Hipskind J E, Gren J M, Barr D J
Cook County Hospital, Chicago, Illinois, USA.
Prehosp Disaster Med. 1997 Oct-Dec;12(4):278-83.
Patients refusing hospital transportation occurs in 5% to 25% of out-of-hospital calls. Little is known about these calls. This study was needed to determine the demographics, inherent risks, and timing of refused calls.
This was a prospective review of all run sheets of patients who refused transportation were collected for a two month period. Demographic data and medical information was collected. Each run was placed into one of three categories of need for transport and further evaluation: 1) minimal; 2) moderate; and 3) definite. The Greater Elgin Area Mobile Intensive Care Program (GEA-MICP) based at Sherman Hospital in Elgin, Illinois, was the setting. The GEA-MICP is an Emergency Medical Services (EMS) system comprised of 17 advanced life support (ALS) ambulance agencies servicing northeastern Illinois. Study subjects were all patients who refused transportation to a hospital by ALS ambulance during July 1993 and February 1994. Paramedics were required to complete a run sheet for all calls.
Overall, 30% (683 of 2,270) of all runs resulted in refusal of transportation. Patients who most commonly refused transportation were asymptomatic, 11-40 years old and involved in a motor vehicle crash. They usually had no past medical history, normal vital signs, and a normal mental status. Patients generally signed for their own release after evaluation. The average time to arrival was 4.2 minutes and average time spent on scene by paramedics was 18.4 minutes. Of the patients, 72% were judged to have minimal need, 25% were felt to have a moderate need, and 3% were felt to definitely need transport to a hospital for further evaluation and/or treatment.
There are many cases when EMS are activated, but transportation is refused. Most refusals occur after paramedic evaluation. Providing paramedics with primary care training and protocols would standardize care given to patients and provide a mechanism for discharge instructions and follow-up for those who chose not to be transported to a hospital. Patients judged to require further treatment had unique characteristics. These data may be useful in identifying potentially sicker patients allowing a concentrated effort to transport this subset of patients to a hospital.
在院外急救呼叫中，有5%至25%的患者会拒绝医院转运。人们对这些呼叫了解甚少。本研究旨在确定拒绝呼叫患者的人口统计学特征、潜在风险及发生时间。
对两个月内所有拒绝转运患者的急救记录进行前瞻性回顾。收集人口统计学数据和医疗信息。每次急救分为三类转运需求及进一步评估类别之一：1）轻微；2）中度；3）明确。研究地点为伊利诺伊州埃尔金市谢尔曼医院的大埃尔金地区移动重症护理项目（GEA - MICP）。GEA - MICP是一个紧急医疗服务（EMS）系统，由17个高级生命支持（ALS）救护车机构组成，服务于伊利诺伊州东北部。研究对象为1993年7月至1994年2月期间所有拒绝由ALS救护车转运至医院的患者。急救人员需为所有呼叫填写急救记录。
总体而言，所有急救中有30%（2270次中的683次）导致转运被拒绝。最常拒绝转运的患者无症状，年龄在11至40岁之间，且涉及机动车碰撞事故。他们通常无既往病史，生命体征正常，精神状态正常。患者通常在评估后自行签字离开。平均到达时间为4.2分钟，急救人员在现场的平均停留时间为18.4分钟。其中，72%的患者被判定为转运需求轻微，25%被认为有中度需求，3%被认为确实需要转运至医院进行进一步评估和/或治疗。
在许多情况下，EMS被启动，但转运被拒绝。大多数拒绝发生在急救人员评估之后。为急救人员提供初级护理培训和方案将使给予患者的护理标准化，并为那些选择不转运至医院的患者提供出院指导和随访机制。被判定需要进一步治疗的患者具有独特特征。这些数据可能有助于识别潜在病情较重的患者，以便集中精力将这部分患者转运至医院。
