Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-18T06:50:56.908Z Has data issue: false hasContentIssue false
  • English
  • Français

National Study of Ambulance Transports to United States Emergency Departments: Importance of Mental Health Problems

Published online by Cambridge University Press:  28 June 2012

Gregory Luke Larkin ,
Cynthia A. Claassen ,
Andrea J. Pelletier  and
Carlos A. Camargo Jr.
Gregory Luke Larkin*
Affiliation:
Department of Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
Cynthia A. Claassen
Affiliation:
Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA
Andrea J. Pelletier
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
Carlos A. Camargo Jr.
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
*
Gregory Luke Larkin, MD MSPH University of Texas Southwestern Medical Center 5323 Harry Hines Blvd. Dallas, Texas 75390-8579 USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Understanding ambulance utilization patterns is essential to assessing prehospital system capacity and preparedness at the national level.

Objective:

To describe the characteristics of patients transported to US emergency departments (EDs) by ambulance and to determine predictors of ambulance utilization.

Methods:

Data were obtained from the National Hospital Ambulatory Medical Care Survey using mode of arrival, demographic and visit information, ICD-9-CM E and V-codes, and classified reasons for the visit.

Results:

The rates for ED visits of persons conveyed by ambulence were stable between 1997 and 2003, consisting of approximately one in every seven ED visits (14%). In 2003, there were 16.2 million ED visits for which an ambulance was used in the US. However, for patients with mental health visits, nearly one in three ED presentations (31%) arrived by ambulance. Significantly higher rates of ambulance use were associated with: (1) mental health visits; (2) older age; (3) African-Americans; (4) Medicare or self-pay insurance status; (5) urban ED location; (6) US regions outside of the South; (7) presentation between 12 midnight to 0800 hours; (8) injury-related visits; (9) urgent visit status; and/or (10) those resulting in hospital admission. Among mental health patients, older age, self-pay insurance status, urban ED location, regions outside the southern US, and urgent visit classification predicted ambulance use. Ambulance usage within the mental health group was highest for suicide and lowest for mood and anxiety disorder-related visits.

Conclusion:

Reliance on ambulance services varies by age, insurance status, geographic factors, time of day, urgency of visit, subsequent admission status, and type of mental health disorder. Even after controlling for many confounding factors, mental health problems remain an important predictor of ambulance use.

Keywords

ambulance transportsemergency department visitsepidemiologymental healthNational Hospital Ambulatory Medical Care Survey (NHAMCS)
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 21 , Issue 2 , April 2006 , pp. 82 - 90
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1McCaig, LF, Stussman, BJ: National Hospital Ambulatory Medical Care Survey: 2003 Emergency Department Summary. Hyattsville, Maryland: National Center for Health Statistics; 26 May 2005. p 358.Google Scholar
2Council for Medical Schemes: National Reference Price List for Ambulance Services, Effective From 1 January 2004. 2004. Available at http://www.medicalschemes.com/Publications/ZipPublications/NHRPL%20Schedules/Amb ulance%20Services%202006_v06.doc.Google Scholar
3Markwood, S: Senate Special Committee of Aging Forum on Keeping America's Seniors Moving: Examining Ways to Improve Senior Transportation. Washington, DC 2003.Google Scholar
4Heritage, H: Public Perceptions of costs for healthcare products and services differ widely: Estimated costs of an ambulance trip. Wall Street Journal. 2004;3(13):5.Google Scholar
5Yamane, K: Hospital Emergency Departments-Crowded Conditions Vary Among Hospitals and Communities. Washington DC: US General Accounting Office; 2005 2003:3–460.Google Scholar
6Schull, MJ, Morrison, LJ, Vermeulen, M, et al. : Emergency department overcrowding and ambulance transport delays for patients with chest pain. CMAJ 2003;168(3):277–283.Google ScholarPubMed
7Asplin, B, Magid, D, Rhodes, KV, et al. : A conceptual model of emergency department crowding. Ann Emerg Med 2003;42:173–180.CrossRefGoogle ScholarPubMed
8Huang, C., Chen, W, Ma, M, et al. : Ambulance utilization in metropolitan and rural areas of Taiwan. J Formos Med Assoc 2001;100(9):581–586.Google ScholarPubMed
9Cadigan, RT, Bugarin, CE: Predicting demand for emergency ambulance service. Ann Emerg Med 1989;18:618–621.CrossRefGoogle ScholarPubMed
10Gibson, G: An analysis of the demand for emergency ambulance service in an urban area. Am J Public Health 1971;61:2158–2161.CrossRefGoogle Scholar
11Aldrich, CA, Hisserich, JC, Lave, LB: An analysis of the demand for emergency ambulance service in an urban area. Am J Emerg Med 1971;61:1156–1169.Google Scholar
12Schuman, LJ, Wolfe, H, Sepulveda, J: Estimating demand for emergency transportation. Med Care 1977;15:738–749.CrossRefGoogle ScholarPubMed
13Rucker, DW, Edwards, RA, Burstin, HR, et al. : Patient-specific predictors of ambulance use. Ann Emerg Med 1997;29(4):484–491.CrossRefGoogle ScholarPubMed
14Larkin, G, Claassen, C., Emond, J, et al. : Trends in US emergency department visits for mental health conditions, 1992 to 2001. Psychiatric Services 2005;56(6):671–677.CrossRefGoogle ScholarPubMed
15Jarvis, E, Kirmayer, L, Jarvis, G, et al. : The role of Afro-Canadian status in police or ambulance referral to emergency psychiatric services. Psychiatric Services 2005;56(6):705–710.CrossRefGoogle Scholar
16Spooren, D, Buylaert, W, Henderick, H, et al. : Patients with psychiatric emergencies transported by an ambulance in an urban region. Eur J Emerg Med 1996;3(1):14.CrossRefGoogle Scholar
17Brown, E, Sindelar, J: The emergency problem of ambulance misuse. Ann Emerg Med 1993;22:646–650.CrossRefGoogle ScholarPubMed
18Little, GF, Barton, D: Inappropriate use of the ambulance service. Eur J Emerg Med 1998;5(3):307–311.CrossRefGoogle ScholarPubMed
19Palazzo, FF, Warner, OJ, Harron, M, et al. : Misuse of the London ambulance service: How much and why? Accid Emerg Med 1998;15(6):368–370.CrossRefGoogle ScholarPubMed
20Clark, MJ, Purdie, J, FitzGerald, GJ, et al. : Predictors of demand for emergency prehospital care: An Australian study. Prehosp Disaster Med 1999;14(3):167–173.CrossRefGoogle ScholarPubMed
21County of San Diego HHSA, Division of Emergency Medical Services Prehospital Database. FY 1999-2004. 2005.Google Scholar
22Stussman, BJ: National Hospital Ambulatory Medical Care Survey: 1994 emergency department summary. Adv Data 1996; 275:1–20.Google Scholar
23Public Health Service and Health Care Financing Administration. International Classification of Diseases, Ninth Revision, Clinical Modification. 1991. Located at: Public Health Service, Washington, DC.Google Scholar
24McCaig, LF, Burt, CW: National Hospital Ambulatory Medical Care Survey: 2001 Emergency Department Summary. Advance Data 2003;335 (04 June 2003):1–36.Google Scholar
25Schneider, D, Appleton, L, McLemore, T: A reason for visit classification for ambulatory care. National Center for Health Statistics. Vital Health Stat 2. 1979;78(i–vi, 1–63).Google Scholar
26US Department of Health, Education and Welfare, Public Health Service: Census. Available at http://www.census.gov. Accessed 05 January 2004.Google Scholar
27Dickinson, ET, Verdile, VP, Kostyun, CT, et al. : Geriatric use of emergency medical services. Ann Emerg Med 1996; 1996(27):199–203.CrossRefGoogle ScholarPubMed
28Clark, MJ, FitzGerald, G: Older people's use of ambulance services: A population based analysis. J Accid Emerg Med 1999;16(2):108–111.CrossRefGoogle ScholarPubMed
29National Center for Health Statistics: Health United States. Centers for Disease Control and Prevention (CDC), Hyattsville, Maryland National Center for Health Statistics, 2005.Google Scholar
30Hazlett, SB, McCarthy, ML, Londner, MS, et al. : Epidemiology of adult psychiatric visits to US emergency departments. Acad Emerg Med 2004;11(2):193–195.CrossRefGoogle ScholarPubMed
31Schmidt, TA, 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(4):366–370.CrossRefGoogle Scholar
32Wennberg, JE: Dealing with medical practice variations: A proposal for action. Health Affairs 1984;3(2):6–32.CrossRefGoogle ScholarPubMed
33Wennberg, JE: Understanding geographic variations in health care delivery. N Eng J Med 1999;340(1):52–53. [comment]CrossRefGoogle ScholarPubMed
34Wennberg, JE: Unwarranted variations in healthcare delivery: implications for academic medical centers. BMJ 2002;325(7370):961–964. [comment]CrossRefGoogle Scholar
35Lambe, S, Washington, DL, Fink, A, et al. : Trends in the use and capacity of California's emergency departments, 1990–1999. Ann Emerg Med 2002;39(4):389–396.CrossRefGoogle ScholarPubMed
36Schafermeyer, RW, Asplin, BR: Hospital and emergency department overcrowding in the United States. Emerg Med 2003;15:22–27.CrossRefGoogle Scholar
37Claassen, CA, Kashner, TM, Gilfillan, S, et al. : Psychiatric emergency service use after implementation of managed care in a public mental health system. Psychiatric Services 2005;56(6):691–698.CrossRefGoogle Scholar
38Brokaw, J, Olson, L, Fullerton, L, et al. : Repeated ambulance use by patients with acute alcohol intoxication, seizure disorder, and respiratory illness. Am J Emerg Med 1998;16(2):141–144.CrossRefGoogle ScholarPubMed
39Fullerton, L, Olson, L, Crandall, C., et al. : Relationships between ambulance transports for alcohol intoxication and assault. Acad Emerg Med 1998;5(4):325–329.CrossRefGoogle ScholarPubMed
40Dhossche, DM, Ghani, SO: Who brings patients to the psychiatric emergency room? Psychosocial and psychiatric correlates. Gen Hosp Psychiatry 1998;20(4):235–240.CrossRefGoogle Scholar
41Malenka, DJ, McLerran, D, Roos, N, et al. : Using administrative data to describe case mix: A comparison with the medical record. Journal of Clinical Epidemiology 1994;47(9):1027–1032.CrossRefGoogle ScholarPubMed
42Tintinalli, JE, Peacock, FW, Wright, MA: Emergency medical evaluation of psychiatric patients. Ann Emerg Med 1994;23(4):859–862.CrossRefGoogle ScholarPubMed
43Litovitz, GL, Hedberg, M, Wise, TN, et al. : Recognition of psychological and cognitive impairments in the emergency department. Am J Emerg Med 1985;3:400–402.CrossRefGoogle ScholarPubMed
44Gold, I, Baraff, LJ: Psychiatric screening in the emergency department: Its effect on physician behavior. Ann Emerg Med 1989;18:875–880.CrossRefGoogle ScholarPubMed
45Meldon, SW, Emerman, CL, Schubert, DS: Recognition of depression in geriatric ED patients by emergency physicians. Ann Emerg Med 1997;30(4):442–447.CrossRefGoogle ScholarPubMed
46Schriger, DL, Gibbons, PS, Langone, CA, et al. : Enabling the diagnosis of occult psychiatric illness in the emergency department: A randomized, controlled trial of the computerized, self-administered PRIME-MD Diagnostic System. Ann Emerg Med 2001;37(2):132–140.CrossRefGoogle ScholarPubMed
47Schuster, MA, Stein, BD, Jaycox, LH: A national survey of stress reactions after the September 11, 2001 terrorist attacks. N Engl J Med 2001;345:1507–1512.CrossRefGoogle ScholarPubMed
48Glass, TA: Understanding public response to disasters. Public Health Rep 2001;116 Suppl 2:69–73.CrossRefGoogle ScholarPubMed