C AN P ARAMEDICS S AFELY D ECIDE W HICH P ATIENTS D O N OT N EED A MBULANCE T RANSPORT OR E MERGENCY D EPARTMENT C ARE ?
- 1 January 2002
- journal article
- research article
- Published by Informa UK Limited in Prehospital Emergency Care
- Vol. 6 (4), 383-386
- https://doi.org/10.1080/10903120290937978
Abstract
Objectives. To determine whether paramedics can safely decide which patients do not require ambulance transport or emergency department (ED) care. Methods. This was a prospective survey and linked medical record review. Paramedics completed a brief questionnaire for each patient they transported to a university hospital ED during a one-month period. A faculty emergency physician masked to the survey results reviewed hospital records. Ambulance transport was defined as “needed” if the charted differential diagnosis included diagnoses that could necessitate treatment in an ambulance. ED care was defined as “needed” if treatment of these diagnoses would necessitate resources not available in local urgent care centers (UCCs). Results. Two hundred thirty-six patients were transported; 183 corresponding ED charts were found. Agreement between paramedics and need determined by ED chart review was low for both transport method [kappa (κ) = 0.47, 95% confidence interval (95% CI) = 0.34-0.60] and ED care (κ = 0.32, 95% CI = 0.17-0.46). Paramedics recommended alternative transport for 97 patients, 23 of whom needed ambulance transport. Paramedics recommended non-ED care for 71 patients, 32 of whom needed ED care. Conclusion. Paramedics cannot safely determine which patients do not need ambulance transport or ED care.Keywords
This publication has 7 references indexed in Scilit:
- Inappropriate Use of Emergency Medical Services Transport: Comparison of Provider and Patient PerspectivesAcademic Emergency Medicine, 1999
- Use of Emergency Medical Service transport system in medical patients up to 36 months of agePediatric Emergency Care, 1998
- Repeated ambulance use by patients with acute alcohol intoxication, seizure disorder, and respiratory illnessThe American Journal of Emergency Medicine, 1998
- Characteristics of Fatal Ambulance Crashes During Emergency and Non-emergency OperationPrehospital and Disaster Medicine, 1994
- The emergent problem of ambulance misuseAnnals of Emergency Medicine, 1993
- Prehospital emergency services and health maintenance organizationsAnnals of Emergency Medicine, 1986
- Measures of emergency ambulance effectiveness: Unmet need and inappropriate useJournal of the American College of Emergency Physicians, 1977