Heinonen Kari, Kuisma Markku, Puolakka Tuukka
Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
Helsinki Emergency Medical Services Study Group, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland.
Emerg Med J. 2025 Jul 22;42(8):542-547. doi: 10.1136/emermed-2024-214555.
In Finland, more than a third of the patients attended by the emergency medical services (EMS) are discharged on scene without ambulance transport, with reported recontact of <10% and 24-hour to 48-hour mortality of 0.3%-3.5%. In cases of disturbing or violent behaviour or suspected criminal activity, patients can also be discharged directly to police custody, with or without consultation with a prehospital physician. This study reports the incidence of patient deterioration in these situations.
All EMS calls between 2013 and 2021 with patient discharge to police custody were collected from electronic prehospital patient records and combined with data from the national causes of death registry. Patient and EMS call-related factors were studied to identify associations with EMS recontact, ambulance transport or death within 48 hours after discharge to police custody.
A total of 2184 patients were discharged directly to police custody by EMS, of whom 6% (132) involved a prehospital physician's consultation. The most common reasons for ambulance dispatch were intoxications (n=497, 22.8%), falls (n=439, 20.1%) and assaults (n=188, 8.6%). The mean (SD) age was 44.1 (16.2) years, 78.2% were male, and 1736 patients (79.5%) were reported to be under the influence of alcohol. A new EMS contact within 48 hours occurred in 192 (8.8%) cases; 26 patients were still in police custody at the time. Ambulance transport was required in 126 (5.8%) cases; 19 of these were for patients still in custody. Consultation with a prehospital physician was associated with EMS recontact (OR 2.79, 95% CI 1.76 to 4.40) and ambulance transport (OR 3.51, 95% CI 2.12 to 5.82). Three (0.14%) patients died in custody; none had a prehospital physician consultation. Alcohol use was not associated with a new EMS contact after discharge or patient death.
Violent behaviour and the use of alcohol and drugs were common in patients who were discharged to police custody. Despite this, discharge to police custody was not found to have a higher EMS recontact or mortality rate than non-conveyance in general.
在芬兰，超过三分之一由紧急医疗服务（EMS）接诊的患者在现场被放行，无需救护车转运，据报告再次联系的比例小于10%，24小时至48小时死亡率为0.3% - 3.5%。对于行为干扰或暴力行为或涉嫌犯罪活动的情况，患者也可直接被移交警方羁押，无论是否咨询过院前医生。本研究报告了这些情况下患者病情恶化的发生率。
从电子院前患者记录中收集2013年至2021年间所有患者被移交警方羁押的EMS呼叫记录，并与国家死亡原因登记处的数据相结合。研究患者和EMS呼叫相关因素，以确定与移交警方羁押后48小时内EMS再次联系、救护车转运或死亡之间的关联。
共有2184名患者由EMS直接移交警方羁押，其中6%（132例）涉及院前医生的咨询。救护车出动的最常见原因是中毒（n = 497，22.8%）、跌倒（n = 439，20.1%）和袭击（n = 188，8.6%）。平均（标准差）年龄为44.1（16.2）岁，78.2%为男性，1736名患者（79.5%）报告有酒精影响。48小时内有192例（8.8%）发生了新的EMS联系；其中26例患者当时仍被警方羁押。126例（5.8%）需要救护车转运；其中19例是针对仍被羁押的患者。与院前医生的咨询与EMS再次联系（比值比2.79，95%置信区间1.开区间6至4.4开区间）和救护车转运（比值比3.51，95%置信区间2.12至5.82）相关。3例（0.14%）患者在羁押期间死亡；均未咨询过院前医生。饮酒与出院后的新EMS联系或患者死亡无关。
被移交警方羁押的患者中暴力行为以及酒精和药物使用很常见。尽管如此，与一般情况下不转运相比，移交警方羁押并未发现有更高的EMS再次联系率或死亡率。
