title: Factors associated with the difficulty in hospital acceptance at the scene by emergency medical service personnel: a population-based study in Osaka City, Japan.
abstract: To investigate the association between the difficulty in hospital acceptance at the scene by emergency medical service (EMS) personnel and prehospital demographic factors and reasons for EMS calls.
  
  
  
  A retrospective, observational study.
  
  
  
  Osaka City, Japan.
  
  
  
  A total of 100 649 patients transported to medical institutions by EMS from January 2013 to December 2013.
  
  
  
  The definition of difficulty in hospital acceptance at the scene was EMS personnel making ≥5 phone calls to medical institutions until a decision to transport was determined. Multivariable analysis was used to assess the relationship between difficulty in hospital acceptance and prehospital factors and reasons for EMS calls.
  
  
  
  Multivariable analysis showed the elderly, foreigners, loss of consciousness, holiday/weekend, and night-time to be positively associated with difficulty in hospital acceptance at the scene. As reasons for EMS calls, gas poisoning (adjusted OR 3.281, 95% CI 1.201 to 8.965), trauma by assault (adjusted OR 2.662, 95% CI 2.390 to 2.966), self-induced drug abuse/gas poisoning (adjusted OR 4.527, 95% CI 3.921 to 5.228) and self-induced trauma (adjusted OR 1.708, 95% CI 1.369 to 2.130) were positively associated with the difficulty in hospital acceptance at the scene.
  
  
  
  Ambulance records in Osaka City showed that certain prehospital factors such as night-time were positively associated with difficulty in hospital acceptance at the scene, and reasons for EMS calls, such as self-induced drug abuse/gas poisoning, were also positive predictors for difficulty in hospital acceptance at the scene.
authors: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors: Yusuke
authors: Y
authors: Katayama
authors: Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
authors: Tetsuhisa
authors: T
authors: Kitamura
authors: Division Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan.
authors: Kosuke
authors: K
authors: Kiyohara
authors: Kyoto University Health Services, Kyoto, Japan.
authors: Taku
authors: T
authors: Iwami
authors: Kyoto University Health Services, Kyoto, Japan.
authors: Takashi
authors: T
authors: Kawamura
authors: Osaka Municipal Fire Department, Osaka, Japan.
authors: Sumito
authors: S
authors: Hayashida
authors: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors: Kazuhisa
authors: K
authors: Yoshiya
authors: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors: Hiroshi
authors: H
authors: Ogura
authors: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors: Takeshi
authors: T
authors: Shimazu
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000552:Ambulances; D002648:Child; D003142:Communication; D003657:Decision Making; D004634:Emergency Medical Technicians; D004636:Emergency Service, Hospital; D005006:Ethnicity; D005260:Female; D005739:Gas Poisoning; D006761:Hospitals; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D016079:Refusal to Treat; D012189:Retrospective Studies; D019966:Substance-Related Disorders; D014474:Unconsciousness; D014947:Wounds and Injuries; D055815:Young Adult
keywords: emergency medical service; hospital acceptance; pre-hospital factors