title: Can Medical Decision-making at the Scene by EMS Staff Reduce the Number of Unnecessary Ambulance Transportations, but Still Be Safe?
abstract: OBJECTIVE
  The aim of this study was to evaluate the procedures adopted by the staff of the Shiraz Emergency Medical Services (EMS) and the outcome of the patients discharged from the scene over a one-year period.
  
  
  BACKGROUND
  Unnecessary use of ambulances results in the overloading of EMS and the over-crowding of emergency departments. Medical assessment at the scene by EMS staff may reduce these issues. In an earlier study in Shiraz, 36% of the patients were left at home/discharged directly from the scene with or without treatment by EMS staff after consulting a physician at the dispatch center. However, there has been no evaluation of this system with regard to mortality and morbidity.
  
  
  METHODS
  Retrospective data on all missions performed by the Shiraz EMS (2012-2013) were reviewed. All the patients discharged from the scene by the EMS staff on the 5th, 15th, and 25th days of each month were included. A questionnaire with nine questions was designed, and available patients/relatives were interviewed prospectively (2014; follow-up period 4-12 months).
  
  
  RESULTS
  Out of 3019 cases contacted, 994 (almost 33%) replied. There were 26%-93% reductions in the complaints in all disease categories. A group of the patients left the scene at their own will. Of those who were discharged by the EMS staff at the scene, over 60% were without any complaints. Twelve out of 253 patients died after they were sent home by the EMS staff.
  
  
  CONCLUSIONS
  Patients may be discharged at the scene by EMS staff and after consulting a physician. However, there is a need for a solid protocol to ensure total patient safety. This calls for a prospective study.
authors.affiliation: Prehospital and Disaster Medicine Centre, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Medical Informatic Management, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mahmoudreza
authors.initials: M
authors.lastname: Peyravi
authors.affiliation: Pre-hospital and Disaster Medicine Centre, Department of Surgery, Institute of clinical sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Örtenwall
authors.affiliation: Pre-hospital and Disaster Medicine Centre, Department of Surgery, Institute of clinical sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
authors.forename: Amir
authors.initials: A
authors.lastname: Khorram-Manesh
keywords: Ambulance Transportation; Discharging from the Scene; EMS; Outcome; decision-making