On-scene alternatives for emergency ambulance crews attending patients who do not need to travel to the accident and emergency department: a review of the literature

With rising demand and recognition of the variety of cases attended by emergency ambulance crews, services have been considering alternative ways of providing non-urgent care. This paper describes and appraises the research literature concerning on-scene alternatives to conveyance to an emergency department, focusing on the: (1) profile and outcomes of patients attended but not conveyed by emergency crews; (2) triage ability of crews; (3) effectiveness and safety of protocols that allow crews to convey patients to alternative receiving units or to self care. The literature search was conducted through standard medical databases, supplemented with manual searches. Very few “live” studies were identified, and fewer still that included a control group. Findings indicated a complex area, with the introduction of protocols allowing crews to leave patients at scene carrying clinical risk. Robust research evidence concerning alternatives to current emergency care models is needed urgently to inform service and practice development.

[1]  Randy Thompson,et al.  Development and Evaluation of Criteria Allowing Paramedics to Treat and Release Patients Presenting with Hypoglycemia: A Retrospective Study , 1991, Prehospital and Disaster Medicine.

[2]  H. Thode,et al.  Outcome of patients who refused out-of-hospital medical assistance. , 1996, The American journal of emergency medicine.

[3]  A. Pelberg,et al.  Unnecessary Emergency Transport and Care of Grand Mal Seizures , 1993, American journal of medical quality : the official journal of the American College of Medical Quality.

[4]  Max Henderson,et al.  Reforming emergency care , 2004 .

[5]  M. Hauswald.  C AN P ARAMEDICS S AFELY D ECIDE W HICH P ATIENTS D O N OT N EED A MBULANCE T RANSPORT OR E MERGENCY D EPARTMENT C ARE ? , 2002, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[6]  P. Schnitzer,et al.  Medicolegal documentation of prehospital triage. , 1990, Annals of emergency medicine.

[7]  P. Schnitzer,et al.  The “No-Patient” Run: 2,698 Patients Evaluated but Not Transported by Paramedics , 1991, Prehospital and Disaster Medicine.

[8]  J. Nguyen-Van-Tam,et al.  Emergency (999) calls to the ambulance service that do not result in the patient being transported to hospital: an epidemiological study , 2002, Emergency medicine journal : EMJ.

[9]  M. Koenigsberg,et al.  A review of prehospital care litigation in a large metropolitan EMS system. , 1990, Annals of emergency medicine.

[10]  Emergency medical service. , 1974, Journal of the Mississippi State Medical Association.

[11]  G. Bolton.  No thank you , 1997, The Lancet.

[12]  R. Domeier,et al.  71. Prospective Evaluation of Criteria Allowing Paramedics to Treat and Release Patients Presenting with Hypoglycemia , 1996, Prehospital and Disaster Medicine.

[13]  H. Snooks,et al.  Appropriateness of use of emergency ambulances. , 1998, Journal of accident & emergency medicine.

[14]  B. Holroyd,et al.  Prehospital patients refusing care. , 1988, Annals of emergency medicine.

[15]  H. Snooks,et al.  Trends in demand for emergency ambulance services in Wiltshire over nine years: observational study , 2002, BMJ : British Medical Journal.

[16]  S. Davidson,et al.  Patient-Initiated Refusals of Prehospital Care: Ambulance Call Report Documentation, Patient Outcome, and On-line Medical Command , 1995, Prehospital and Disaster Medicine.

[17]  M. Gratton,et al.  P ROSPECTIVE D ETERMINATION OF M EDICAL N ECESSITY FOR A MBULANCE T RANSPORT BY P ARAMEDICS , 2003 .

[18]  F. Shofer,et al.  The short-term outcome of hypoglycemic diabetic patients who refuse ambulance transport after out-of-hospital therapy. , 1998, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[19]  A. Egol,et al.  The ten-year malpractice experience of a large urban EMS system. , 1985, Annals of emergency medicine.

[20]  N. Mann,et al.  Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport. , 2000, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[21]  P. Paris,et al.  The Outcome of Patients Refusing Prehospital Transportation , 1992, Prehospital and Disaster Medicine.

[22]  J. Barbera,et al.  EMS-initiated refusal and alternative methods of transport. , 1998, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[23]  H. Snooks.  New models of care for 999 callers with conditions that are neither life-threatening nor serious: results of a national survey , 2000 .

[24]  J. Broderick,et al.  Frequency and accuracy of prehospital diagnosis of acute stroke. , 1995, Stroke.

[25]  J. Hedges,et al.  Patients who initially refuse prehospital evaluation and/or therapy. , 1990, The American journal of emergency medicine.

[26]  J. Rubin,et al.  Out-of-hospital treatment of hypoglycemia: refusal of transport and patient outcome. , 1998, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[27]  P. Pepe,et al.  Follow-up and Outcome of Patients Who Decline or Are Denied Transport by EMS , 1992, Prehospital and Disaster Medicine.

[28]  T. Rea,et al.  A N E MERGENCY M EDICAL S ERVICES P ROGRAM OF A LTERNATE D ESTINATION OF P ATIENT C ARE , 2002, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.