Prospective determination of medical necessity for ambulance transport by paramedics

Matthew C. Gratton, Stefanie R. Ellison, Jason Hunt, Oscar Ma

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objective. It has been estimated that between 11% and 61% of ambulance transports to emergency departments are not medically necessary. This study's objective was to analyze paramedic ability to determine the medical necessity of ambulance transport to the emergency department. Methods. Paramedics prospectively assessed adult patients transported to an emergency department during a six-week period. The setting was an urban, all advanced life support, public utility model emergency medical services (EMS) system with 58,000 transports per year. Paramedics determined medical necessity of patient transport based on the following five criteria: 1) need for out-of-hospital intervention; 2) need for expedient transport; 3) potential for self-harm; 4) severe pain; or 5) other. On arrival in the emergency department, the emergency physician made a blinded determination based on the same criteria. Kappa statistics were used to assess agreement. Results. Data forms were completed on 825 of 1,420 (58%) patients transported. Emergency physicians determined 248 (30%) transports were not necessary, paramedics 236 (29%), with agreement in 76.2% (K = 0.42) of cases. Paramedics undertriaged 92 patients (11%). Rates of agreement on the five criteria were: 1) 71.9% (K = 0.43); 2) 77.7% (K = 0.22); 3) 89.6% (K = 0.40); 4) 89.6 (K = 0.32); and 5) 82.2% (K = 0.29). Conclusions. Paramedics and emergency physicians agreed that a significant percentage of patients did not require ambulance transport to the emergency department. Despite only moderate agreement regarding which patients needed transport, the undertriage rate was low.

Original languageEnglish (US)
Pages (from-to)466-469
Number of pages4
JournalPrehospital Emergency Care
Volume7
Issue number4
StatePublished - Oct 2003
Externally publishedYes

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Allied Health Personnel
Ambulances
Hospital Emergency Service
Physicians
Emergencies
Emergency Medical Technicians
Aptitude
Emergency Medical Services
Pain

Keywords

  • Ambulance
  • Emergency department
  • Emergency medical services
  • Paramedic

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Prospective determination of medical necessity for ambulance transport by paramedics. / Gratton, Matthew C.; Ellison, Stefanie R.; Hunt, Jason; Ma, Oscar.

In: Prehospital Emergency Care, Vol. 7, No. 4, 10.2003, p. 466-469.

Research output: Contribution to journalArticle

Gratton, Matthew C. ; Ellison, Stefanie R. ; Hunt, Jason ; Ma, Oscar. / Prospective determination of medical necessity for ambulance transport by paramedics. In: Prehospital Emergency Care. 2003 ; Vol. 7, No. 4. pp. 466-469.
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