Abstract
BackgroundAfter on-scene examination and /or treatment, emergency medical services (EMS) nurses must decide whether the patient requires further assessment or treatment, most frequently in a hospital. The primary objective of this study was to assess the reliability of the current EMS protocol by determining whether the decision not to transport the patient to a care provider was correct or not.MethodsAdults receiving on-scene medical care by an EMS rapid responder or full team without transport to the hospital were included in this prospective observational study. The primary outcome measure was secondary consultation within 24 h after an on-scene EMS evaluation without transport for the same or a closely related complaint. The secondary outcome measures were patient satisfaction, type of secondarily consulted health care provider, provisional and definitive diagnosis, and correctness of the EMS members’ decision to provide on-scene medical care without transport.ResultsOf the 1095 participating patients, 271 (24.7%) patients requested secondary medical attention for the same complaint. This percentage was significantly larger in incidents attended by an ambulance team than by a rapid responder (N = 248 (26.5%) vs. N = 23 (14.4%); p < 0.05). In eleven (1.0%) cases an urgent medical diagnosis requiring admission was missed. A total of 873 (79.7%) patients were satisfied with the decision not to be transported. In 44 (4.0%) cases the EMS nurse’s decision was rated incorrect since the patient needed help contradictory to the EMS nurse’s recommendation.ConclusionsThe data show that EMS nurses can effectively examine patients, but a low threshold of referral for consultation should be considered because one in four patients requested secondary medical attention for the same complaint(s) again. However, due to a low response rate (11.3%) more research is needed to further determine the safety of the current EMS protocol.Trial registrationNot applicable.
Highlights
After on-scene examination and /or treatment, emergency medical services (EMS) nurses must decide whether the patient requires further assessment or treatment, most frequently in a hospital
All patients aged 18 years or older who were evaluated on-scene by EMS but not transported to the hospital were eligible for inclusion, regardless of weather conditions
A total of 8260 (46.0%) dispatches were excluded based on the exclusion criteria and 9689 patients refused to participate
Summary
After on-scene examination and /or treatment, emergency medical services (EMS) nurses must decide whether the patient requires further assessment or treatment, most frequently in a hospital. In the Netherlands, patients may seek acute medical attention by contacting their own general practitioner (GP), a GP employed at an out-of-hours GP services unit, a clinical emergency department (ED) or a regional EMS Dispatch Center. EMS nurses operate in an ambulance team with a driver (without a nursing or medical degree) or as a solitary rapid responder in a car or on a motorbike without the possibility to transport a patient. A pilot study in our region showed that ambulance teams and rapid responders do not transport patients in 14.7% and 66.3% of cases, respectively [2]. Two small retrospective studies suggest that a decision not to transport a patient to a hospital was justified in 93–99% of cases [3, 4], but data on the outcomes of such patients are not readily available in the (inter)national literature [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
