PMID- 37078829
OWN - NLM
STAT- MEDLINE
DCOM- 20240202
LR  - 20240206
IS  - 1545-0066 (Electronic)
IS  - 1090-3127 (Linking)
VI  - 28
IP  - 2
DP  - 2024
TI  - Short-Term Outcomes and Patient Perceptions after Paramedic Non-Transport during 
      the COVID-19 Pandemic.
PG  - 418-424
LID - 10.1080/10903127.2023.2205512 [doi]
AB  - BACKGROUND: EMS frequently encounter patients who decline transport, yet there 
      are little data to inform the safety of patient and/or paramedic-initiated 
      assess, treat, and refer (ATR) protocols. We determined patient decision-making 
      and short-term outcomes after non-transport by EMS during the COVID-19 pandemic. 
      METHODS: This was a prospective, observational study of a random sample of 
      patients evaluated and not transported by EMS from August 2020 to March 2021. 
      From the EMS database, we randomly selected a daily sample of adult patients with 
      disposition of ATR. We excluded patients dispositioned against medical advice 
      (AMA) and those in police custody. Investigators contacted patients by phone to 
      administer a standardized survey regarding decision-making, symptom progression, 
      follow-up care, and satisfaction with non-transport decision. We also determined 
      the proportion of patients who re-contacted 9-1-1 within 72 h, and unexpected 
      deaths within 72 h using coroner data. Descriptive statistics were calculated. 
      RESULTS: Of 4613 non-transported patients, 3330 (72%) patients for whom the 
      disposition was ATR were included. Patients were 46% male with a median age of 49 
      (inter-quartile range (IQR) 31-67). Median vital signs measurements fell within 
      the normal range. Investigators successfully contacted 584/3330 patients (18%). 
      The most common reason for failure was lack of accurate phone number. The most 
      common reasons patients reported for not going to the ED on initial encounter 
      were: felt reassured after the paramedic assessment (151/584, 26%), medical 
      complaint resolved (113/584, 19%), paramedic suggested transport was not required 
      (73/584, 13%), concern for COVID-19 exposure (57/584, 10%), and initial concern 
      was not medical (46/584, 8%). Ninety-five percent (552/584) were satisfied with 
      the non-transport decision and 49% (284/584) had sought follow-up care. The 
      majority (501/584, 86%) reported equal, improved, or resolved symptoms, while 80 
      patients (13%) reported worse symptoms, of whom (64/80, 80%) remained satisfied 
      with the non-transport decision. Overall, there were 154 of 3330 (4.6%) 9-1-1 
      recontacts within 72 h. Based on coroner data, three unexpected deaths (0.09%) 
      occurred within 72 h of the initial EMS calls. CONCLUSION: Paramedic disposition 
      by ATR protocols resulted in a low rate of 9-1-1 recontact. Unexpected deaths 
      were extremely rare. Patient satisfaction with the non-transport decision was 
      high.
FAU - Bosson, Nichole
AU  - Bosson N
AUID- ORCID: 0000-0001-8356-0772
AD  - Los Angeles County EMS Agency, Santa Fe Springs, California.
AD  - Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist 
      Institute for Research, Torrance, California.
AD  - David Geffen School of Medicine at UCLA, Los Angeles, California.
FAU - Toy, Jake
AU  - Toy J
AUID- ORCID: 0000-0002-0089-5495
AD  - Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist 
      Institute for Research, Torrance, California.
FAU - Chang, Allen
AU  - Chang A
AD  - Los Angeles County EMS Agency, Santa Fe Springs, California.
AD  - Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist 
      Institute for Research, Torrance, California.
FAU - Haase, David
AU  - Haase D
AD  - Department of Emergency Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, 
      California.
FAU - Kipust, Adam
AU  - Kipust A
AD  - University of California Los Angeles, Los Angeles, California.
FAU - Korotzer, Liana
AU  - Korotzer L
AD  - Santa Clara University, Santa Clara, California.
FAU - Warren, Jonathan
AU  - Warren J
AD  - Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist 
      Institute for Research, Torrance, California.
FAU - Kim, Yun Son
AU  - Kim YS
AD  - Los Angeles County Fire Department, Los Angeles, California.
FAU - Kazan, Clayton
AU  - Kazan C
AD  - Los Angeles County Fire Department, Los Angeles, California.
FAU - Gausche-Hill, Marianne
AU  - Gausche-Hill M
AUID- ORCID: 0000-0002-6367-8455
AD  - Los Angeles County EMS Agency, Santa Fe Springs, California.
AD  - Harbor-UCLA Medical Center Department of Emergency Medicine and the Lundquist 
      Institute for Research, Torrance, California.
AD  - David Geffen School of Medicine at UCLA, Los Angeles, California.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20230503
PL  - England
TA  - Prehosp Emerg Care
JT  - Prehospital emergency care
JID - 9703530
SB  - IM
MH  - Adult
MH  - Humans
MH  - Male
MH  - Female
MH  - *Emergency Medical Services
MH  - Paramedics
MH  - Prospective Studies
MH  - Pandemics
MH  - *COVID-19
EDAT- 2023/04/20 13:41
MHDA- 2024/02/02 06:43
CRDT- 2023/04/20 09:53
PHST- 2024/02/02 06:43 [medline]
PHST- 2023/04/20 13:41 [pubmed]
PHST- 2023/04/20 09:53 [entrez]
AID - 10.1080/10903127.2023.2205512 [doi]
PST - ppublish
SO  - Prehosp Emerg Care. 2024;28(2):418-424. doi: 10.1080/10903127.2023.2205512. Epub 
      2023 May 3.