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Original research
Outcomes of adult patients discharged at scene by emergency medical services
  1. Melanie Villani1,2,
  2. Emily Nehme1,2,
  3. Shelley Cox1,2,
  4. David Anderson1,2,3,
  5. Nicola Reinders1,
  6. Ziad Nehme1,2
  1. 1 Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
  2. 2 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  3. 3 Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Prahran, Victoria, Australia
  1. Correspondence to Dr Melanie Villani, Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; melanie.villani2{at}ambulance.vic.gov.au

Abstract

Background The outcomes of patients who call an ambulance but are discharged at scene reflect the safety and quality of emergency medical service (EMS) care. While previous studies have examined the outcomes of patients discharged at scene, none have specifically focused on paramedic-initiated discharge. This study aims to describe the outcomes of adult patients discharged at scene by paramedics and identify factors associated with 72-hour outcomes.

Methods This was a retrospective data linkage study on consecutive adult EMS patients discharged at scene by paramedics in Victoria, Australia, between 1 January 2015 and 30 June 2019. Multivariable logistic regression was used to investigate factors associated with EMS recontact, ED presentation, hospital admission and serious adverse events (death, cardiac arrest, category 1 triage or intensive care unit admission) within 72 hours of the initial emergency call.

Results There were 375 758 cases of adults discharged at scene following EMS attendance, of which 222 571 (59.2%) were paramedic-initiated decisions. Of these, 6.8% recontacted EMS, 5.0% presented to ED, 2.4% were admitted to hospital and 0.3% had a serious adverse event in the following 72 hours. The odds of EMS recontact were increased in cases related to mental health (adjusted OR (AOR) 1.41 (95% CI 1.33 to 1.49)), among low-income government concession holders (AOR 1.61 (95% CI 1.55 to 1.67)) and in areas of low socioeconomic advantage (AOR 1.19 (95% CI 1.13 to 1.25)). The odds of hospital admission were increased in cases related to infection (AOR 3.14 (95% CI 2.80 to 3.52)) and pain (AOR 1.93 (95% CI 1.75 to 2.14)). The strongest driver of serious adverse events was an abnormal vital sign (AOR 4.81 (95% CI 3.87 to 5.98)).

Conclusion The occurrence of hospital admission and adverse events is rare in those discharged at scene, suggesting generally safe decision-making. However, increased attention to elderly, multimorbid patients or patients with infection and pain is recommended, as is further research examining the use of tools to aid paramedic recognition of potential for deterioration.

  • emergency ambulance systems
  • emergency responders
  • safety
  • pre-hospital care

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/emermed-2023-213777

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Handling editor Kirsty Challen

    • X @Ziad_Nehme1

    • Contributors MV, EN and ZN contributed to the study conception, design and drafting of manuscript. All authors contributed to interpretation of results and critical revision of manuscript. MV is the guarantor and is responsible for the overall content of the work and all authors approve of the manuscript.

    • Funding EN is supported by a National Health and Medical Research Council Postgraduate Scholarship (#2003449). ZN is supported by a Future Leader Fellowship (#105690) from the National Heart Foundation of Australia.

    • Competing interests EN and ZN are supported as per Funding Statement. All other authors report no competing interests.

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

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.