Knapp Barry J, Kerns Brian L, Riley Ivan, Powers James
Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, Virginia 23507-1999, USA.
J Emerg Med. 2009 Feb;36(2):157-61. doi: 10.1016/j.jemermed.2007.06.028. Epub 2007 Nov 19.
The objectives of this study were 1) to determine the number and characteristics of emergency medical services (EMS) agencies within the 200 largest US cities that sanction EMS-initiated refusal of transport; and 2) to determine the extent of no-cost alternative transport mechanisms among those agencies that allow EMS-initiated refusal of transport. EMS agencies located within the 200 largest US cities were contacted via telephone and surveyed as to whether their agency sanctioned EMS-initiated refusal of transport (EMS-IROT). Agencies with a policy were further questioned regarding its components and usage patterns. The telephone survey contacted 100% (200) of the target population. Currently, 7.0% (14) of EMS agencies have EMS-IROT protocols, with 64% (9) of those requiring direct medical oversight. Five (2.5%) of the 200 agencies sanctioned EMS-IROT without requiring online medical approval. Average annual call volume of the five agencies not requiring direct medical oversight was 70,800; their EMS-IROT protocols have been in existence a mean of 19.8 years. None of these agencies had a no-cost alternative transport mechanism. Three (1.5%) agencies terminated EMS-IROT protocols in the past. EMS-initiated refusal of transport continues to be a rare entity among US EMS agencies. Those that do not require direct medical oversight tend to have well-established programs, though no agency offered a formal no-cost alternative transport mechanism.
1）确定美国最大的200个城市中批准紧急医疗服务（EMS）人员发起拒绝转运的紧急医疗服务机构的数量和特征；2）确定在那些允许EMS人员发起拒绝转运的机构中，免费替代转运机制的普及程度。通过电话联系了位于美国最大的200个城市内的紧急医疗服务机构，并就其机构是否批准EMS人员发起拒绝转运（EMS-IROT）进行了调查。对有相关政策的机构进一步询问了其政策内容和使用模式。电话调查覆盖了100%（200个）的目标人群。目前，7.0%（14个）的紧急医疗服务机构有EMS-IROT协议，其中64%（9个）要求直接医疗监督。200个机构中有5个（2.5%）批准EMS-IROT但不要求在线医疗批准。这5个不要求直接医疗监督的机构的年平均呼叫量为70,800次；它们的EMS-IROT协议平均已存在19.8年。这些机构中没有一个有免费替代转运机制。有3个（1.5%）机构在过去终止了EMS-IROT协议。在美国紧急医疗服务机构中，EMS人员发起拒绝转运仍然是一种罕见的情况。那些不要求直接医疗监督的机构往往有完善的项目，不过没有一个机构提供正式的免费替代转运机制。
