Against all advice: an analysis of out-of-hospital refusals of care.
OBJECTIVE
We examine the characteristics of patients involved in out-of-hospital emergency medical services (EMS) incidents that result in refusal of care and determine the rates of subsequent EMS, emergency department (ED), and inpatient care, as well as death within 7 days.


METHODS
Utah statewide EMS data identifying refusals of care were probabilistically linked to Utah statewide ED, inpatient, and death certificate data within 7 days of the initial EMS refusals for 1996 to 1998. Refusals were defined as incidents in which field treatment or transport was refused and did not include incidents in which EMS providers deemed care or transport unnecessary.


RESULTS
Of 277244 EMS incidents, 14109 (5.1%) resulted in refusals of care. For all age groups, motor vehicle crash dispatches resulted in the highest rate of refusal of care, ranging from 8.0% to 11.7%. Slightly more than 3% of patients involved in a refusal of care incident had a subsequent EMS dispatch within a week. One fifth of the patients involved in EMS refusals of care had a subsequent ED visit. Less than 2% of the EMS refusal patients were hospitalized; hospitalization was highest among children younger than 3 years and adults older than 64 years. Twenty-five adults died within a week of refusing EMS care, of whom 19 (76.0%) were older than 64 years.


CONCLUSIONS
Refusal of care incidents are a small segment of all EMS incidents. They arise from a variety of situations, and the risk for missed intervention may be minimal.
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA. Stacey.Knight@hsc.utah.edu
Stacey
S
Knight
Lenora M
LM
Olson
Lawrence J
LJ
Cook
N Clay
NC
Mann
Howard M
HM
Corneli
J Michael
JM
Dean
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D008498:Medical Record Linkage / Q000379:methods; D008875:Middle Aged; D012307:Risk Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014589:Utah / Q000453:epidemiology