The “No-Patient” Run: 2,698 Patients Evaluated but Not Transported by Paramedics

Abstract

Patients evaluated by paramedics but not transported by ambulance to the hospital (“no-patient” runs or NPR) form a large part of the volume of ambulance runs in many emergency medical service (EMS) systems and account for 50–90 % of litigation brought against paramedics. Since there are no published studies of this important population, this paper provides a demographic description of the encounters and the prehospital patient disposition in one EMS system. Of all EMS runs for 1987 in the system studied, 2,698 (26.1 %) met NPR criteria. Mean run time for the NPR was 18.5±10.5 min versus 43.1 min for patients transported. The proportion of NPR was unrelated to sex or EMS response type, but was increased in those over age 40 years (p<.001) (Chi square), but was less for those over age 50 years (p<.001) compared to all ages. The proportion of NPR was associated with hour of the day (p<.01), with the highest proportion seen between 0000–0559 hours when overall run volume was lowest. The most frequent prehospital assessments in NPR were minor trauma (25.3 % of NPR), blunt head trauma (18.5%), and no illness or injury (15.9%). Most NPR patients were evaluated by medics and released (46.5%), while 22.7% sought medical care by private vehicle. Treatment or monitoring was performed in 17.6% and refused in 23.8% of NPR cases. Patient disposition was: released to friends/relatives (39.1%); presumed alone (35.5%); to police (18.2%); or other medical care (7.3 %). Medical control physician contact was not required, but was used in 2.1% of NPR cases.

This is the first study of NPR in an EMS system. It describes patient demographics, disposition, and differences from transported patients. Emergency Medical Services providers specifically should examine this population in their systems to maintain patient care standards and decrease medicolegal risks.