title: Can paramedics safely decide which patients do not need ambulance transport or emergency department care?
abstract: OBJECTIVE
  To determine whether paramedics can safely decide which patients do not require ambulance transport or emergency department (ED) care.
  
  
  METHODS
  This was a prospective survey and linked medical record review. Paramedics completed a brief questionnaire for each patient they transported to a university hospital ED during a one-month period. A faculty emergency physician masked to the survey results reviewed hospital records. Ambulance transport was defined as "needed" if the charted differential diagnosis included diagnoses that could necessitate treatment in an ambulance. ED care was defined as "needed" if treatment of these diagnoses would necessitate resources not available in local urgent care centers (UCCs).
  
  
  RESULTS
  Two hundred thirty-six patients were transported; 183 corresponding ED charts were found. Agreement between paramedics and need determined by ED chart review was low for both transport method [kappa (kappa) = 0.47, 95% confidence interval (95% CI) = 0.34-0.60] and ED care (kappa = 0.32, 95% CI = 0.17-0.46). Paramedics recommended alternative transport for 97 patients, 23 of whom needed ambulance transport. Paramedics recommended non-ED care for 71 patients, 32 of whom needed ED care.
  
  
  CONCLUSIONS
  Paramedics cannot safely determine which patients do not need ambulance transport or ED care.
authors.affiliation: Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque 87131-5121, USA. mhauswald@salud.unm.edu
authors.forename: Mark
authors.initials: M
authors.lastname: Hauswald
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003657:Decision Making; D004634:Emergency Medical Technicians / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014187:Transportation of Patients; D014218:Triage