title: Outcome of travelers who refuse transport after emergency medical services evaluation at an international airport.
abstract: OBJECTIVE
  To determine the short-term outcome of patients refusing transport after emergency medical services (EMS) evaluation at an international airport.
  
  
  METHODS
  This was a prospective, descriptive, observational study of patients who refused transport after evaluation by Philadelphia Fire Department paramedics at Philadelphia International Airport from July 2003 through March 2004. Paramedics contacted a medical command physician (MCP), who recorded the patient's contact information. Three days later, one investigator attempted to contact the patient to administer a survey of the medical course in the three days following the initial encounter.
  
  
  RESULTS
  Of 90 patients enrolled, 64 (71%) were reached in follow-up. Their average age was 45 years (range 10 months to 80 years); 41 (63%) were female. The most common presenting complaints were trauma-related (22 patients, 34%), neurologic (12, 19%), and gastrointestinal (7, 11%). The most common reasons for refusing transport were belief that their complaint was not serious (48, 75%) and fear they would miss a flight (34 patients, 53%). In the three days following the initial encounter, no patients recontacted 9-1-1, 16 patients (25%) had a recurrence of their initial complaints, and 32 patients (50%) saw or talked to a physician. There was one hospitalization but no deaths. Among patients lost to follow-up, no deaths of U.S. citizens were detected.
  
  
  CONCLUSIONS
  Most patients who refused transport after EMS evaluation at an international airport had good short-term outcomes. These results may assist paramedics and MCPs to manage refusals in this setting and to allow patients to make informed decisions.
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-4283, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Marsan
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.forename: Edward T
authors.initials: ET
authors.lastname: Dickinson
authors.forename: C Crawford
authors.initials: CC
authors.lastname: Mechem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000401:Aircraft; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015143:Philadelphia / Q000453:epidemiology; D011446:Prospective Studies; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014195:Travel