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Can Paramedics Safely Refuse Transport of Non-Urgent Patients?

Published online by Cambridge University Press:  19 September 2016

Alex J. Fraess-Phillips
Alex J. Fraess-Phillips*
Affiliation:
School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
*
Correspondence: Alex J. Fraess-Phillips, MSc School of Health Sciences University of Northern British Columbia 3333 University Way, Prince George, British Columbia, Canada, V2N 4Z9, E-mail: alex.fraess-phillips@alumni.unbc.ca
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Abstract

Objective

The goal of this search was to review the current literature regarding paramedic triage of primary care patients and the safety of paramedic-initiated non-transport of non-urgent patients.

Methods

A narrative literature review was conducted using the Medline (Medline Industries, Inc.; Mundelein, Illinois USA) database and a manual search of Google Scholar (Google; Mountain View, California USA).

Results

Only 11 studies were found investigating paramedic triage and safety of non-transport of non-urgent patients. It was found that triage agreement between paramedic and emergency department staff generally is poor and that paramedics are limited in their abilities to predict the ultimate admission location of their patients. However, these triage decisions and admission predictions are much more accurate when the patient’s condition is the result of trauma and when the patient requires critical care services. Furthermore, the literature provides very limited support for the safety of paramedic triage in the refusal of non-urgent patient transport, especially without physician oversight. Though many non-transported patients are satisfied with the quality of non-urgent treatment that they receive from paramedics, the rates of under-triage and subsequent hospitalization reported in the literature are too high to suggest that this practice can be adopted widely.

Conclusion

There is insufficient evidence to suggest that non-urgent patients can safely be refused transport based on paramedic triage alone. Further attempts to implement paramedic-initiated non-transport of non-urgent patients should be approached with careful triage protocol development, paramedic training, and pilot studies. Future primary research and systematic reviews also are required to build on the currently limited literature.

Fraess-PhillipsAJ. Can Paramedics Safely Refuse Transport of Non-Urgent Patients?Prehosp Disaster Med. 2016;31(6):667–674.

Keywords

allied health professionalEmergency Medical Servicestransportation of patientstriage
Type
Special Reports
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 6 , December 2016 , pp. 667 - 674
Copyright
© World Association for Disaster and Emergency Medicine 2016 

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