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ObjectivesA high number of emergency medical service (EMS) patients are not transported to hospital by ambulance. Various non-transport protocols and guidelines have been implemented by different EMS providers. The present study examines subsequent tertiary care ED and hospital admission and mortality of the patients assessed and not transported by EMS in Northern Finland and evaluates the factors predicting these outcomes.MethodsData from EMS missions with a registered non-transportation code during 1 January 2018–31 December 2018 were screened retrospectively. EMS charts were retrieved from a local EMS database and data concerning hospital admission and mortality were collected from the medical records of Oulu University Hospital, Oulu, Finland.ResultsA total of 12 530 EMS non-transport missions were included. Of those, a total of 344 (2.7%) patients were admitted to tertiary care ED in 48 hours after the EMS contact, and 229 (1.8%) of them were further admitted to the hospital. Patients with the dispatch code ‘abdominal pain’, clinical presentation with fever or hyperglycaemia, physician phone consultation and a decision not to transport during night hours were associated with a higher risk of ED admission within 48 hours after EMS contact. Overall 48-hour and 30-day mortalities of non-transported patients were 0.2% (n=25) and 1.0% (n=128), respectively.ConclusionIn this cohort, the rate of subsequent tertiary care ED admission and mortality in the non-transported EMS patients was low. Dispatch code abdominal pain, clinical presentation with fever or hyperglycaemia, physician phone consultation and night-hours increased the risk of ED admission within 48 hours after EMS contact.

BackgroundThe increasing usage of emergency medical services (EMS) missions is a challenge in modern practice. This study was designed to examine the association of the income level of residential areas on the rate of EMS missions and the frequency of EMS use in these areas.MethodsAll EMS missions for adult patients (>18 years) encountered by one rescue department in Northern Finland between June 2015 and May 2017 were analysed. The area served was categorised into four categories, according to the median annual income of the postal code areas. EMS missions per 1000 person-years, rate of non-transport missions and the number of dispatches to frequent (>4 EMS calls/year and highly frequent (>10 calls/year)EMS users per area were investigated.ResultsThere were 62 759 EMS missions, 34.8% of which resulted in non-transport. The crude rate of EMS dispatches was higher in the low-income area compared with other income areas (133.3 vs 108.9 vs 111.3 vs 73.6/1000 person-years) as well as the rate of high-frequency user dispatches (21.5 vs 11.5 vs 7.2 vs 4.3/1000-person years). The rate of non-transports missions was higher also (69.4 vs 43.4 vs 42.5. vs 30.6/1000 person-years). The highest crude rate of EMS use was found in people older than 65 years living in the lowest income areas (294.8/1000 person-years). After age adjustment, the highest rate of EMS use was found in rural areas with the lowest income (146.3/1000 person-years).ConclusionsThe rate of the EMS missions and non-transport missions differs significantly among different income areas. Resource usage was significantly higher in the low income areas. This information can be used in planning allocation of EMS and preventive healthcare resources.

Tutkimuksen tarkoitus: Kuvata sairaanhoitajan puhelimessa toteuttaman hoidon tarpeen arvioinnin (PHTA) resurssien käyttöä ja kustannuksia ja verrata niitä ensihoidon resurssien käyttöön ja kustannuksiin. Aineisto ja menetelmät: Ensihoidon kiireettömien tehtävien määrät ja kestot kerättiin ensihoidon tietojärjestelmistä. Ensihoidon ja PHTA:n kustannukset kerättiin talousarvioista vuodelta 2018 Kainuussa ja Oulussa. Aineistosta laskettiin teoreettiset ensihoidon ja PHTA:n vuosikustannukset ja resurssien käyttö Kainuussa. Laskelmien avulla mallinnettiin Ouluun vastaavat kustannukset sekä teoreettiset säästöt. Tulokset: Vuonna 2018 Kainuussa ensihoidon kiireettömiä tehtäviä oli 5295 ja Oulussa 8598. Laskennallinen kiireettömän ensihoitotehtävän hinta oli Kainuussa 172,80€ ja Oulussa 102,70€, sekä yhden tehtävän käsittelyn hinta PHTA:lla hinta oli 7€. Ensihoitopalveluun integroidun PHTA:n tuomat teoreettiset säästöt ovat Oulussa ja Kainuussa 258 199-294 912€/vuosi. Henkilöstöresurssitarpeen väheneminen on yli 5000 tuntia vuodessa. Päätelmät: PHTA:n integroiminen ensihoitopalveluun voi tuottaa säästöjä ja hillitä ensihoidon tehtävämäärien nousua. Vapautuvat ensihoidon resurssit voitaisiin kohdentaa kiireellisten potilaiden hoitoon. PHTA:n käyttöönotto olisi mahdollista nykyisillä palvelurakenteilla.