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  • Emergency department admission and mortality of the non-transported emergency medical service patients: a cohort study from Northern Finland

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Original research
Emergency department admission and mortality of the non-transported emergency medical service patients: a cohort study from Northern Finland
  1. Lauri Laukkanen1,2,
  2. Sanna Lahtinen2,3,
  3. Lasse Raatiniemi2,4,
  4. Ari Ehrola5,
  5. Timo Kaakinen2,3,
  6. Janne Liisanantti2,3
  1. 1 Faculty of Medicine, Oulu University, Oulu, Finland
  2. 2 Research Group of Surgery, Anaesthesiology and Intensive Care Medicine, Oulu University Hospital District, Oulu, Finland
  3. 3 Department of Anaesthesiology, Oulu University Hospital, Oulu, Finland
  4. 4 Centre for Pre-Hospital Emergency Care, Oulu University Hospital District, Oulu, Finland
  5. 5 Emergency Medical Services, Oulu-Koillismaa Rescue Department, Oulu University Hospital District, Oulu, Finland
  1. Correspondence to Lauri Laukkanen, Oulu University Faculty of Medicine, Oulu, Finland; lauri.laukkanen{at}student.oulu.fi

Abstract

Objectives A high number of emergency medical service (EMS) patients are not transported to hospital by ambulance. Various non-transport protocols and guidelines have been implemented by different EMS providers. The present study examines subsequent tertiary care ED and hospital admission and mortality of the patients assessed and not transported by EMS in Northern Finland and evaluates the factors predicting these outcomes.

Methods Data from EMS missions with a registered non-transportation code during 1 January 2018–31 December 2018 were screened retrospectively. EMS charts were retrieved from a local EMS database and data concerning hospital admission and mortality were collected from the medical records of Oulu University Hospital, Oulu, Finland.

Results A total of 12 530 EMS non-transport missions were included. Of those, a total of 344 (2.7%) patients were admitted to tertiary care ED in 48 hours after the EMS contact, and 229 (1.8%) of them were further admitted to the hospital. Patients with the dispatch code ‘abdominal pain’, clinical presentation with fever or hyperglycaemia, physician phone consultation and a decision not to transport during night hours were associated with a higher risk of ED admission within 48 hours after EMS contact. Overall 48-hour and 30-day mortalities of non-transported patients were 0.2% (n=25) and 1.0% (n=128), respectively.

Conclusion In this cohort, the rate of subsequent tertiary care ED admission and mortality in the non-transported EMS patients was low. Dispatch code abdominal pain, clinical presentation with fever or hyperglycaemia, physician phone consultation and night-hours increased the risk of ED admission within 48 hours after EMS contact.

  • emergency medical services
  • mortality
  • ED
  • non-transport
  • patient safety
  • prehospital care

Data availability statement

Data are available on reasonable request from the corresponding author and with approval from the administration of Oulu University Hospital.

https://doi.org/10.1136/emermed-2020-209914

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    Data availability statement

    Data are available on reasonable request from the corresponding author and with approval from the administration of Oulu University Hospital.

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    Footnotes

    • Handling editor Caroline Leech

    • SL and LR contributed equally.

    • Contributors LL, JL and LR designed the study. AE collected the data from electronic emergency medical service journals, and LL performed the data analysis. LL and SL wrote the initial draft of the manuscript, and JL, LR, AE and TK contributed to redrafting and refinement of the manuscript. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.