Prospective evaluation of an emergency medical services-administered alternative transport protocol

The ability of emergency medical services (EMS) providers to offer an alternative means of nonemergent transport for patients with minor medical complaints is a rarely sanctioned concept in U.S. EMS systems.

To prospectively determine if paramedics using transport guidelines can identify patients with minor medical problems who can be safely transported by a nonmedical alternative transport mechanism (taxi).

Paramedics in the city of Norfolk, Virginia, who had more than one year of experience and who had completed the study orientation course were eligible to enroll subjects in the study. Predetermined alternative transport exclusion criteria as well as inclusion guidelines were provided to paramedics. After on-scene evaluation, paramedics identified subjects who met the enrollment criteria and were deemed safe for emergent ambulance transport. Enrolled subjects were provided a prepaid taxi voucher, which allowed for transport to the closest emergency department (ED). Patients who refused study participation were transported to the ED by ambulance.

Ninety-three subjects were enrolled and transported to the ED via taxi. Eleven patients identified by EMS as meeting enrollment criteria refused study participation. The average time from taxi dispatch to ED triage was 43 minutes (95% confidence interval [CI] = 38 to 48). Nine (10%) subjects transported by taxi were ultimately admitted to the hospital. None of the study participants required ED blood transfusions or emergent procedures or suffered an adverse event that could be directly attributed to the delay in ED arrival by taxi.

The ability of EMS to safely triage patients who activate the 9-1-1 system to an alternative transport mechanism remains an unproven concept. Our study adds to the concerns of other published literature that EMS providers underestimate the potential severity of illness.