Repeated ambulance use by patients with acute alcohol intoxication, seizure disorder, and respiratory illness

Brokaw, Jennifer; Olson, Lenora M.; Fullerton, Lynne; Tandberg, Dan; Sklar, David P.

doi:10.1016/s0735-6757(98)90031-6

Cited by 50 publications

(42 citation statements)

References 14 publications

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“…Much of our population was marginally housed and suspected to be of a lower socioeconomic status, and in this population, ambulance transport may be financially covered by social assistance. Substance use has also been linked to increased ambulance use, with rates as high as 20% of transports attributable to alcohol 21,22 and as high as 70% in repeat emergency medical services users. 22 In this study, 50.4% of ambulance arrivals involved a substance diagnosis, which may be an underestimate given the high percentage of individuals arriving by ambulance who LWBS.…”

Section: Discussionmentioning

confidence: 99%

“…Substance use has also been linked to increased ambulance use, with rates as high as 20% of transports attributable to alcohol 21,22 and as high as 70% in repeat emergency medical services users. 22 In this study, 50.4% of ambulance arrivals involved a substance diagnosis, which may be an underestimate given the high percentage of individuals arriving by ambulance who LWBS. Often an ambulance is not called by the patient but rather by passersby, who call to report a person found down on the street.…”

Section: Discussionmentioning

confidence: 99%

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Frequent users of an inner-city emergency department

Geurts

Palatnick²,

Strome³

et al. 2012

CJEM

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Background: Within the emergency department (ED) patient population there is a subset of patients who make frequent visits. This chart review sought to characterize this population and identify strategies to reduce frequent ED visits. Methods: Frequent use at an urban tertiary care centre was defined as 15 or more visits over 1 year. The details of each visit-demographics, entrance complaint, discharge diagnosis, arrival method, Canadian Triage and Acuity Scale (CTAS) score, and length of stay-were analyzed and compared to data from the entire ED population for the same period. Results: Ninety-two patients generated 2,390 ED visits (of 25,523 patients and 44,204 visits). This population was predominantly male (66%) and middle-aged (median 42 years), with no fixed address (27.2%). Patients arrived by ambulance in 59.3% of visits with less acute CTAS scores than the general population. Substance use accounted for 26.9% of entrance complaints. Increased lengths of stay were associated with female gender and abnormal vital signs, whereas shorter stays were associated with no fixed address and substance use (p , 0.05). Admissions were lower than the general population, and women were twice as likely as men to be admitted (p , 0.05). Patients left without being seen in 15.8% of visits. Conclusions: High-frequency ED users are more likely to be male, younger, and marginally housed and to present secondary to substance use. Although admissions among this population are low, the costs associated with these presentations are high. Interventions designed to decrease visits and improve the health of this population appear warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Frequent users of an inner-city emergency department

Geurts

Palatnick²,

Strome³

et al. 2012

CJEM

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show abstract

“…Better planning and integration of EMS, at all levels (regional, national) is essential for maintaining a secure and reliable public healthcare system [1,2]. ED-overcrowding, which is also linked to a hospital's resource constraints, may result in ambulance diversions and overloading of ambulance capacity and endanger patients' safety and disaster preparedness [1,[3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Prehospital triage, discrepancy in priority-setting between emergency medical dispatch centre and ambulance crews

Khorram‐Manesh

Montán

Hedelin

et al. 2010

Eur J Trauma Emerg Surg

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Appropriate ambulance use is one important part of emergency preparedness. Overuse results in decreased emergency medical services (EMS) availability and ED-overcrowding. Several factors, such as an imprecise triage system and increased public demands, may influence such overutilization. Improving the triage system and comprehensive public education on appropriate use of ambulances are two important steps toward a better use of national EMS resources.

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“…Patients with ethanol intoxication, respiratory complaints, seizure, and complications of diabetes appear to be more predisposed to refuse transport. 7 Patients with seizures were ranked second by ICD-9 codes among patients transported by the Philadelphia Fire Department for fiscal year 1998-1999. The objective of the current study was to determine the short-term outcome of patients with an established diagnosis of seizure disorder who had another seizure followed by activation of EMS, and the patient refused transport after returning to baseline mental status.…”

Section: Crawford Mechem MD Jennifer Barger Rn Frances S Shofmentioning

confidence: 99%

Short‐term Outcome of Seizure Patients Who Refuse Transport after Out‐of‐hospital Evaluation

Mechem

Barger

Shofer

et al. 2001

Academic Emergency Medicine

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Abstract. Objective: To determine the short-term outcome of patients with a known seizure disorder who have a seizure, are evaluated by out-of-hospital care providers, and refuse transport. Methods: This was a prospective study conducted over a 15-month period. Philadelphia Fire Department paramedics contacted a medical command physician whenever they encountered a patient with a known seizure disorder who had had another seizure and was refusing transport. After confirming that the patient had the mental capacity to refuse care and understood the associated risks, the physician recorded the patient's name, address, and telephone number. Beginning three days later, a registered nurse attempted to reach the patient by telephone and administer a brief questionnaire about his or her medical outcome. Patients not reached by telephone were sent a certified letter. The names of patients lost to follow-up were compared with medical examiner records to confirm that they had not died during the follow-up period. Results: Of 63 patients enrolled in the study, 52 (82.5%) were reached in follow-up. Of these, three (5.8%) had another seizure within 72 hours and recontacted 911. One of these patients (1.9%) was hospitalized. Twenty (38.5%) patients contacted their primary care physicians. There were no deaths, including patients lost to follow-up. Conclusions: Most patients (94.2%) who were evaluated by out-of-hospital care providers for a seizure and refused transport had no further seizure activity in the subsequent 72 hours. However, because there is a risk of recurrence, out-of-hospital care providers and medical command physicians should ensure that patients understand the risks of refusal.

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Repeated ambulance use by patients with acute alcohol intoxication, seizure disorder, and respiratory illness

Cited by 50 publications

References 14 publications

Frequent users of an inner-city emergency department

Frequent users of an inner-city emergency department

Prehospital triage, discrepancy in priority-setting between emergency medical dispatch centre and ambulance crews

Short‐term Outcome of Seizure Patients Who Refuse Transport after Out‐of‐hospital Evaluation

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