Objectives
Prehospital transport decisions depend on a combination of protocols, judgment, and patient acuity/preference. Non-protocolized out-of-area transport may result in unnecessary delays and resource strain.
Methods
We retrospectively reviewed one year of scene transports by a rural, hospital-based EMS system, analyzing transport rationale and comparing hospital admission and specialist consultation as surrogates for decision appropriateness.
Results
Among 2,223 transports, 281 were out-of-area. The most common reasons were patient preference unrelated to prior care (40%) and clinician judgment (24%). Admission rates were highest for per protocol (85%) and patient preference related to prior care (67%), and lowest for no explanation (41%) and clinician judgment (47%). Rates of specialist consultation in the ED were highest in per protocol (69%) and clinician judgment (47%) and lowest in no explanation (23%) and patient preference unrelated to prior care (30%). Clinician judgment was less predictive of admission and specialist consultation for non-trauma and pediatric patients. Median out-of-service time was more than twice as long for out-of-area transports (140 min) versus transports to the nearest facility (62 min). For out-of-area transports discharged from the ED without specialty consultation (n = 104), ambulances traveled an additional 52 miles/patient.
Conclusions
Unit out-of-service time more than doubled for non-protocolized out-of-area transports and rationale for destination decisions variably predicted admission and specialist consultation rates. Patient preference unrelated to prior care and clinician judgement in pediatric and non-trauma populations were less predictive of admission and specialist consultation. Transport guidelines should balance decision rationale with resource preservation, especially in low-resource systems.
Previous publication: Manuscript in Prehospital Emergency Care
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The Burden of Non-Protocolized Patient Transport Outside of Response Area on a Rural Emergency Medical Services System by Hill Stoecklein, MD, Isabel Shimanski, Chris Ryba, MD, Joe Carnell & Scott Youngquist, MD, MS