Paramedic on Scene Time for Patients Initially Refusing Treatment or Transport

Introduction: Patients initially refusing care (PIRC) place their health in jeopardy and consume paramedic and base-station physician time. This study quantifies the time spent on-scene related to PIRC cases. Methods: A retrospective analysis of 128 PIRC cases was performed in the Multomah County EMS system. Results: The PIRC cases had a significantly longer mean on-scene time than did non-refusal cases (30.3 vs 14.6 min; p<.001). Medication administration by paramedics (14 % of patients) significantly increased the on-scene time. Overall, the mean time on-scene was not affected by age, gender, vital signs (pulse, blood pressure, respiratory rate), police involvement, and whether the patient was transported. The type of call had limited influence on on-scene time, although mean on-scene time was significantly longer for altered mental status cases than for trauma related cases (35.6 vs 22.4 min; p<.03). Conclusions: PIRC cases create a burden on the EMS system by consuming paramedic and base-station physician time and by preventing these personnel from responding to other calls.