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Once again Emergency Medical Services (EMS) initiated refusal of hospital treatment has come under the spotlight. Emergency Medical Systems which are designed to transport critically ill or injured patients to Emergency Centers are being overburdened in many parts of the world by high volumes of patients with minor illnesses that do not require immediate transportation. A study from Virginia investigated prehospital discharge protocols in US city EMS systems. Some systems had medical supervision, whilst others were paramedic driven. The study does touch on a few concerns, such as the extent of undertriaging by EMS providers, as well as the need for alternative means of transport if EMS do not provide. Until prehospital discharge protocols have been validated, it would seem sensible to be very cautious before implementing this (J Emerg Med 2009;36:116–20).


Mass gathering events take many shapes and forms, but all share the same characteristic of presenting a considerable challenge for those planning medical cover. A study of patient contacts during mass gatherings revealed that it is possible to predict …

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