Patients Who Refuse Transportation by Ambulance: A Case Series

1997 ◽  
Vol 12 (4) ◽  
pp. 45-50 ◽  
Author(s):  
John E. Hipskind ◽  
JM Gren ◽  
DJ Barr
Keyword(s):  
Medical Information ◽  
Life Support ◽  
Motor Vehicle ◽  
Demographic Data ◽  
Vital Signs ◽  
Case Series ◽  
Advanced Life Support ◽  
Care Program ◽  
Motor Vehicle Crash ◽  
Discharge Instructions

AbstractIntroduction:Patients refusing hospital transportation occurs in 5% to 25% of out-of-hospital calls. Little is known about these calls. This study was needed to determine the demographics, inherent risks, and timing of refused calls.Methods:This was a prospective review of all run sheets of patients who refused transportation were collected for a two month period. Demographic data and medical information was collected. Each run was placed into one of three categories of need for transport and further evaluation: 1) minimal; 2) moderate; and 3) definite. The Greater Elgin Area Mobile Intensive Care Program (GEA-MICP) based at Sherman Hospital in Elgin, Illinois, was the setting. The GEA-MICP is an Emergency Medical Services (EMS) system comprised of 17 advanced life support (ALS) ambulance agencies servicing northeastern Illinois. Study subjects were all patients who refused transportation to a hospital by ALS ambulance during July 1993 and February 1994. Paramedics were required to complete a run sheet for all calls.Results:Overall, 30% (683 of2,270) of all runs resulted in refusal of transportation. Patients who most commonly refused transportation were asymptomatic, 11–40 years old and involved in a motor vehicle crash. They usually had no past medical history, normal vital signs, and a normal mental status. Patients generally signed for their own release after evaluation. The average time to arrival was 4.2 minutes and average time spent on scene by paramedics was 18.4 minutes. Of the patients, 72% were judged to have minimal need, 25% were felt to have a moderate need, and 3% were felt to definitely need transport to a hospital for further evaluation and/or treatment.Conclusion:There are many cases when EMS are activated, but transportation is refused. Most refusals occur after paramedic evaluation. Providing paramedics with primary care training and protocols would standardize care given to patients and provide a mechanism for discharge instructions and follow-up for those who chose not to be transported to a hospital. Patients judged to require further treatment had unique characteristics. These data may be useful in identifying potentially sicker patients allowing a concentrated effort to transport this subset of patients to a hospital.

Epidemiology of Pediatric EMS Practice: A Multistate Analysis

1996 ◽  
Vol 11 (3) ◽  
pp. 180-187 ◽  
Author(s):  
Steven M. Joyce ◽  
Douglas E. Brown ◽  
Elizabeth A. Nelson
Keyword(s):  
Patient Care ◽  
Life Support ◽  
Motor Vehicle ◽  
Vital Signs ◽  
Advanced Life Support ◽  
Severity Of Illness ◽  
Outcome Data ◽  
Data Set ◽  
Incident Type ◽  
Large Patient

AbstractObjective:To describe the epidemiology of pediatric emergency medical services (EMS) practice in a large patient population from several geographic areas.Design:Retrospective computer analysis of EMS databases from four states using a common data set and analysis system.Setting:Pennsylvania, Tennessee, Mississippi, and Nevada (except Clark County), 1990 through 1992.Methods:All patient-care reports of patients 14 years old and younger were extracted from the EMS databases and analyzed for the following factors: age, gender, date, elapsed pre-hospital times, incident type, mechanism of injury, call disposition, illness or injuries encountered, severity of illness/injury (by abnormal vital signs), and basic life support (BLS) and advanced life support (ALS) treatment delivered.Results:A total of 1,512,907 patient care reports were reviewed. Those of 61,132 children were extracted for analysis. These children comprised about 4% of prehospital responses. Male subjects predominated (56%), and children aged 7 through 14 years represented 46% of cases. Most calls occurred in the evening and daylight hours. Children were transported by ambulance in 89% of cases, and care was refused in 7.7%. Mean response time was 9±16 minutes, mean scene time 12±14 minutes, and mean transport time 14±20 minutes. Traumatic incidents predominated at 42%, with motor vehicle accidents and falls the most common mechanisms. Blunt injuries accounted for 94% of trauma, whereas respiratory problems, seizures, and poisoning/overdose were the most common medical problems. Vital signs were obtained in 56% of cases. Abnormal vital signs were noted in 21% of these, and the presumptive causes were similar in distribution to those of the general population, with the addition of cardiac arrest. The most commonly used treatments were spinal immobilization, oxygen administration, intravenous access and several ALS medications. An ALS capability was available in more than half the runs, but ALS treatment was delivered in only 14% of those cases. Outcome data were not available.Conclusion:This multistate analysis of pediatric EMS epidemiology confirms findings reported in smaller regional studies, with several exceptions. Excessive scene times were not noted. Few children had serious disorders as evidenced by abnormal vital signs. An ALS treatment, when available, was used infrequently. These findings have implications for EMS planners and educators.

IS ADVANCED LIFE SUPPORT APPROPRIATE FOR VICTIMS OF MOTOR VEHICLE ACCIDEHTS

1986 ◽  
Vol 26 (7) ◽  
pp. 682 ◽  
Author(s):  
H. D. Reines ◽  
R. A. Bartlett ◽  
N. E. Chudy ◽  
K. R. Krigau ◽  
M. A. McKnew ◽  
...  
Keyword(s):  
Life Support ◽  
Motor Vehicle ◽  
Advanced Life Support

THE EFFECT OF ADVANCED LIFE SUPPORT AND SOPHISTICATED HOSPITAL SYSTEMS ON MOTOR VEHICLE MORTALITY

1983 ◽  
Vol 23 (7) ◽  
pp. 626
Author(s):  
Raymond H. Alexander ◽  
Peter T. Pons ◽  
Jeffrey Krischer ◽  
Patricia Hunt
Keyword(s):  
Life Support ◽  
Motor Vehicle ◽  
Advanced Life Support ◽  
Hospital Systems

The Effect of Advanced Life Support and Sophisticated Hospital Systems on Motor Vehicle Mortality

1984 ◽  
Vol 24 (6) ◽  
pp. 486-490 ◽  
Author(s):  
RAYMOND H. ALEXANDER ◽  
PETER T. PONS ◽  
JEFFREY KRISCHER ◽  
PATRICIA HUNT
Keyword(s):  
Life Support ◽  
Motor Vehicle ◽  
Advanced Life Support ◽  
Hospital Systems

scholarly journals Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Riccardo Giudici ◽  
Armando Lancioni ◽  
Hedwige Gay ◽  
Gabriele Bassi ◽  
Osvaldo Chiara ◽  
...  
Keyword(s):  
Injury Severity ◽  
Life Support ◽  
Trauma Registry ◽  
Demographic Data ◽  
Advanced Life Support ◽  
Severe Trauma ◽  
Trauma Patients ◽  
Icu Admission ◽  
Patient Admissions ◽  
High Level

Abstract Backgrounds The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods. Methods A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography. Results During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001). Conclusions The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.

Is Advanced Life Support Appropriate for Victims of Motor Vehicle Accidents: The South Carolina Highway Trauma Project

1988 ◽  
Vol 28 (5) ◽  
pp. 563-570 ◽  
Author(s):  
H DAVID REINES ◽  
ROBERT L. BARTLETT ◽  
NANCY E. CHUDY ◽  
KARUNGARI R. KIRAGU ◽  
MARK A. McKNEW
Keyword(s):  
South Carolina ◽  
Life Support ◽  
Motor Vehicle ◽  
Advanced Life Support ◽  
Motor Vehicle Accidents ◽  
The South ◽  
Vehicle Accidents

scholarly journals Inter-observer agreement using the Canadian Emergency Department Triage and Acuity Scale

CJEM ◽  
2002 ◽  
Vol 4 (01) ◽  
pp. 16-22 ◽  
Author(s):  
Daria Manos ◽  
David A. Petrie ◽  
Robert C. Beveridge ◽  
Stephen Walter ◽  
James Ducharme
Keyword(s):  
Emergency Department ◽  
Emergency Care ◽  
Life Support ◽  
Vital Signs ◽  
Advanced Life Support ◽  
Emergency Department Patient ◽  
Observer Agreement ◽  
Care Providers ◽  
Emergency Department Triage ◽  
Triage Level

ABSTRACTObjective:To determine the inter-observer agreement on triage assignment by first-time users with diverse training and background using the Canadian Emergency Department Triage and Acuity Scale (CTAS).Methods:Twenty emergency care providers (5 physicians, 5 nurses, 5 Basic Life Support paramedics and 5 Advanced Life Support paramedics) at a large urban teaching hospital participated in the study. Observers used the 5-level CTAS to independently assign triage levels for 42 case scenarios abstracted from actual emergency department patient presentations. Case scenarios consisted of vital signs, mode of arrival, presenting complaint and verbatim triage nursing notes. Participants were not given any specific training on the scale, although a detailed one-page summary was included with each questionnaire. Kappa values with quadratic weights were used to measure agreement for the study group as a whole and for each profession.Results:For the 41 case scenarios analyzed, the overall agreement was significant (quadratic-weighted κ = 0.77, 95% confidence interval, 0.76–0.78). For all observers, modal agreement within one triage level was 94.9%. Exact modal agreement was 63.4%. Agreement varied by triage level and was highest for Level I (most urgent). A reasonably high level of intra- and inter-professional agreement was also seen.Conclusions:Despite minimal experience with the CTAS, inter-observer agreement among emergency care providers with different backgrounds was significant.

scholarly journals Factors Affecting Unscheduled Return Visits to the Emergency Department among Minor Head Injury Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Kuo-Cheng Wang ◽  
Chung-Hsien Chaou ◽  
Peng-Huei Liu ◽  
Cheng-Yu Chien ◽  
Ching-Hsing Lee
Keyword(s):  
Emergency Department ◽  
Head Injury ◽  
Demographic Data ◽  
Vital Signs ◽  
Minor Head Injury ◽  
Discharge Instructions ◽  
Factors Affecting ◽  
Hospital Patients ◽  
Gcs Score ◽  
Triage Level

Study Objectives. Differences between returning and non-returning minor head injury (MHI) emergency department (ED) patients, between the characteristics of the first visit and revisit, and between admitted and nonadmitted returning patients were investigated. Methods. This was a retrospective study. All discharged ED patients with ICD-9 codes 850.0 to 850.9, 920, and 959.01 in 2013 were enrolled. Patients’ demographic data, vital signs, Glasgow Coma Scale, ED diagnosis, length of stay, triage levels, ED examinations performed, and comorbidities were recorded for analysis. Results. A total of 2,815 patients were enrolled. Of 57 (2%) patients who revisited the ED, 47 (82%) were discharged from the ED and ten (18%) were admitted to the hospital. Patients who returned to the ED were older, and they exhibited more comorbidities. Those who presented with vomiting, triage level of 1 or 2, and GCS score of <15 and who received more blood tests during their first visit were more likely to be admitted when they returned to the ED. Conclusions. Discharging MHI patients who are older or exhibit comorbidities only when symptoms and concerns are relieved completely, providing clear discharge instructions, and arranging timely clinical follow-ups may help reduce such patients’ return rate.

A Comparison of Efficacy of Treatment and Time to Administration of Naloxone by BLS and ALS Providers

2019 ◽  
Vol 34 (04) ◽  
pp. 350-355
Author(s):  
Kenneth Nugent ◽  
Patrick Matthews ◽  
Jamie Gissendaner ◽  
Mia Papas ◽  
Deborah Occident ◽  
...  
Keyword(s):  
Life Support ◽  
Training Session ◽  
Vital Signs ◽  
Advanced Life Support ◽  
The United States ◽  
Control Group ◽  
Opioid Overdose ◽  
Respiratory Compromise ◽  
Naloxone Administration ◽  
Significant Difference

AbstractIntroduction:The administration of naloxone therapy is restricted by scope of practice to Advanced Life Support (ALS) in many Emergency Medical Services (EMS) systems throughout the United States. In Delaware’s two-tiered EMS system, Basic Life Support (BLS) often arrives on-scene prior to ALS, but BLS providers were not previously authorized to administer naloxone. Through a BLS naloxone pilot study, the researchers sought to evaluate BLS naloxone administration and timing compared to ALS.Hypothesis:After undergoing specialized training, BLS providers would be able to appropriately administer naloxone to opioid overdose patients in a more timely manner than ALS providers.Methods:This was a retrospective, observational study using data collected from February 2014 through May 2015 throughout a state BLS naloxone pilot program. A total of 14 out of 72 state BLS agencies participated in the study. Pilot BLS agencies attended a training session on the indications and administration of naloxone, and then were authorized to carry and administer naloxone. Researchers then compared vital signs and the time of BLS arrival to administration of naloxone by BLS and ALS. Data were analyzed using paired and independent sample t-tests, as well as chi-square, as appropriate.Results:A total of 131 incidents of naloxone administration were reviewed. Of those, 62 patients received naloxone by BLS (pilot group) and 69 patients received naloxone by ALS (control group). After naloxone administration, BLS patients showed improvements in heart rate (HR; P &lt; .01), respiratory rate (RR; P &lt; .01), and pulse oximetry (spO2; P &lt; .01); ALS patients also showed improvement in RR (P &lt; .01), and in spO2 (P = .005). There was no significant improvement in HR for ALS providers (P = .189).There was a significant difference in arrival time of BLS to the time of naloxone administration between the two groups, with shorter times in the BLS group compared to the ALS group (1.9 minutes versus 9.8 minutes; P &lt; .01); BLS administration was 7.8 minutes faster when compared to ALS administration (95% CI, 6.2-9.3 minutes).Conclusions:Patients improved similarly and received naloxone therapy sooner when treated by BLS agencies carrying naloxone than those who awaited ALS arrival. All EMS systems should consider allowing BLS to carry and administer naloxone for an effective and potentially faster naloxone administration when treating respiratory compromise related to opiate overdose.

Vital Signs Records Omissions on Prehospital Patient Encounter Forms

1993 ◽  
Vol 8 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Robert L. Moss
Keyword(s):  
Blood Pressure ◽  
Life Support ◽  
Vital Signs ◽  
Advanced Life Support ◽  
False Alarms ◽  
Patient Encounter ◽  
Patient Disposition ◽  
Emergency Medical ◽  
Frequent Failure ◽  
The Impact

AbstractIntroduction:A reported in-field, prospective evaluation of 227 prehospital patient assessments by advanced life support (ALS) emergency medical technicians (EMTs) found a frequent failure to measure vital signs. The objective of this retrospective review was to report the omission frequency of vital signs found in a centralized emergency medical services (EMS) data collection system.Methods:The EMS database contained information from 90,480 optically scanned, prehospital patient encounter forms. Each record identified EMT skill levels, response times, dispatch type, vital signs, medical and trauma information, treatment, and patient disposition. Records for 1989 and 1990 were collected from 92 rural EMS providers who responded to emergency medical and trauma events.Results:Of 90,480 emergency responses, 14,129 (15.6%) were false alarms, deceased, or canceled without vital patient contact. Valid encounters were documented for 76,351 (84.4%) patient contacts. Systolic blood pressure measurements were not recorded for 13,262 (17.4%) patients. Diastolic blood pressure was not recorded for 14,272 (18.7%) patients. A pulse record was not recorded for 12,125 (15.9%) patients. A ventilatory rate was absent in 12,958 (17.0%) patient records.Conclusion:This study found a frequent failure by non-metropolitan basic life support (BLS) and advanced life support (ALS) EMTs to record vital signs on prehospital emergency patient encounter forms. It supports a previous report of direct in-field observations of ALS EMTs failing to measure vital signs during patient assessment. The impact of vital sign omissions upon individual patient care can be assessed only by receiving medical control physicians. In the absence of effective emergency physician networking, the statewide magnitude of the problem among BLS and ALS EMTs has not been recognized as a system issue.

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