The relationship between emergency medical services use and social service needs in a pediatric emergency department population

Background: Emergency Medical Services (EMS) use for children is correlated with areas of resource deprivation as well as child maltreatment. Households using EMS may have more social needs and be willing to accept services.

Objective: To compare social service needs and willingness to accept services in families arriving to a pediatric emergency department (ED) via EMS vs non-EMS, before and during COVID-19.

Participants and setting: Caregivers of children 0-5 years old in a quaternary pediatric ED, with a 1:1 ratio of EMS vs non-EMS arrivals.

Methods: Participants completed a survey of demographics, social service needs, and willingness to accept services, before and during COVID-19.

Results: Of 220 participants, 84 were enrolled before COVID-19. The EMS group reported less full-time employment (34.6% vs 51.8%, p < 0.05) and more social service needs (2.47 vs 1.76 needs, p < 0.05). Mean score for willingness to accept a service provider in the home was 3.62 for EMS and 3.19 for non-EMS (p = 0.09). Mean score for accepting a phone referral was 3.84 for EMS and 3.40 for non-EMS (p = 0.07). COVID-19 impacted needs for both groups (20.9% EMS vs 30.3% non-EMS). For all subjects presenting to the ED, COVID-19 was associated with decreased food insecurity (28.6% vs 15.4%) and children with a chronic medical condition (31.0% vs 12.5%).

Conclusions: The EMS group had more social service needs. There was no difference in social services acceptance. COVID-19 affected both groups' needs. Future interventions may use EMS systems to mitigate social service needs which may be risk factors for child abuse.