Short-Term Outcomes and Patient Perceptions after Paramedic Non-Transport during the COVID-19 Pandemic

Area of Science:

• Emergency medicine
• Public health
• Patient safety

Background:

• Emergency Medical Services (EMS) frequently encounter patients who decline transport.
• Limited data exist on the safety of patient or paramedic-initiated assess, treat, and refer (ATR) protocols.
• This study examined patient decision-making and short-term outcomes following non-transport by EMS during the COVID-19 pandemic.

Purpose of the Study:

• To determine patient decision-making processes when refusing EMS transport.
• To evaluate short-term patient outcomes after non-transport by EMS.
• To assess the safety and patient satisfaction with ATR protocols.

Main Methods:

• Prospective, observational study of a random sample of patients evaluated and not transported by EMS (August 2020 - March 2021).
• Patients were contacted via phone survey to gather data on decision-making, symptom progression, and satisfaction.
• Outcomes assessed included 72-hour 9-1-1 recontact rates and unexpected deaths.

Main Results:

• Of 3330 included patients, 18% were successfully contacted.
• Common reasons for non-transport included reassurance from paramedic assessment, symptom resolution, and perceived lack of necessity for transport.
• Ninety-five percent of contacted patients were satisfied with the non-transport decision, with 4.6% recontacting 9-1-1 within 72 hours and 0.09% experiencing unexpected deaths.

Conclusions:

• Paramedic disposition using ATR protocols demonstrated a low rate of 9-1-1 recontact.
• Unexpected deaths following non-transport decisions were rare.
• Patient satisfaction with non-transport decisions was high, suggesting the safety and efficacy of ATR protocols.