title: Can paramedics accurately identify patients who do not require emergency department care?
abstract: OBJECTIVE
  To determine whether paramedics can identify patients contacting 9-1-1 who do not require emergency department (ED) care.
  
  
  METHODS
  The setting was an urban county with a two-tiered, dual response to 9-1-1 calls comprising eight local fire departments with advanced life support capabilities and a private advanced life support 9-1-1 agency with primary transport responsibilities (approximately 39,000 of the 78,000 total system patient transports in this county per year). The study population consisted of consecutive patients transported by a private transporting paramedic agency. After patient contact and stabilization, paramedics completed a survey detailing the necessity for transport to an ED for each patient. Prior to data analysis, it was determined that patients would be designated as requiring ED care if they 1) were admitted, 2) required surgical, surgical subspecialty, obstetric, or gynecologic consult, or 3) required advanced radiologic procedures (excluding plain films). Sensitivity, specificity, and predictive values for paramedic assessment of necessity for ED care were calculated with 95% confidence intervals (95% CIs).
  
  
  RESULTS
  Over the study period, 313 patients were enrolled. Paramedic assessment was 81% sensitive (72-88%, 95% CI) and 34% specific (28-41%, 95% CI) in predicting requirement for ED care. In 85 cases where paramedics felt ED transport was unnecessary, 27 (32%) met criteria for ED treatment, including 15 (18%) who were admitted and five (6%) who were admitted to an intensive care unit.
  
  
  CONCLUSIONS
  In this urban system, paramedics cannot reliably predict which patients do and do not require ED care.
authors.affiliation: ems.medicaldirector@ocfl.net
authors.forename: Salvatore
authors.initials: S
authors.lastname: Silvestri
authors.forename: Steven G
authors.initials: SG
authors.lastname: Rothrock
authors.forename: Dan
authors.initials: D
authors.lastname: Kennedy
authors.forename: Jay
authors.initials: J
authors.lastname: Ladde
authors.forename: Marsha
authors.initials: M
authors.lastname: Bryant
authors.forename: Joseph
authors.initials: J
authors.lastname: Pagane
mesh_terms: D000368:Aged; D002983:Clinical Competence; D003657:Decision Making; D004632:Emergency Medical Services / Q000592:standards; D004634:Emergency Medical Technicians / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D014218:Triage; D019037:Urban Health Services / Q000592:standards