OUTCOME OF PATIENTS WHO REFUSED OUT-OF-HOSPITAL MEDICAL ASSISTANCE

Activation of the emergency medical services (EMS) system does not alw ays result in transport of a patient to the hospital, This study asses sed the outcomes of patients who refused medical assistance in the fie ld, to determine if refusal of medical assistance (RMA) is associated with poor outcomes, Four high volume suburban volunteer ambulance corp s participated in the study, Consecutive patients who refused medical assistance were prospectively enrolled. Medical and identifying data w ere collected for each patient, Telephone follow up was conducted to d eter mine the patient's condition and if the patient sought further ca re after RMA. Primary endpoints were whether the patient sought furthe r care, was admitted to a hospital, or died subsequent to RMA, Follow up was successfully obtained for 199 of 321 patients enrolled (62%), O f these 199 patients, 95 (48%) sought further medical care within 1 we ek for the same complaint, with 13 being admitted to the hospital, Six of the 13 admitted patients had chief complaints of a cardiac or resp iratory nature, One patient died during hospital admission, Even if no ne of the patients lost to follow up had sought further care, a substa ntial number of patients who refuse out of hospital medical assistance seek further care, Some of these patients require hospital admission, especially those with cardiac or respiratory complaints. Efforts to m inimize RMA should be especially focused on patients with such complai nts. (C) 1996 by W.B. Saunders Company