title: Impact of an after-hours on-call emergency physician on ambulance transports from a county jail.
abstract: OBJECTIVE
  The authors sought to determine if the availability of an after-hours on-call emergency physician by telephone for consultation to the staff at a county jail would safely reduce ambulance emergency department (ED) transport of inmates in the community.
  
  
  METHODS
  The authors conducted a prospective comparison study during the first ten months of an emergency physician on-call program for the county jail in which prospective data were collected on all consultations, including reason for call and disposition (ambulance, deputy, or no ED transport of inmate). They compared this time with a similar period a year before the program in terms of total ambulance transports from the jail. They also reviewed all hospital and jail medical records to assess for any adverse consequences within one month, or subsequent ambulance transport within 24 hours as a result of inmate care after the consultation call.
  
  
  RESULTS
  Total after-hours ambulance transports from the jail decreased significantly from 30.3 transports/month (95% confidence interval [CI], 21.0-39.6) to 9.1 transports/month (95% CI, 4.1-14.0) (p < 0.05). The most common reasons for consultation calls were chest pain (16%), trauma (15%), and abnormal laboratory or radiology results (14%). Of all calls, only 30% resulted in ambulance transport to the ED. On review of records, no adverse outcome or subsequent ambulance transport was identified.
  
  
  CONCLUSIONS
  The initiation of an on-call emergency physician program for after-hours consultation to jail nursing and law enforcement staff safely reduced ambulance transports from a county jail with no adverse outcomes identified.
authors.affiliation: Department of Emergency Medicine, University of California San Diego Medical Center, San Diego, California 92103, USA. tcchan@ucsd.edu
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.forename: Sue
authors.initials: S
authors.lastname: Smith
authors.forename: William
authors.initials: W
authors.lastname: Sparrow
authors.forename: James V
authors.initials: JV
authors.lastname: Dunford
mesh_terms: D039602:After-Hours Care / Q000458:organization & administration*; D000552:Ambulances / Q000706:statistics & numerical data*; D002140:California; D004631:Emergency Medical Service Communication Systems; D004635:Emergency Medicine / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006300:Health Services Misuse; D006801:Humans; D011330:Prisons / Q000458:organization & administration*; D011446:Prospective Studies; D019114:Remote Consultation; D013689:Telephone; D013997:Time Factors