Dr. Melanie Villani1,2, Ms. Emily Nehme1,2, Dr. Shelley Cox1,2, Dr. David Anderson1,2,3,4, Ms. Nicola Reinders1, Dr. Ziad Nehme1,2,3
1Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Australia, 2School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 3Department of Paramedicine, Monash University, Frankston, Australia, 4Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Prahran, Australia
Biography:
A diverse academic background including a PhD focusing on ambulance utilisation for diabetic emergencies, coupled with practical experience as an ALS Paramedic at AV for almost 10 years. Melanie currently works as a research analyst at the Centre for Research and Evaluation at AV
Abstract:
Introduction: There is limited knowledge on patient outcomes following Emergency Medical Services (EMS) scene discharge when the decision is paramedic-initiated. This study aims to describe characteristics of adult patients discharged at scene by paramedics and identify factors associated with 48-hour outcomes.
Methods: A retrospective data linkage study on consecutive adult EMS patients discharged at scene by paramedics between 01 Jan 2015 and 30 June 2019. Multivariable logistic regression was used to investigate factors associated EMS recontact, ED presentation, hospital admission and serious adverse event within 48 hours of the initial emergency call.
Results: There were 375,757 cases of adults discharged at scene following EMS attendance, of which 222,570 (59.2%) were paramedic-initiated decisions. Of these, 5.7% recontacted EMS, 4.5% presented to ED, 2.0% were admitted to hospital and 0.2% had an adverse event in the following 48 hours. The odds of EMS recontact were increased in cases related to alcohol/drugs (AOR 1.43 [95% CI: 1.29 ,1.59]), concession holders (AOR 1.59 [95% CI: 1.51, 1.67]) and in areas of low socioeconomic advantage (AOR 1.19 [95% CI: 1.11, 1.27]). The strongest driver of serious adverse events was abnormal vital signs (AOR 4.20 [95% CI:3.13, 5.64]).
Conclusion: The occurrence of hospital admission and adverse events is rare in those discharged at scene, suggesting generally safe decision-making. However increased attention to elderly, multimorbid patients or patients with infection and pain is recommended, as is further research examining the use of tools to aid paramedic recognition of deterioration.