Impact of interventions for patients refusing emergency medical services transport

Acad Emerg Med. 1995 Jun;2(6):480-5. doi: 10.1111/j.1553-2712.1995.tb03244.x.


Objective: To evaluate the effect of a documentation checklist and on-line medical control contact on ambulance transport of out-of-hospital patients refusing medical assistance.

Methods: Consecutive patients served by four suburban ambulance services who initially refused emergency medical services (EMS) transport to the hospital were prospectively enrolled. In phase 1 (control phase), all patients who initially refused medical attention or transport had an identifying data card completed. In phase 2 (documentation phase), out-of-hospital providers completed a similar data card that contained a checklist of high-risk criteria for a poor outcome if not transported. In phase 3 (intervention phase), a data card similar to that used in phase 2 was completed, and on-line medical control was contacted for all patients with high-risk criteria who refused transport. The primary endpoint was the percentage of patients transported to the hospital.

Results: A total of 361 patients were enrolled. Transport rate varied by phase: control, 17 of 144 (12%); documentation, 11 of 150 (7%); and intervention, 12 of 67 (18%) (chi-square, p = 0.023). Transport of high-risk patients improved with each intervention: control, two of 60 (3%); documentation, seven of 70 (10%); and intervention, 12 of 34 (35%) (chi-square, p = 0.00003). Transport of patients without high-risk criteria decreased with each intervention: control, 15 of 84 (18%); documentation, four of 80 (5%); and intervention, 0 of 33 (0%) (p = 0.0025). Of the 28 patients for whom medical control was contacted, 12 (43%) were transported to the hospital, and only three of these 12 patients (25%) were released from the ED.

Conclusion: Contact with on-line medical control increased the likelihood of transport of high-risk patients who initially refused medical assistance. The appropriateness of the decreased transport rate of patients not meeting high-risk criteria needs further evaluation.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Ambulances
  • Analysis of Variance
  • Documentation
  • Emergency Medical Services / methods
  • Emergency Medical Services / statistics & numerical data*
  • Emergency Medical Services / trends
  • Humans
  • Middle Aged
  • New York
  • Prospective Studies
  • Quality Control
  • Risk Assessment
  • Telemetry*
  • Transportation of Patients / methods
  • Transportation of Patients / statistics & numerical data*
  • Transportation of Patients / trends
  • Treatment Refusal*