prehospital management of pediatric BHEs is correlated to social vulnerability across multiple metrics, pointing to a need to modify care practices and address gaps in care. Tailored EMS protocols or bolstered EMS resources may be necessary to address the needs of vulnerable populations.