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Education and Practice

Paramedic Determinations of Medical Necessity: A Meta-Analysis

, EMT-P, MPH&TM, , PhD, MBA, NREMTP, , MD, , MD, MPH, , MD, , PhD, MPH, EMT-B, , MD, MPA & , MD, MPA show all
Pages 516-527 | Received 23 Oct 2008, Accepted 26 Mar 2009, Published online: 09 Sep 2009

References

  • Wolcott B W. What is an emergency? Depends on whom you ask. JACEP 1979; 8: 241–3
  • Lowe R A, Abbuhl S B. Appropriate standards for “appropriateness” research. Ann Emerg Med 2001; 37: 629–32
  • Foldes S S, Fischer L R, Kaminsky K. What is an emergency? The judgments of two physicians. Ann Emerg Med 1994; 23: 833–40
  • Heilicser B, Stocking C, Siegler M. Ethical dilemmas in emergency medical services: the perspective of the emergency medical technician. Ann Emerg Med 1996; 27: 239–43
  • Billittier A J, Moscati R, Janicke D, Lerner E B, Seymour J, Olsson D. A multisite survey of factors contributing to medically unnecessary ambulance transports. Acad Emerg Med 1996; 3: 1046–52
  • Gibson G. Measures of emergency ambulance effectiveness: unmet need and inappropriate use. JACEP 1977; 6: 389–92
  • Kamper M, Mahoney B D, Nelson S, Peterson J. Feasibility of paramedic treatment and referral of minor illnesses and injuries. Prehosp Emerg Care 2001; 5: 371–8
  • Snooks H, Wrigley H, George S, Thomas E, Smith H, Glasper A. Appropriateness of use of emergency ambulances. J Accid Emerg Med 1998; 15: 212–5
  • Mann C, Guly H. Is the emergency (999) service being misused? Retrospective analysis. BMJ 1998; 316: 437–8
  • Gardner G J. The use and abuse of the emergency ambulance service: some of the factors affecting the decision whether to call an emergency ambulance. Arch Emerg Med 1990; 7(2)81–9
  • Morris D L, Cross A B. Is the emergency ambulance service abused?. BMJ 1980; 281: 121–3
  • Volans A P. Use and abuse of the ambulance service. Prehosp Immediate Care 1998; 2: 190–2
  • Sosnin M, Young D, Dunt D R. A study of emergency ambulance utilisation. Aust Fam Physician 1989; 18: 233–4; 236, 238
  • Rademaker A W, Powell D G, Read J H. Inappropriate use and unmet need in paramedic and nonparamedic ambulance systems. Ann Emerg Med 1987; 16: 553–6
  • Frank S A, de Villiers P J. An analysis of the appropriate use of the Caledon ambulance service in the Overberg. A short report. S Afr Med J 1995; 85: 1185–6
  • Andersen L S. Medicare ambulance services. Issue Brief Cent Medicare Educ 2001; 2(6)1–6
  • Levinson D R. Medicare Payments for Ambulance Transports. Department of Health and Human Services, Office of the Inspector General, Washington, DC 2006, OEI-05–02-00590
  • Chu K H, Gregor M A, Maio R F, Hill E M, Swor R A. Derivation and validation of criteria for determining the appropriateness of nonemergency ambulance transports. Prehosp Emerg Care 1997; 1: 219–26
  • Hauswald M, Jambrosic M. Denial of ambulance reimbursement: can reviewers determine what is an emergency?. Prehosp Emerg Care 2004; 8: 162–5
  • National Association of EMS Physicians. Patient nontransport. Prehosp Emerg Care 2001; 5: 288
  • National Association of EMS Physicians, American College of Emergency Physicians. Alternate ambulance transportation and destination [National Association of EMS Physicians/American College of Emergency Physicians joint position paper]. Prehosp Emerg Care 2001; 5: 289
  • Knapp B J, Kerns B L, Riley I, Powers J. EMS-initiated refusal of transport: the current state of affairs. J Emerg Med 2007; 36: 157–161
  • Cook D J, Mulrow C D, Haynes R B. Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med 1997; 126: 376–91
  • Cochrane Prehospital and Emergency Health Field. Prehospital Search Strategy Terms, Available at: www.cochranepehf.org/article.php?article.39 Accessed February 7, 2008
  • Cone D C, Schmidt T A, Mann N C, Brown L H. Developing research criteria to define medical necessity in emergency medical services. Prehosp Emerg Care 2004; 8: 116–25
  • Cone D C, Benson R, Schmidt T A, Mann N C. Field triage systems: methodologies from the literature. Prehosp Emerg Care 2004; 8: 130–7
  • Mann N C, Schmidt T A, Cone D C. Defining research criteria to characterize medical necessity in emergency medical services: a consensus among experts at the Neely Conference. Prehosp Emerg Care 2004; 8: 138–53
  • Schmidt T A, Cone D C, Mann N C. Criteria currently used to evaluate dispatch triage systems: where do they leave us?. Prehosp Emerg Care 2004; 8: 126–9
  • User's Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, G H Guyatt, D Rennie. AMA Press, Chicago, IL 2002
  • D'Agostino R B, Kwan H. Measuring effectiveness. What to expect without a randomized control group. Med Care 1995; 33(4 suppl)AS95–AS105
  • Barnsley J, Berta W, Cockerill R, MacPhail J, Vayda E. Identifying performance indicators for family practice: assessing levels on consensus. Can Fam Physician 2005; 51: 700–1
  • Lipsey M W, Wilson D B. Practical Meta-Analysis. Sage Publications, Thousand Oaks, CA 2001
  • Basu S, Banerjee M, Sen A. Bayesian inference for kappa from single and multiple studies. Biometrics 2000; 56: 577–82
  • Nam J. Assessment of homogeneity tests for kappa statistics under equal prevalence across studies in reliability. Stat Med 2006; 25: 1521–31
  • Donner A, Eliasziw M, Klar N. Testing homogeneity of kappa statistics. Biometrics 1996; 52: 176–83
  • Haines C J, Lutes R E, Blaser M, Christopher N C. Paramedic initiated non-transport of pediatric patients. Prehosp Emerg Care 2006; 10: 213–9
  • Gratton M C, Ellison S R, Hunt J, Ma O J. Prospective determination of medical necessity for ambulance transport by paramedics. Prehosp Emerg Care 2003; 7: 466–9
  • Dunne R B, Compton S, Welch R D, Zalenski R J, Bock B F. Prehospital on-site triaging. Prehosp Emerg Care 2003; 7: 85–8
  • Silvestri S, Rothrock S G, Kennedy D, Ladde J, Bryant M, Pagane J. Can paramedics accurately identify patients who do not require emergency department care?. Prehosp Emerg Care 2002; 6: 387–90
  • Hauswald M. Can paramedics safely decide which patients do not need ambulance transport or emergency department care?. Prehosp Emerg Care 2002; 6: 383–6
  • Schmidt T A, Atcheson R, Federiuk C, et al. Hospital follow-up of patients categorized as not needing an ambulance using a set of emergency medical technician protocols. Prehosp Emerg Care 2001; 5: 366–70
  • Pointer J E, Levitt M A, Young J C, Promes S B, Messana B J, Ader M E. Can paramedics using guidelines accurately triage patients?. Ann Emerg Med 2001; 38: 268–77
  • Schmidt T, Atcheson R, Federiuk C, et al. Evaluation of protocols allowing emergency medical technicians to determine need for treatment and transport. Acad Emerg Med 2000; 7: 663–9
  • Sasser S M, Brokaw M, Blackwell T H. Paramedic vs. emergency physician decisions regarding the need for emergency department evaluation [abstract]. Acad Emerg Med 1998; 5: 391
  • Zachariah B S, Bryan D, Pepe P E, Griffin M. Follow-up and outcome of patients who decline or are denied transport by EMS. Prehosp Disaster Med 1992; 7: 359–63
  • Levine S D, Colwell C B, Pons P T, Gravitz C, Haukoos J S, McVaney K E. How well do paramedics predict admission to the hospital? A prospective study. J Emerg Med 2006; 31: 1–5
  • Price T G, Hooker E A, Neubauer J. Prehospital provider prediction of emergency department disposition: implications for selective diversion. Prehosp Emerg Care 2005; 9: 322–5
  • Richards J R, Ferrall S J. Triage ability of emergency medical services providers and patient disposition: a prospective study. Prehosp Disaster Med 1999; 14: 174–9
  • Salhanick S D, Sheahan W, Bazarian J J. Use and analysis of field triage criteria for mass gatherings. Prehosp Disaster Med 2003; 18: 347–52
  • Fries G R, McCalla G, Levitt M A, Cordova R. A prospective comparison of paramedic judgment and the trauma triage rule in the prehospital setting. Ann Emerg Med 1994; 24: 885–9
  • Shah M N, Davis C O, Bauer C, Arnold J. Preferences for EMS transport and pediatric emergency department care. Prehosp Emerg Care 2008; 12: 169–75
  • Seltzer A G, Vilke G M, Chan T C, Fisher R, Dunford J V. Outcome study of minors after parental refusal of paramedic transport. Prehosp Emerg Care 2001; 5: 278–83
  • Gerlacher G R, Sirbaugh P E, Macias C G. Prehospital evaluation of non-transported pediatric patients by a large emergency medical services system. Pediatr Emerg Care 2001; 17: 421–4
  • Brown L H, Prasad N H, Grimmer K. Public perceptions of a rural emergency medical services system. Prehosp Disaster Med 1994; 9: 257–9
  • Jacob S L, Jacoby J, Heller M, Stoltzfus J. Patient and physician perspectives on ambulance utilization. Prehosp Emerg Care 2008; 12: 176–81
  • Kawakami C, Ohshige K, Kubota K, Tochikubo O. Influence of socioeconomic factors on medically unnecessary ambulance calls. BMC Health Serv Res 2007; 7: 120
  • Hjalte L, Suserud B, Herlitz J, Karlberg I. Why are people without medical needs transported by ambulance? A study of indications for pre-hospital care. Eur J Emerg Med 2007; 14: 151–6
  • Patterson P D, Moore C G. Inter-rater agreement using one component of the Neely Conference criteria for determining medical necessity of EMS transports [abstract]. Prehosp Emerg Care 2006; 10: 121–2
  • Patterson P D, Moore C G, Brice J H, Baxley E G. Use of ED diagnosis to determine medical necessity of EMS transports. Prehosp Emerg Care 2006; 10: 488–93
  • Gorelick M H, Alessandrini E A, Cronan K, Shults J. Revised pediatric emergency assessment tool (RePEAT): a severity index for pediatric emergency care. Acad Emerg Med 2007; 14: 316–23
  • Newgard C D, Cudnik M, Warden C R, Hedges J R. The predictive value and appropriate ranges of prehospital physiological parameters for high-risk injured children. Pediatr Emerg Care 2007; 23: 450–6
  • Kahale J, Osmond M H, Nesbitt L, Stiell I G. What are the characteristics and outcomes of nontransported pediatric patients?. Prehosp Emerg Care 2006; 10: 28–34
  • Zachariah B S. The problem of ambulance misuse: whose problem is it, anyway?. Acad Emerg Med 1999; 6: 2–5
  • Krohmer J R. Appropriate emergency medical services transport. Acad Emerg Med 1999; 6: 5–7
  • Jaslow D, Barbera J A, Johnson E, Moore W. EMS-initiated refusal and alternative methods of transport. Prehosp Emerg Care 1998; 2: 18–22
  • Snooks H A, Dale J, Hartley-Sharpe C, Halter M. On-scene alternatives for emergency ambulance crews attending patients who do not need to travel to the accident and emergency department: a review of the literature. Emerg Med J 2004; 21: 212–5
  • Mulholland S A, Gabbe B J, Cameron P. Victorian State Trauma Outcomes Registry and Monitoring Group (VSTORM). Is paramedic judgment useful in prehospital trauma triage?. Injury 2005; 36: 1298–305
  • Emerman C L, Shade B, Kubincanek J. A comparison of EMT judgment and prehospital trauma triage instruments. J Trauma 1991; 31: 1369–75
  • Lerner E B. Studies evaluating current field triage: 1966–2005. Prehosp Emerg Care 2006; 10: 303–6
  • O'Connor R E. Trauma triage: concepts in prehospital trauma care. Prehosp Emerg Care 2006; 10: 307–10
  • Koehler J J, Malafa S A, Hillesland J, et al. A multicenter validation of the prehospital index. Ann Emerg Med 1987; 16: 380–5
  • Maslanka A M. Scoring systems and triage from the field. Emerg Med Clin North Am 1993; 11: 15–27
  • Scheetz L J, Zhang J, Kolassa J E. Using crash scene variables to predict the need for trauma center care in older persons. Res Nurs Health 2007; 30: 399–412
  • Petrie D A, Tallon J M, Crowell W, Cain E, Martell P, McManus D. Medically appropriate use of helicopter EMS: the mission acceptance/triage process. Air Med J 2007; 26(1)50–4
  • Benner J P, Brauning G, Green M, Caldwell W, Borloz M P, Brady W J. Disagreement between transport team and ED staff regarding the prehospital assessment of air medically evacuated scene patients. Air Med J 2006; 25(4)165–169
  • Bledsoe B E, Wesley A K, Eckstein M, Dunn T M, O'Keefe M F. Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis. J Trauma 2006; 60: 1257–65
  • Neely K W, Norton R L, Schmidt T A. The strength of specific EMS dispatcher questions for identifying patients with important clinical field findings. Prehosp Emerg Care 2000; 4: 322–6
  • Key C B, Pepe P E, Persse D E, Calderon D. Can first responders be sent to selected 9-1-1 emergency medical services calls without an ambulance?. Acad Emerg Med 2003; 10: 339–46
  • Shah M N, Bishop P, Lerner E B, Fairbanks R J, Davis E A. Validation of using EMS dispatch codes to identify low-acuity patients. Prehosp Emerg Care 2005; 9: 24–31
  • Hinchey P, Myers B, Zalkin J, Lewis R, Garner D. Low acuity EMS dispatch criteria can reliably identify patients without high-acuity illness or injury. Prehosp Emerg Care 2007; 11: 42–8
  • Feldman M J, Verbeek P R, Lyons D G, Chad S J, Craig A M, Schwartz B. Comparison of the medical priority dispatch system to an out-of-hospital patient acuity score. Acad Emerg Med 2006; 13: 954–60
  • Schmidt T, Neely K W, Adams A L, et al. Is it possible to safely triage callers to EMS dispatch centers to alternative resources?. Prehosp Emerg Care 2003; 7: 368–74
  • Reilly M J. Accuracy of a priority medical dispatch system in dispatching cardiac emergencies in a suburban community. Prehosp Disaster Med 2006; 21(2 suppl 2)77–81
  • Sporer K A, Youngblood G M, Rodriguez R M. The ability of emergency medical dispatch codes of medical complaints to predict ALS prehospital interventions. Prehosp Emerg Care 2007; 11: 192–8
  • Snooks H, Williams S, Crouch R, Foster T, Hartley-Sharpe C, Dale J. NHS emergency response to 999 calls: alternatives for cases that are neither life threatening nor serious. BMJ 2002; 325: 330–3
  • Dale J, Higgins J, Williams S, et al. Computer assisted assessment and advice for “non-serious” 999 ambulance service callers: the potential impact on ambulance dispatch. Emerg Med J 2003; 20: 178–83
  • Woollard M. Emergency calls not requiring an urgent ambulance response: expert consensus. Prehosp Emerg Care 2003; 7: 384–91
  • Haskins P A, Ellis D G, Mayrose J. Predicted utilization of emergency medical services telemedicine in decreasing ambulance transports. Prehosp Emerg Care 2002; 6: 445–8
  • Stark G, Hedges J R, Neely K W, Norton R. Patients who initially refuse prehospital evaluation and/or therapy. Am J Emerg Med 1990; 8: 509–11
  • Moss S T, Chan T C, Buchanan J, Dunford J V, Vilke G M. Outcome study of prehospital patients signed out against medical advice by field paramedics. Ann Emerg Med 1998; 31: 247–50
  • Mechem C C, Kreshak A A, Barger J, Shofer F S. The short-term outcome of hypoglycemic diabetic patients who refuse ambulance transport after out-of-hospital therapy. Acad Emerg Med 1998; 5: 768–72
  • Lerner E B, Billittier A J, Lance D R, Janicke D M, Teuscher J A. Can paramedics safely treat and discharge hypoglycemic patients in the field?. Am J Emerg Med. 2003; 21: 115–20
  • Socransky S J, Pirrallo R G, Rubin J M. Out-of-hospital treatment of hypoglycemia: refusal of transport and patient outcome. Acad Emerg Med 1998; 5: 1080–5
  • Selden B S, Schnitzer P G, Nolan F X, Veronesi J F. The “no-patient” run: 2,698 patients evaluated but not transported by paramedics. Prehosp Disaster Med 1991; 6: 135–42
  • Hipskind J E, Gren J M, Barr D J. Patients who refuse transportation by ambulance: a case series. Prehosp Disaster Med 1997; 12: 278–83
  • Marks P J, Daniel T D, Afolabi O, Spiers G, Nguyen-Van-Tam J S. Emergency (999) calls to the ambulance service that do not result in the patient being transported to hospital: an epidemiological study. Emerg Med J 2002; 19: 449–52
  • Cone D C, Kim D T, Davidson S J. Patient-initiated refusals of prehospital care: patient outcome, ambulance call report documentation, and on-line medical command. Prehosp Disaster Med 1995; 10: 3–9
  • Burstein J L, Henry M C, Alicandro J, Gentile D, Thode H C, Jr, Hollander J E. Outcome of patients who refused out-of-hospital medical assistance. Am J Emerg Med 1996; 14: 23–6
  • Schaefer R A, Rea T D, Plorde M, Peiguss K, Goldberg P, Murray J A. An emergency medical services program of alternate destination of patient care. Prehosp Emerg Care 2002; 6: 309–14

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