Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport

Terri Schmidt, Regina Atcheson, Carol Federiuk, N. Clay Mann, Tannert Pinney, Dave Fuller, Kyran Colbry

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Objective: To determine whether emergency medical technicians (EMTs) can safely apply protocols to assign transport options and to assess agreement between groups of providers on application of the protocols. Methods: Developed protocols categorized patients as: 1) needs ambulance; 2) go to the emergency department (ED) by alternative means; 3) contact primary care provider (PCP); or 4) treat and release. After education on the application of the protocols, first responders and ambulance EMTs categorized patients at the scene prior to transport but did not change current practice. Ambulance reports were reviewed using a predetermined list of critical events that signified the need for an ambulance. Results: The EMTs categorized 1,300 study patients as follows: 1,023 (79%) needed ambulance transport, 200 (15%) could go to the ED by alternative means, 63 (5%) could contact a PCP, 14 (1%) could be treated and released. Categorizations by a first responder and the transporting EMT were compared for 209 patients. Collapsing categories to 'need ambulance/do hot need ambulance' showed fair concordance (kappa = 0.51). Initially, 30 of 277 (11%) patients determined not to need an ambulance appeared to experience a critical event. After review, 23 patients had events that may not warrant advanced life support transport. Seven (3%) had critical events in the ambulance warranting ambulance transport. Most were miscategonized by the EMT. Overall sensitivity and specificity for identifying patients needing ambulance transport were 94.5% and 32.8%, respectively. Conclusions: From 3% to 11% of patients determined on scene not to need an ambulance had a critical event. Emergency medical services systems need to determine an acceptable rate of undertriage. Further study is needed to determine whether better adherence to the protocols might increase safety.

Original languageEnglish (US)
Pages (from-to)663-669
Number of pages7
JournalAcademic Emergency Medicine
Volume7
Issue number6
StatePublished - Jun 2000

Fingerprint

Emergency Medical Technicians
Ambulances
Therapeutics
Hospital Emergency Service
Primary Health Care
Emergency Medical Services

Keywords

  • Emergency medical technicians
  • EMS
  • Guidelines
  • Transport
  • Triage

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Schmidt, T., Atcheson, R., Federiuk, C., Mann, N. C., Pinney, T., Fuller, D., & Colbry, K. (2000). Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport. Academic Emergency Medicine, 7(6), 663-669.

Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport. / Schmidt, Terri; Atcheson, Regina; Federiuk, Carol; Mann, N. Clay; Pinney, Tannert; Fuller, Dave; Colbry, Kyran.

In: Academic Emergency Medicine, Vol. 7, No. 6, 06.2000, p. 663-669.

Research output: Contribution to journalArticle

Schmidt, T, Atcheson, R, Federiuk, C, Mann, NC, Pinney, T, Fuller, D & Colbry, K 2000, 'Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport', Academic Emergency Medicine, vol. 7, no. 6, pp. 663-669.
Schmidt T, Atcheson R, Federiuk C, Mann NC, Pinney T, Fuller D et al. Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport. Academic Emergency Medicine. 2000 Jun;7(6):663-669.
Schmidt, Terri ; Atcheson, Regina ; Federiuk, Carol ; Mann, N. Clay ; Pinney, Tannert ; Fuller, Dave ; Colbry, Kyran. / Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport. In: Academic Emergency Medicine. 2000 ; Vol. 7, No. 6. pp. 663-669.
@article{d370dcd58e57490eb10636e776a9ed32,
title = "Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport",
abstract = "Objective: To determine whether emergency medical technicians (EMTs) can safely apply protocols to assign transport options and to assess agreement between groups of providers on application of the protocols. Methods: Developed protocols categorized patients as: 1) needs ambulance; 2) go to the emergency department (ED) by alternative means; 3) contact primary care provider (PCP); or 4) treat and release. After education on the application of the protocols, first responders and ambulance EMTs categorized patients at the scene prior to transport but did not change current practice. Ambulance reports were reviewed using a predetermined list of critical events that signified the need for an ambulance. Results: The EMTs categorized 1,300 study patients as follows: 1,023 (79{\%}) needed ambulance transport, 200 (15{\%}) could go to the ED by alternative means, 63 (5{\%}) could contact a PCP, 14 (1{\%}) could be treated and released. Categorizations by a first responder and the transporting EMT were compared for 209 patients. Collapsing categories to 'need ambulance/do hot need ambulance' showed fair concordance (kappa = 0.51). Initially, 30 of 277 (11{\%}) patients determined not to need an ambulance appeared to experience a critical event. After review, 23 patients had events that may not warrant advanced life support transport. Seven (3{\%}) had critical events in the ambulance warranting ambulance transport. Most were miscategonized by the EMT. Overall sensitivity and specificity for identifying patients needing ambulance transport were 94.5{\%} and 32.8{\%}, respectively. Conclusions: From 3{\%} to 11{\%} of patients determined on scene not to need an ambulance had a critical event. Emergency medical services systems need to determine an acceptable rate of undertriage. Further study is needed to determine whether better adherence to the protocols might increase safety.",
keywords = "Emergency medical technicians, EMS, Guidelines, Transport, Triage",
author = "Terri Schmidt and Regina Atcheson and Carol Federiuk and Mann, {N. Clay} and Tannert Pinney and Dave Fuller and Kyran Colbry",
year = "2000",
month = "6",
language = "English (US)",
volume = "7",
pages = "663--669",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport

AU - Schmidt, Terri

AU - Atcheson, Regina

AU - Federiuk, Carol

AU - Mann, N. Clay

AU - Pinney, Tannert

AU - Fuller, Dave

AU - Colbry, Kyran

PY - 2000/6

Y1 - 2000/6

N2 - Objective: To determine whether emergency medical technicians (EMTs) can safely apply protocols to assign transport options and to assess agreement between groups of providers on application of the protocols. Methods: Developed protocols categorized patients as: 1) needs ambulance; 2) go to the emergency department (ED) by alternative means; 3) contact primary care provider (PCP); or 4) treat and release. After education on the application of the protocols, first responders and ambulance EMTs categorized patients at the scene prior to transport but did not change current practice. Ambulance reports were reviewed using a predetermined list of critical events that signified the need for an ambulance. Results: The EMTs categorized 1,300 study patients as follows: 1,023 (79%) needed ambulance transport, 200 (15%) could go to the ED by alternative means, 63 (5%) could contact a PCP, 14 (1%) could be treated and released. Categorizations by a first responder and the transporting EMT were compared for 209 patients. Collapsing categories to 'need ambulance/do hot need ambulance' showed fair concordance (kappa = 0.51). Initially, 30 of 277 (11%) patients determined not to need an ambulance appeared to experience a critical event. After review, 23 patients had events that may not warrant advanced life support transport. Seven (3%) had critical events in the ambulance warranting ambulance transport. Most were miscategonized by the EMT. Overall sensitivity and specificity for identifying patients needing ambulance transport were 94.5% and 32.8%, respectively. Conclusions: From 3% to 11% of patients determined on scene not to need an ambulance had a critical event. Emergency medical services systems need to determine an acceptable rate of undertriage. Further study is needed to determine whether better adherence to the protocols might increase safety.

AB - Objective: To determine whether emergency medical technicians (EMTs) can safely apply protocols to assign transport options and to assess agreement between groups of providers on application of the protocols. Methods: Developed protocols categorized patients as: 1) needs ambulance; 2) go to the emergency department (ED) by alternative means; 3) contact primary care provider (PCP); or 4) treat and release. After education on the application of the protocols, first responders and ambulance EMTs categorized patients at the scene prior to transport but did not change current practice. Ambulance reports were reviewed using a predetermined list of critical events that signified the need for an ambulance. Results: The EMTs categorized 1,300 study patients as follows: 1,023 (79%) needed ambulance transport, 200 (15%) could go to the ED by alternative means, 63 (5%) could contact a PCP, 14 (1%) could be treated and released. Categorizations by a first responder and the transporting EMT were compared for 209 patients. Collapsing categories to 'need ambulance/do hot need ambulance' showed fair concordance (kappa = 0.51). Initially, 30 of 277 (11%) patients determined not to need an ambulance appeared to experience a critical event. After review, 23 patients had events that may not warrant advanced life support transport. Seven (3%) had critical events in the ambulance warranting ambulance transport. Most were miscategonized by the EMT. Overall sensitivity and specificity for identifying patients needing ambulance transport were 94.5% and 32.8%, respectively. Conclusions: From 3% to 11% of patients determined on scene not to need an ambulance had a critical event. Emergency medical services systems need to determine an acceptable rate of undertriage. Further study is needed to determine whether better adherence to the protocols might increase safety.

KW - Emergency medical technicians

KW - EMS

KW - Guidelines

KW - Transport

KW - Triage

UR - http://www.scopus.com/inward/record.url?scp=0034045869&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034045869&partnerID=8YFLogxK

M3 - Article

VL - 7

SP - 663

EP - 669

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 6

ER -