title: Outcome of patients who refused out-of-hospital medical assistance.
abstract: Activation of the emergency medical services (EMS) system does not always result in transport of a patient to the hospital. This study assessed the outcomes of patients who refused medical assistance in the field, to determine if refusal of medical assistance (RMA) is associated with poor outcomes. Four high-volume suburban volunteer ambulance corps participated in the study. Consecutive patients who refused medical assistance were prospectively enrolled. Medical and identifying data were collected for each patient. Telephone follow-up was conducted to determine the patient's condition and if the patient sought further care after RMA. Primary endpoints were whether the patient sought further care, was admitted to a hospital, or died subsequent to RMA. Follow-up was successfully obtained for 199 of 321 patients enrolled (62%). Of these 199 patients, 95 (48%) sought further medical care within 1 week for the same complaint, with 13 being admitted to the hospital. Six of the 13 admitted patients had chief complaints of a cardiac or respiratory nature. One patient died during hospital admission. Even if none of the patients lost to follow-up had sought further care, a substantial number of patients who refuse out-of-hospital medical assistance seek further care. Some of these patients require hospital admission, especially those with cardiac or respiratory complaints. Efforts to minimize RMA should be especially focused on patients with such complaints.
authors.affiliation: Department of Emergency Medicine, University Medical Center, State University of New York, Stony Brook 11794-7400, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Burstein
authors.forename: M C
authors.initials: MC
authors.lastname: Henry
authors.forename: J
authors.initials: J
authors.lastname: Alicandro
authors.forename: D
authors.initials: D
authors.lastname: Gentile
authors.forename: H C
authors.initials: HC
authors.lastname: Thode
authors.forename: J E
authors.initials: JE
authors.lastname: Hollander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006302:Health Services Research; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D009026:Mortality; D009518:New York; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D011379:Prognosis; D018881:Suburban Health; D016312:Treatment Refusal