Burstein J L, Henry M C, Alicandro J, Gentile D, Thode H C, Hollander J E
Department of Emergency Medicine, University Medical Center, State University of New York, Stony Brook 11794-7400, USA.
Am J Emerg Med. 1996 Jan;14(1):23-6. doi: 10.1016/s0735-6757(96)90007-8.
Activation of the emergency medical services (EMS) system does not always result in transport of a patient to the hospital. This study assessed the outcomes of patients who refused medical assistance in the field, to determine if refusal of medical assistance (RMA) is associated with poor outcomes. Four high-volume suburban volunteer ambulance corps participated in the study. Consecutive patients who refused medical assistance were prospectively enrolled. Medical and identifying data were collected for each patient. Telephone follow-up was conducted to determine the patient's condition and if the patient sought further care after RMA. Primary endpoints were whether the patient sought further care, was admitted to a hospital, or died subsequent to RMA. Follow-up was successfully obtained for 199 of 321 patients enrolled (62%). Of these 199 patients, 95 (48%) sought further medical care within 1 week for the same complaint, with 13 being admitted to the hospital. Six of the 13 admitted patients had chief complaints of a cardiac or respiratory nature. One patient died during hospital admission. Even if none of the patients lost to follow-up had sought further care, a substantial number of patients who refuse out-of-hospital medical assistance seek further care. Some of these patients require hospital admission, especially those with cardiac or respiratory complaints. Efforts to minimize RMA should be especially focused on patients with such complaints.
激活紧急医疗服务（EMS）系统并不总是会导致患者被送往医院。本研究评估了在现场拒绝医疗救助的患者的结局，以确定拒绝医疗救助（RMA）是否与不良结局相关。四个高业务量的郊区志愿救护队参与了该研究。前瞻性纳入连续拒绝医疗救助的患者。收集每位患者的医疗和身份识别数据。通过电话随访以确定患者的状况以及患者在拒绝医疗救助后是否寻求进一步治疗。主要终点是患者在拒绝医疗救助后是否寻求进一步治疗、是否入院或死亡。对纳入的321例患者中的199例（62%）成功进行了随访。在这199例患者中，95例（48%）因相同主诉在1周内寻求了进一步医疗护理，其中13例入院。13例入院患者中有6例主要主诉为心脏或呼吸系统疾病。1例患者在住院期间死亡。即使所有失访患者均未寻求进一步治疗，仍有相当数量拒绝院外医疗救助的患者寻求进一步治疗。其中一些患者需要入院治疗，尤其是那些有心脏或呼吸系统主诉的患者。尽量减少拒绝医疗救助的努力应特别关注有此类主诉的患者。
