Richards J R, Ferrall S J
Division of Emergency Medicine, University of California, Davis, Medical Center, Sacramento, USA.
Acad Emerg Med. 1999 Jan;6(1):14-20. doi: 10.1111/j.1553-2712.1999.tb00088.x.
To determine the extent of inappropriate ambulance use from the perspectives of both emergency medical services (EMS) providers and patients utilizing EMS transport, assess level of agreement, and identify variables associated with inappropriate ambulance use.
A prospective cross-sectional study was done of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban university hospital ED. EMS providers and patients completed a survey with questions regarding their perceptions of whether the need for ambulance transport was an emergency or a nonemergency. Patient demographic information and availability of alternate means of transportation to the hospital were also evaluated.
Eight hundred eighty-seven patients were included in the study. EMS providers thought that 501 patient transports were appropriate and represented true emergencies, whereas 689 patients believed their medical problems were true emergencies. A significant number of patients (n=415, 47%) had access to alternative transportation to the hospital. Blunt traumatic injury and altered mental status were the most common reasons for EMS transport. Patient characteristics significantly associated with EMS provider perception of a true emergency were male gender, age >51 years, higher education, chest pain/cardiac complaints, shortness of breath/respiratory complaints, and Medicare insurance. Characteristics significantly associated with patients who perceived themselves to have true emergencies were black ethnicity, higher education, shortness of breath/respiratory complaints, and Medicare insurance. There was 75% agreement between EMS providers and patients on appropriateness of ambulance transport (kappa=0.84).
Inappropriate ambulance use is a significant problem from both EMS provider and patient perspectives. Certain patient characteristics are associated with a higher probability of appropriate and inappropriate uses of EMS transport. A large number of patients transported by ambulance have alternative means of transportation but elect not to use them.
从紧急医疗服务（EMS）提供者和使用EMS转运的患者两个角度，确定不适当使用救护车的程度，评估一致程度，并识别与不适当使用救护车相关的变量。
对1997年2月期间连续到达城市大学医院急诊科的救护车运送患者进行前瞻性横断面研究。EMS提供者和患者完成了一项调查，其中包含关于他们对救护车转运需求是紧急情况还是非紧急情况的看法的问题。还评估了患者的人口统计学信息以及前往医院的其他交通方式的可用性。
887名患者纳入研究。EMS提供者认为501次患者转运是合适的，代表真正的紧急情况，而689名患者认为他们的医疗问题是真正的紧急情况。相当多的患者（n = 415，47%）有前往医院的其他交通方式。钝性创伤和精神状态改变是EMS转运最常见的原因。与EMS提供者认为是真正紧急情况显著相关的患者特征为男性、年龄>51岁、高等教育、胸痛/心脏不适、呼吸急促/呼吸系统不适以及医疗保险。与认为自己有真正紧急情况的患者显著相关的特征为黑人种族、高等教育、呼吸急促/呼吸系统不适以及医疗保险。EMS提供者和患者在救护车转运适宜性方面的一致率为75%（kappa = 0.84）。
从不适当使用救护车是一个重大问题。某些患者特征与适当和不适当使用EMS转运的较高可能性相关。大量乘坐救护车转运的患者有其他交通方式但选择不使用。
