Academic Emergency Medicine, 2011

Objectives-The purpose of this study was to describe the associations between individual health insurance and ambulance utilization using a national sample of patients who receive emergency department (ED) care.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Background: There is a growing demand for emergency medical services (EMS) and patients are repeatedly transported by ambulance services. For many patients, especially those with chronic disease, there may be better ways of delivering care. We examined the symptom at time of emergency call and the hospital diagnosis for those ambulance users who repeatedly received an ambulance. Methods: Population-based historic cohort study of patients receiving an ambulance after an emergency call between 2011 and 2014: one-time users (i.e. one ambulance run in any 12 month period) were compared to twotime users (two runs in any 12 month period) and frequent users (>two runs). The presenting symptom according to the Danish Index for Emergency Care from the EMS calls and the hospital ICD-10 discharge diagnoses were obtained from patient records. Results: We included 52 533 patients (65 932 emergency ambulance runs). Repeated users constituted 16% of the patients (two-time users 11% and frequent users 5%) and one third of all ambulance runs. The symptoms showing the largest increase in frequency with increasing ambulance use were breathing difficulty (N = 3 905-15% were frequent users); seizure (N = 2 437-10% were frequent users), chest pain (N = 7 616-17% were frequent users), and alcohol intoxication (N = 1 998-5% were frequent users). The hospital diagnoses with a corresponding increase were respiratory diseases (N = 4 381)-13% were frequent users), mental disorders (predominately abuse of alcohol) (N = 3 087-10% were frequent users) and neurological diseases (predominately epilepsy) (N = 2 207-6% were frequent users). 5% of one-time users, 12% of two-time users and 16% of frequent users had a Charlson Comorbidity Index > = 3. Conclusion: Repeated use of ambulance services was common and associated with chronic health problems such as chronic respiratory diseases, epilepsy, mental disorders with alcohol abuse and comorbidity. Alternative methods of caring for many of these patients should be considered. Trial registration: None.

Annals of Emergency Medicine, 2010

patients who arrived by ambulance or personal transport. We performed bivariate analysis to assess the extent to which all patients and a subset of critically ill patients use ambulance transport relative to self-transport.

Annals of Emergency Medicine, 2017

Context-Evidence on variability in emergency medical services (EMS) use is limited. Objective-To obtain national evidence on geographic variation in the use of ambulance transport to the emergency department (ED) among Medicare enrollees, and assess the role of health status, socioeconomic status (SES) and provider availability. Design, Setting, and Participants-We used 2010 Medicare claims data for a random sample of 999,999 enrollees aged 66 and older, and identified ambulance transport and ED use. Main Outcomes Measures-Number of ambulance transports to ED per 100 person-years (ambulance transport rate) and proportion (%) of ED visits by ambulance transport by hospital referral regions (HRR). Results-The national ambulance transport rate was 22.2 and the overall proportion of ED visits by ambulance was 36.7%. Relative to HRRs in the lowest rate quartile, HRRs in the highest quartile had a 75% higher ambulance transport rate (incidence rate ratio (IRR), 1.75; 95% confidence interval (CI) = [1.69, 1.81]) and a 15.5% higher proportion of ED visits by ambulance (IRR, 1.155; 95% CI = [1.146, 1.164]). Adjusting for health status, SES, and provider availability

Academic Emergency Medicine, 2004

Objective: To determine how ambulance transportation is associated with resource use in the emergency department (ED). Methods: A retrospective administrative database review of patient visits to a Montreal tertiary care hospital ED in one year (April 2000-March 2001). Measures of resource use included ED length of stay, admission to the hospital, and whether consultations and radiology/imaging tests (excluding plain-film x-rays) were ordered from the ED. Results: During the study period, 39,674 patients made 59,142 visits to the ED. Ambulance transportation was used for 15.6% of these ED visits. Compared with non-ambulance visits, ambulance visits were more likely to be made by older patients (mean age: 68 vs. 47 years), to be made by females (59% vs. 55%), to have a greater triage urgency score (mean on 1-5 scale, with 1 most urgent: 2.7 vs. 3.9), and to occur after office hours, 5 PM to 9 AM (47% vs. 43%). Ambulance visits were also more likely than non-ambulance visits to result in: a longer length of stay (mean: 13.3 hours [95% CI ¼ 13.0 to 13.6] vs. 5.9 [95% CI ¼ 5.8 to 6.0]), hospital admission (40% vs. 10%) (odds ratio [OR]: 5.94 [95% CI ¼ 5.59 to 6.33]), consultations (56% vs. 20%) (OR: 5.15 [95% ¼ 4.86 to 5.45]), and radiology/imaging tests (20% vs. 12%) (OR: 1.93 [95% CI ¼ 1.81 to 2.07]). In multivariate models that adjusted for the effects of age, gender, triage urgency, and temporal factors, ambulance transportation maintained its association with greater resource use. Conclusions: This preliminary study indicates that patients arriving at the ED by ambulance use significantly more resources than their walk-in counterparts.

Annals of Emergency Medicine, 2003

Study objective: We determine the relationship between physician, nursing, and patient factors on emergency department use of ambulance diversion.

The American Journal of Emergency Medicine, 1996

To evaluate the pattern of use of basic life support (BLS) ambulances in a pediatric population, emergency medical service (EMS) and pediatric emergency department (PED) records from an urban hospital PED for all children transported to PED by ambulance during a 1-month study period were retrospectively reviewed. Excluded were: (1) advanced life support transport, (2) transport from other medical-facility, (3) patients with chronic medical disability without acute decompensation, and (4) patients in police custody. BLS transport was considered inappropriate if:

Journal of Emergency Nursing, 2009

Introduction: Although frequent ED users account for a small percentage of ED visits, these patients can drain the system, contributing to overcrowding and lowered quality of care.

Prehospital Emergency Care, 2012

Objective: Older adults, those aged 65 and older, frequently require emergency care. However, only limited national data describe the Emergency Medical Services (EMS) care provided to older adults. We sought to determine the characteristics of EMS care provided to older adults in the United States. Methods: We used data from the 2014 National Emergency Medical Services Information System (NEMSIS), encompassing EMS response data from 46 States and territories. We excluded EMS responses for children <18 years, interfacility transports, intercepts, nonemergency medical transports, and standby responses. We defined older adults as age ࣙ65 years. We compared patient demographics (age, sex, race, primary payer), response characteristics (dispatch time, location type, time intervals), and clinical course (clinical impression, injury, procedures, medications) between older and younger adult EMS emergency 9-1-1 responses. Results: During the study period there were 20,212,245 EMS emergency responses. Among the 16,116,219 adult EMS responses, there were 6,569,064 (40.76%) older and 9,547,155 (59.24%) younger adults. Older EMS patients were more likely to be white and the EMS incident to be located in healthcare facilities (clinic, hospital, nursing home). Compared with younger patients, older EMS patients were more likely to present with syncope (5.68% vs.

2017

Department of Health and Human Services (HHS) under cooperative agreement # U1CRH30041. The information, conclusions and opinions expressed in this document are those of the authors and no endorsement by FORHP, HRSA, HHS, or the University of Kentucky is intended or should be inferred. ©2017 Rural & Underserved Health Research Center, University of Kentucky. Ambulance Services for Medicare Beneficiaries: State Differences in Usage, 2012-2014