Inappropriate use of emergency medical services transport: Comparison of provider and patient perspectives

Objectives: To determine the extent of inappropriate ambulance use from the perspectives of both emergency medical services (EMS) providers and patien ts utilizing EMS transport, assess level of agreement, and identify variabl es associated with inappropriate ambulance use. Methods: A prospective cros s-sectional study was done of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban university hospital ED. EMS providers and patients completed a survey with questions regarding their perceptions of whether the need for ambulance transport was an emerg ency or a nonemergency. Patient demographic information and availability of alternate means of transportation to the hospital were also evaluated. Res ults: Eight hundred eighty-seven patients were included in the study. EMS p roviders thought that 501 patient transports were appropriate and represent ed true emergencies, whereas 689 patients believed their medical problems w ere true emergencies. A significant number of patients (n = 415, 47%) had a ccess to alternative transportation to the hospital. Blunt traumatic injury and altered mental status were the most common reasons for EMS transport. Patient characteristics significantly associated with EMS provider percepti on of a true emergency were male gender, age >51 years, higher education, c hest pain/cardiac complaints, shortness of breath/respiratory complaints, a nd Medicare insurance. Characteristics significantly associated with patien ts who perceived themselves to have true emergencies were black ethnicity, higher education, shortness of breath/respiratory complaints, and Medicare insurance. There was 75% agreement between EMS providers and patients on ap propriateness of ambulance transport (kappa = 0.84). Conclusion: Inappropri ate ambulance use is a significant problem from both EMS provider and patie nt perspectives. Certain patient characteristics are associated with a high er probability of appropriate and inappropriate uses of EMS transport. A la rge number of patients transported by ambulance have alternative means of t ransportation but elect not to use them.