title: Long-Term Mortality of Emergency Medical Services Patients.
abstract: OBJECTIVE
  Emergency medical services (EMS) provides out-of-hospital care to patients with life-threatening conditions, but the long-term outcomes of EMS patients are unknown. We seek to determine the long-term mortality of EMS patients in Denmark.
  
  
  METHODS
  We analyzed linked EMS, hospital, and vital status data from 3 of 5 geographic regions in Denmark. We included events from July 1, 2011, to December 31, 2012. We classified EMS events according to primary dispatch category (unconsciousness/cardiac arrest, accidents/trauma, chest pain, dyspnea, neurologic symptoms, and other EMS patients). The primary outcome was 1-year mortality adjusted for age, sex, and Charlson comorbidity index.
  
  
  RESULTS
  Among 142,125 EMS events, primary dispatch categories were unconsciousness or cardiac arrest 5,563 (3.9%), accidents or trauma 40,784 (28.7%), chest pain 20,945 (14.7%), dyspnea 9,607 (6.8%), neurologic symptoms 17,804 (12.5%), and other EMS patients 47,422 (33.4%). One-year mortality rates were unconscious or cardiac arrest 54.7% (95% confidence interval [CI] 53.4% to 56.1%), accidents or trauma 7.8 (95% CI 7.5% to 8.1%), chest pain 8.5% (95% CI 8.1% to 9.0%), dyspnea 27.7% (95% CI 26.7% to 28.7%), neurologic symptoms 14.1% (95% CI 13.6% to 14.7%), and other EMS patients 11.1% (95% CI 10.8% to 11.4%). Compared with other EMS conditions, adjusted 1-year mortality was higher in unconsciousness or cardiac arrest (risk ratio [RR] 2.6; 95% CI 2.5 to 2.7), dyspnea (RR 1.5; 95% CI 1.4 to 1.5), and in neurologic symptoms (RR 1.1; 95% CI 1.0 to 1.1), but lower in chest pain (RR 0.6; 95% CI 0.6 to 0.7) and accidents or trauma (RR 0.8; 95% CI 0.8 to 0.8).
  
  
  CONCLUSIONS
  EMS patients with unconsciousness or cardiac arrest, dyspnea, and neurologic symptoms are at highest risk of long-term mortality. Our results suggest a potential for outcome improvement in these patients.
authors.affiliation: Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: botker@fastmail.fm.
authors.forename: Morten T
authors.initials: MT
authors.lastname: Bøtker
authors.affiliation: Department of Cardiology B, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Terkelsen
authors.affiliation: Emergency Medical Communication Center, Capital Region of Denmark, Copenhagen, Denmark.
authors.forename: Jan N
authors.initials: JN
authors.lastname: Sørensen
authors.affiliation: Mobile Emergency Care Unit, Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark.
authors.forename: Søren B
authors.initials: SB
authors.lastname: Jepsen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Søren P
authors.initials: SP
authors.lastname: Johnsen
authors.affiliation: Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Erika F
authors.initials: EF
authors.lastname: Christensen
authors.affiliation: Research and Development, Prehospital Emergency Medical Services, Central Denmark Region, Aarhus, Denmark; Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mikkel S
authors.initials: MS
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D003718:Denmark / Q000453:epidemiology; D004417:Dyspnea / Q000401:mortality*; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000401:mortality*; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality*; D011379:Prognosis; D012041:Regional Medical Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D014474:Unconsciousness / Q000401:mortality*