Jaslow D, Barbera J A, Johnson E, Moore W
Department of Emergency Medicine, George Washington University, Washington, DC, USA.
Prehosp Emerg Care. 1998 Jan-Mar;2(1):18-22. doi: 10.1080/10903129808958834.
EMS systems in every one of the 200 largest cities in the United States were surveyed by telephone regarding EMS-initiated refusal policies, involvement of physicians in the decision-making process, and the presence or absence of alternatives to EMS transport.
100% of the target population responded to the telephone survey. Only 34 (17%) EMS systems have written protocols that allow EMS providers to refuse emergency ambulance transport for patients judged to have minor illness or injury after examination. Twenty-one (62%) of these EMS systems do not require on-line physician approval for EMS-initiated refusals. Seven (21%) EMS systems that allow refusal of transport also have a formalized alternative transport program in place. Nationwide, only 19 (10%) cities surveyed offer some type of alternative to ambulance transport, most commonly taxi and minivan.
The authors report the first national survey of EMS-initiated refusal practices. Few urban EMS systems have implemented this policy to decrease utilization by persons with low-acuity illness or injury. This may be related to the fact that few EMS systems currently have alternatives to emergency ambulance transport.
1）描述美国那些批准急救医疗服务（EMS）人员发起拒绝转运患者的城市中患者转运协议的特点；2）描述紧急救护车转运替代方案的频率和类型。
通过电话对美国200个最大城市中的每一个城市的急救医疗服务系统进行调查，内容涉及急救医疗服务人员发起的拒绝政策、医生在决策过程中的参与情况以及是否存在急救医疗服务转运的替代方案。
100%的目标人群回应了电话调查。只有34个（17%）急救医疗服务系统制定了书面协议，允许急救医疗服务人员在检查后拒绝为被判定患有轻微疾病或受伤的患者提供紧急救护车转运服务。其中21个（62%）急救医疗服务系统在急救医疗服务人员发起拒绝转运时不需要在线医生批准。7个（21%）允许拒绝转运的急救医疗服务系统也有正式的替代转运计划。在全国范围内，接受调查的城市中只有19个（10%）提供某种类型的救护车转运替代方案，最常见的是出租车和小型货车。
作者报告了首次关于急救医疗服务人员发起拒绝转运做法的全国性调查。很少有城市急救医疗服务系统实施这一政策以减少低 acuity 疾病或受伤人员的使用率。这可能与目前很少有急救医疗服务系统有紧急救护车转运的替代方案这一事实有关。
