Evaluation of Protocols Allowing Emergency Medical Technicians to Determine Need for Treatment and Transport

Schmidt, Terri A.; Atcheson, Regina; Federiuk, Carol; Mann, N. Clay; Pinney, Tannert; Fuller, Dave; Colbry, Kyran

doi:10.1111/j.1553-2712.2000.tb02041.x

Cited by 74 publications

(42 citation statements)

References 18 publications

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“…2,[17][18][19][20][21][22][23][24] These results are consistent but likely ask the wrong question. The medics should not be asked whether or not these patients will receive further evaluation and/or admission to the hospital, just whether they will arrive at the ED via an ambulance.…”

Section: Redirection After Medic Evaluationsupporting

confidence: 74%

911 Patient Redirection

Sporer

2017

Prehosp. Disaster med.

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Sporer KA. 911 patient redirection. Prehosp Disaster Med. 2017;32(6):589-592.The 911 Emergency Medical Services (EMS) system has become a victim of its own success. It is one of the few services coordinated by government that will always respond in a matter of minutes. The 911 EMS system is used for a variety of medical and nonmedical reasons with most metropolitan systems noting sizable increases in the number of calls each year. Current practice, public expectations, and regulations have hampered innovation to best manage this tsunami of patients. 1 Multiple systems have been grappling with this issue and are developing various novel approaches to 911 patient redirection. Many of these have arisen spontaneously, are unique to their local system, and few have been published in peer-reviewed journals. Only a handful of countries have developed an organized approach to this issue.In every EMS system, there is a large subset of patients -23%-33% -who are not transported after EMS evaluation.2 These patients are commonly lumped together as Against Medical Advice (AMA) patients, an unfortunate term that doesn't capture the full complexity of decision making in these post-evaluation, non-transported patients. Only one study has examined the complexity of these patients and found a number of themes, including resolution of symptoms, alternative follow-up and treatment, and alternative transport. The investigators felt that only eight percent of patients categorized as AMA were truly refusing the advice of the paramedics. There have been two studies of AMA patients that have matched hospital outcomes. One from Utah (USA) examined the outcomes of 14,109 prehospital AMA cases. It had a five percent rate of prehospital AMA cases, meaning that these were likely true refusal of care cases. Among these patients, three percent had another EMS dispatch within the week, fewer than two percent were hospitalized, and 25 adults died within a week of refusing care. 4 The authors noted that most of the inpatient admissions and causes of death were unrelated to the initial EMS incident. A similar study was performed in Australia. They had a non-transport rate of 15%, and of 19,737 AMA patients, six percent requested a subsequent ambulance, 3.3% were admitted to the hospital, and 0.2% died. 5Any program that is developed to redirect 911 EMS patients should be careful to compare the post-intervention rate of patient redirection with the pre-intervention rate of non-transport/AMA, as the idea is not just to recategorize the existing AMA patients. In addition, any systematic method of 911 patient redirection should have fairly standard methodology to measure efficacy. Metrics should include the total number of calls, the total number of post-contact non-transports, the total number of patients enrolled into the specific program, the total number of patients redirected, and to include patient safety and satisfaction surveys. Dispatch RedirectionThere are a number of EMS systems that have incorporated practices that redirect specific categ...

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Section: Redirection After Medic Evaluationsupporting

confidence: 74%

911 Patient Redirection

Sporer

2017

Prehosp. Disaster med.

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“…4 As assessments and treatments of patients in prehospital emergency medical care are becoming more advanced and complex, prehospital emergency care is on the eve of a new and emerging role. 5 Many organizations are searching for alternatives to Accident and Emergency (A&E) treatments, 6 but according to a recent systematic review, prehospital personnel's preparedness for this task is poor. 7 Another future task will include "clinical pathways".…”

Section: Introductionmentioning

confidence: 99%

Decision-Support Tool in Prehospital Care: A Systematic Review of Randomized Trials

Hagiwara

Henricson

Jönsson

et al. 2011

Prehosp. Disaster med.

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Objective: The objective of this study was to evaluate the effects of the decision support tool (DST) on the assessment of the acutely ill or injured out-of-hospital patient. Methods: This study included systematic reviews of randomized controlled trials (RCT) where the DST was compared to usual care in and out of the hospital setting. The databases scanned include: (1) Cochrane Reviews (up to January 2010); (2) Cochrane Controlled Clinical Trials (1979 to January 2010); (3) Cinahl (1986 to January 2010); and (4) Pubmed/ Medline (1926 to January 2010). In addition, information was gathered from related magazines, prehospital home pages, databases for theses, conferences, grey literature and ongoing trials. Results: Use of the DST in prehospital care may have the possibility to decrease "time to definitive care" and improve diagnostic accuracy among prehospital personnel, but more studies are needed. Conclusions:The amount of data in this review is too small to be able to draw any reliable conclusions about the impact of the use of the DST on prehospital care. The research in this review indicates that there are very few RCTs that evaluate the use of the DST in prehospital care. IntroductionPrehospital patient assessment is different compared to assessments provided in hospitals. Often, the ambulance personnel are sent to medical emergencies with very little background information. The person who initiates the call for help sometimes is not able to describe the situation, and therefore, the ambulance personnel have difficulties preparing themselves for the task. The ambulance personnel's work situation has been described as "extreme". "They have routinely required working in environments of extreme and constant uncertainty." 1 These environmental factors lead to great strain on the prehospital caregiver's ability when assessing patients. In addition, there have been very few randomized controlled trials (RTC) that have evaluated prehospital care. 2 When 14 ambulance nurses in Sweden were asked about factors that influence their decision-making, several factors that were crucial for the decision were elicited. Important factors included: (1) time of day; (2) season and weather; (3) amount of time before other resources could arrive to the scene; (4) if there was threat of security; (5) stress; (6) environment; (7) diagnosis and; (8) type of patient assessed. 3 A qualitative study by Wireklint Sundström described the need of an "open mind" in the performance of prehospital assessments, and noted that prehospital caregivers must put their preconceived ideas aside when they meet and assess patients. 4 As assessments and treatments of patients in prehospital emergency medical care are becoming more advanced and complex, prehospital emergency care is on the eve of a new and emerging role. 5 Many organizations are searching for alternatives to Accident and Emergency (A&E) treatments, 6 but according to a recent systematic review, prehospital personnel's preparedness for this task is poor. 7 Another future task ...

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“…Schmidt et al published the first study that attempted to validate EMS transport protocols that were developed and gave EMS providers a choice of patient transport options. 7 The triage protocols were developed by an "expert" panel and included eight cardinal conditions mandating transport. EMS personnel then assigned a convenience sample of 1,300 transport patients to one of four transport categories: EMS transport, transport by alternative means, referral to primary care provider within 24 hours, or treatment at the scene only.…”

Section: Discussionmentioning

confidence: 99%