Abstract

This research study aimed to investigate the association between demographic and operational factors and emergency medical services (EMS) missions ending in non-conveyance (NC) due to patient-initiated refusal (PIR). We conducted a retrospective population-based registry study by analyzing 67,620 EMS missions dispatched to the scene during 2018 in the Riyadh province. First, the number and percentages of conveyances statuses were calculated. Then, using crude and adjusted linear and logistic regression analysis, we determined which characteristics were predictors of NC due to PIR. We found that 23,991 (34.4%) of missions ended in NC due to PIR, and 5969 ended in EMS-initiated refusal (8.6%). NC rates due to PIR were higher for women, adults, for missions in Riyadh city, during nighttime, for medical emergencies, and for advanced life support (ALS) crews. We also found the following additional predictors significantly associated with the odds of NC due to PIR in crude regression analyses: age category, geographical location, EMS-shift, time of call, emergency type, and response time. We conclude that the NC rate represents half of all missions for patients requesting EMS, and the rate in Riyadh city has increased compared to previous studies. Most NC cases occur for the highest urgency level of medical emergency type in Riyadh city during the nighttime with ALS crews. NC due to PIR involves younger patients more than elderly, and females more than males. This study’s findings have provided empirical evidence that indicate that conducting further studies involving EMS providers, patients, and the public to identify precise and detailed reasons is required.

Highlights

  • We considered the association of outcomes for emergency medical services (EMS) missions, whether they ended by conveyance or non-conveyance statuses, with the time factors related to the daily operational periods by EMS providers or the time when patients request EMS support

  • NC due to patient-initiated refusal (PIR) was recorded for 35.5%, while NC due to EMSinitiated refusal (EIR) was recorded for 8.8% of patients

  • Of the complete sam- 5 of 13 ple, NC due to PIR was recorded for 35.5%, while NC due to EIR was recorded for 8.8%

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Summary

Introduction

Emergency medical services (EMS) crews can decide not to convey non-emergency patients to emergency departments (EDs) and only treat them at the scene, even if they had been triaged by phone as being high-acuity [1] This non-conveyance (NC) by EMSinitiated refusal (EIR) reduces the burden on EDs and increase the benefits for the patient conditions of the Creative Commons.

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