|
Author |
Jacob Hutton |
Date |
2020-07-15 |
|
Reviewer |
- |
Edited |
2020-10-22 |
You are dispatched to a 78-year-old female patient in an assisted living facility. She is complaining of some weakness and malaise. She has a pre-existing condition of cognitive decline. The nearest hospital is a 45-minute drive from the facility, and it is 2100hrs.
What are the relevant factors to consider when deciding whether to transport this patient to the hospital versus non-conveyance? What are the key indicators that prehospital personnel can utilize in their decision matrices to aid in analyzing the risks and benefits of non-conveyance for this patient? What are the key clinical presentations that are most likely to require further interaction with the health care system?
“For patients who undergo contact with EMS in the pre-hospital setting, does the ability of the EMS crew to make a non-conveyance decision compared to inability of the EMS crew to make such a decision result in higher likelihood of patients having to re-contact 911 or hospital admittance?”
|
Population |
For patients interacting with EMS in the pre-hospital setting |
|
Intervention |
Does non-conveyance of patients |
|
Comparison |
As compared to bringing all patients to the emergency department |
|
Outcome |
Result in any outcome differences as measured by morbidity/mortality, later ED admission, or re-contact with EMS? |
Pubmed: (non-conveyance OR patient refusal) AND (EMS OR paramedics) AND (safety OR morbidity OR mortality OR re-admittance)
96 Results (14 relevant) on 2020-07-15
Current evidence surrounding the effectiveness of non-conveyance guidelines show that prehospital personnel are able to make non-conveyance decisions with a reasonable level of accuracy and that rates of patient re-interaction with the healthcare chain is low. Within 48 hours of non-conveyance, re-interaction with the healthcare chain has been measured to occur in 2.4%-12.6% of patients. Factors associated with higher rates of re-interaction include extremes of age, existence of a mental, neurological, or behavioural disorder. More research is still needed to further characterize specific risk factors associated with re-interaction.
Diseases of the circulatory system, injury, poisoning, and diseases of the respiratory system are represented in higher proportions in conveyance groups, while patients with previously diagnosed mental, behavioural, and neurodevelopmental disorders are overrepresented in the non-conveyance group.