Adverse events during interfacility transfers by ground advanced life support services.
OBJECTIVE
To identify risk factors for adverse events that occur during interfacility transfers by advanced life support (ALS).


METHODS
A four-year, retrospective, case series.


METHODS
Three ALS units in a rural/suburban emergency medical services (EMS) system.


METHODS
351 transports to or from twelve acute care facilities; two patients records could not be located.


METHODS
Patients were classified by illness/injury, transporting staff, and ongoing therapy; these were correlated with frequency of ALS intervention and patient deterioration.


RESULTS
During the study period, the number of transfers as a percentage of total calls (1.1%-5.2%) rose consistently. There were 11 illness/injury categories; the largest was cardiac (44%, 154 patients). Hospital staff accompanied the patient in 15% (52). Advanced life support (ALS) therapy was required in 4.9% (17): one monitored cardiac arrest was defibrillated successfully, 13 patients required unanticipated medication therapy, and three were noted to have clinical deterioration en route. The upper 95% confidence limit for cardiac arrest is 12.9/1,000 transfers or 20.8/1,000 hours. Patient deterioration and the need for ALS intervention were associated with the presence of medication infusions (p < .05), but not with hospital staff (p > .40).


CONCLUSIONS
Interfacility transfers of a heterogeneous group of patients in this series involve a low risk of cardiac arrest. Patients with medication infusions are at higher risk of deterioration and more frequently require ALS intervention en route. The presence of hospital staff had no measurable effect. These findings have implications for the development of ALS transfer protocols.
Wuerz
R
R
Division of Emergency Medicine, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey 17033, USA.
Meador
S
S
D000552:Ambulances; D004632:Emergency Medical Services; D006301:Health Services Needs and Demand; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008020:Life Support Care; D010360:Patient Transfer; D012189:Retrospective Studies; D012307:Risk Factors; D012423:Rural Health; D018881:Suburban Health; D013997:Time Factors