Outcome of Travelers Who Refuse Transport after Emergency Medical Services Evaluation at an International Airport

Abstract

Objective. To determine the short-term outcome of patients refusing transport after emergency medical services (EMS) evaluation at an international airport. Methods. This was a prospective, descriptive, observational study of patients who refused transport after evaluation by Philadelphia Fire Department paramedics at Philadelphia International Airport from July 2003 through March 2004. Paramedics contacted a medical command physician (MCP), who recorded the patient's contact information. Three days later, one investigator attempted to contact the patient to administer a survey of the medical course in the three days following the initial encounter. Results. Of 90 patients enrolled, 64 (71%) were reached in follow-up. Their average age was 45 years (range 10 months to 80 years); 41 (63%) were female. The most common presenting complaints were trauma-related (22 patients, 34%), neurologic (12, 19%), andgastrointestinal (7, 11%). The most common reasons for refusing transport were belief that their complaint was not serious (48, 75%) andfear they would miss a flight (34 patients, 53%). In the three days following the initial encounter, no patients recontacted 9-1-1, 16 patients (25%) had a recurrence of their initial complaints, and32 patients (50%) saw or talked to a physician. There was one hospitalization but no deaths. Among patients lost to follow-up, no deaths of U.S. citizens were detected. Conclusions. Most patients who refused transport after EMS evaluation at an international airport had good short-term outcomes. These results may assist paramedics andMCPs to manage refusals in this setting andto allow patients to make informed decisions. Key words: emergency medical services; treatment refusal; outcome assessment (healthcare).