The Prevalence and Characteristics of Non-Transports in a Provincial Emergency Medical Services System: A Population-Based Study

Abstract

BackgroundEmergency Medical Services (EMS) provide patients with out-of-hospital care, but not all patients are transported to the hospital. Non-transport represents an often undefined yet potentially significant risk for poor clinical outcomes. Few North American studies have quantified this risk. ObjectiveThe objectives of this study were to determine the prevalence of non-transport and 48-h adverse event (composite of relapse responses that resulted in transport or death) and to identify characteristics associated with either outcome. MethodsAn analysis of pooled cross-sectional, population-based administrative data from the provincial EMS electronic charting system in 2014 was conducted. Determination of non-transport was based on recorded call outcome. The data were searched by patient identifiers to determine the 48-h adverse event rate. Paramedic-documented patient, operational, and environmental characteristics were included in the logistic regression models. ResultsOf 74,293 emergency responses, 14,072 (18.9%) were non-transport and, of those, 798 (5.6%) resulted in a 48-h adverse event. The characteristics statistically significantly and independently associated with non-transport and 48-h adverse event were younger age (odds ratio [OR] 1.72; 99.9% confidence interval [CI] 1.46–2.02), nonspecific paramedic clinical impression (OR 5; 99.9% CI 4.48–5.57), more than 7 comorbidities (OR 0.47; 99.9% CI 0.42–0.53), and incident location (jail) (OR 2.88; 99.9% CI 2.22–3.74). ConclusionsThis study provides an estimate of prevalence of non-transports and 48-h adverse event in a provincial mixed rural–urban EMS system. The results of this study describe the scope of non-transport and present several characteristics associated with non-transport. Future study should examine the appropriateness of EMS responses and methods to mitigate risk of adverse event after non-transport.