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Patients Who Refuse Transportation by Ambulance: A Case Series

Published online by Cambridge University Press:  28 June 2012

John E. Hipskind ,
JM Gren  and
DJ Barr
John E. Hipskind*
Affiliation:
Cook County Hospital, Chicago, Illinois, currently at Kaweah Delta District Hospital, Visalia, California, USA
JM Gren
Affiliation:
Sherman Hospital, GEA-MICP, Elgin, Illinois, USA
DJ Barr
Affiliation:
School of Public Health, University of Illinoisat Chicago, Chicago, Illinois, USA
*
Kaweah Delta District Hospital, Department of Emergency Medicine, 400 West Mineral King Avenue, Visalia, CA 93277USA, E-mail: Johnfran@theworks.com
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Abstract

Introduction:

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.

Keywords

COBRAcompetencycomplicationslitigationparamedicsprehospitalrefusaltransportation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 12 , Issue 4 , December 1997 , pp. 45 - 50
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1997

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