Discrepancies Between Emergency Transport Modality and Emergency Department Outcomes: An Epidemiological Analysis

Prehospital emergency services have evolved significantly, with increased specialization and deployment of advanced transport systems. However, concerns have been raised regarding the potential overutilization of these resources by patients who may not present with clinically urgent conditions. This study aims to investigate the relationship between the mode of arrival to the Emergency Department (ED) and the clinical severity upon evaluation, emphasizing the appropriateness of advanced emergency transport use.

We conducted a multicenter retrospective observational study analyzing all ED visits (n = 1 282 976) from January 1, 2019, to December 31, 2023, across seven hospitals in the Province of Bolzano, Italy. Data were extracted from electronic health records. Variables included patient demographics, mode of arrival, triage priority and hospital admission. Logistic regression models adjusted for hospital-level clustering were used to assess associations between transport modality and outcomes.

Most patients (77.4%) arrived by self-transport, while 0.8% arrived by helicopter. Although advanced transport was associated with higher odds of urgent triage and hospital admission, a substantial proportion of patients transported by helicopter (approximately 50%) or physician-staffed ambulance (approximately 30%) were discharged or assigned non-urgent triage codes. Logistic regression confirmed that advanced transport significantly decreased the odds of receiving a non-urgent code and increased the likelihood of admission; however, notable overtriage persisted.

The findings highlight a mismatch between transport modality and clinical urgency in a significant number of cases. Enhancing emergency dispatch protocols and refining prehospital triage systems are critical to ensuring resource sustainability and optimizing care delivery within public healthcare systems.