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Follow-up and Outcome of Patients Who Decline or Are Denied Transport by EMS

Published online by Cambridge University Press:  28 June 2012

Brian S. Zachariah ,
David Bryan ,
Paul E. Pepe  and
Monica Griffin
Brian S. Zachariah*
Affiliation:
Assistant Professor, Department of Surgery, Division of Emergency Medicine, University of Texas Health Science Center, Houston, TX; Medical Director, Harris County Emergency Corps, Houston, TX
David Bryan
Affiliation:
University of Texas Health Science Center, Houston, TX
Paul E. Pepe
Affiliation:
Associate Professor of Medicine, Surgery, and Pediatrics, Baylor College of Medicine, Houston, TX; Director, City of Houston Center for Resuscitation and Emergency Medical Services, Houston, TX
Monica Griffin
Affiliation:
University of Texas Health Science Center, Houston, TX
*
City of Houston Center for Resuscitation and Emergency Medical Services, 410 Bagby, Suite 300, Houston, TX 77002-1595USA
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Abstract

Introduction:

In recent years, several authors have begun to address the medical and legal risks associated with patients refusing or being refused transport by emergency medical services (EMS) systems. However, data regarding patient outcomes still are lacking.

Purpose:

The purpose of this study was to determine: 1) why patients are not transported; and 2) the subsequent outcome of these patients.

Setting:

A busy, suburban, volunteer EMS service with indirect medical control, but no guidelines for non-transport of patients.

Methods:

A retrospective review of the records of 158 consecutive EMS incidents in which an ambulance was called, but the patient was not transported. Follow-up was attempted by telephone contact with the patient and/or family.

Results:

Telephone follow-up was established successfully for 93 cases (59%). Of the 93 patients, 60 (64.5%) subsequently sought care from a physician, 15 of whom (25%) later were admitted. The mean hospital stay was 6.6±7.9 days (median=3 days) with a range of 1–30 days. Two were admitted to an intensive care unit (ICU) and two others died. Of the 93 study cases, 43 (46%) involved situations in which the patient refused transport. Paramedics declined transport or mutually agreed not to transport in 50 cases (54%). This latter category accounted for 11 (73%) of the 15 hospitalizations. Ten percent of patients (or their families) stated that they were dissatisfied with the non-transport decisions.

Conclusions:

Serious, even fatal outcomes were identified in the follow-up of patients not transported by EMS. Although a direct causal relationship was not established within the context of this study, situations in which EMS personnel either denied transport (or mutually agreed with the patient not to transport by ambulance) were twice as likely to result in hospitalization than were those cases in which the patients declined transportation against the advice of the EMS personnel.

Keywords

ambulanceemergency medical services (EMS)liabilitymedical controlmedicolegaloutcomepatient transportrefusal of transport
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 4 , December 1992 , pp. 359 - 364
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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