911 non‑transport problem

Nearly one in four 911 ambulance responses end without a ride to the hospital, and about 6% of those patients call back within 72 hours. (eso.com) The 6% figure comes from an analysis of 22.5 million emergency medical services encounters from 2018 through 2022, presented at the National Association of EMS Physicians meeting in San Diego in January 2025. The study found that most of those return encounters ended in transport. (eso.com) (tandfonline.com) A separate population-based study in Nova Scotia found 18.9% of 74,293 emergency responses in 2014 were non-transports, and 5.6% of those cases had a 48-hour adverse event such as a relapse response that led to transport or death. The authors called non-transport “an often undefined yet potentially significant risk” in emergency medical services. (pubmed.ncbi.nlm.nih.gov) Non-transport is the outcome when paramedics treat a patient on scene, a clinician gives advice by phone, or a patient declines ambulance transport. As more systems use treatment-in-place, telehealth, and other alternatives to the emergency department, that decision is becoming a larger part of routine 911 care. (eso.com) (pubmed.ncbi.nlm.nih.gov) The risk is not evenly spread across all patients. In the national analysis, cardiac and pulmonary complaints were among the conditions that stood out in return calls after non-transport, according to the researchers’ summary of the findings. (eso.com) Return visits within 72 hours are already used in hospitals as a quality check after discharge, and emergency medical services researchers are applying the same idea to ambulance care. A 2023 study of 98,043 encounters at one urban agency found 3,951 had a repeat encounter within 72 hours, and non-transported patients had higher odds of a bounceback than transported patients. (pubmed.ncbi.nlm.nih.gov) (annemergmed.com) Linked-data work in England found that after a non-transported ambulance call, 9% of patients re-contacted the ambulance service, 12.6% went to an emergency department, 6.3% were admitted to a hospital, and 0.3% died within three days. Most patients had no later health event, but the study showed that follow-up risk does not disappear when the ambulance leaves. (pubmed.ncbi.nlm.nih.gov) For ambulance agencies, the numbers turn a common field judgment into a measurable system issue: staffing, dispatch, and medical oversight all depend on how often crews leave patients at home and how often those patients come back. For hospitals, the same data shape planning for emergency department arrivals that happen hours after the first 911 call, not during it. (eso.com) (pubmed.ncbi.nlm.nih.gov) The central question is the one paramedics already face on scene: who can safely stay home, and who only looks stable for the moment. The newer research does not argue that every 911 patient needs transport, but it does show how often that call has to be made twice. (eso.com)