From the Guidelines
Paramedics in Australia should urgently transport patients to the emergency department when they present with life-threatening conditions that require immediate medical intervention, such as cardiac emergencies, respiratory distress, major trauma, stroke symptoms, severe infections, acute abdominal emergencies, obstetric emergencies, severe burns, drug overdoses, and mental health crises with imminent risk of harm. These conditions are considered life-threatening and require prompt medical attention to prevent morbidity, mortality, and to improve quality of life. The decision to transport a patient urgently is based on clinical practice guidelines that take into account vital signs, assessment findings, and response to initial interventions. For example, patients with chest pain unrelieved by nitrates, oxygen saturation below 94% despite supplemental oxygen, systolic blood pressure below 90mmHg, or Glasgow Coma Scale score below 13 typically warrant urgent transport 1. Rapid transport decisions are critical as they directly impact patient outcomes, particularly for time-sensitive conditions like stroke where "time is brain" and heart attacks where "time is muscle" 1. Some key conditions that require urgent transport include:
- Cardiac emergencies, such as heart attacks, severe arrhythmias, and cardiac arrest
- Respiratory distress, such as severe asthma attacks, anaphylaxis, and airway obstruction
- Major trauma, such as severe bleeding, head injuries, spinal injuries, and multiple fractures
- Stroke symptoms, such as facial drooping, arm weakness, and speech difficulties
- Severe infections, such as sepsis with signs like high fever, altered mental status, and low blood pressure
- Acute abdominal emergencies, such as appendicitis, bowel obstruction, and ruptured aneurysms
- Obstetric emergencies, such as active labor complications, placental abruption, and eclampsia
- Severe burns, drug overdoses, and mental health crises with imminent risk of harm. Paramedics should follow specific clinical practice guidelines to determine the urgency of transport, and rapid transport decisions are critical to improve patient outcomes 1.
From the Research
Conditions for Urgent Transport to Emergency Department
The decision to transport patients urgently to the emergency department in Australia should be based on the severity of their condition. According to the studies, the following conditions may require urgent transport:
- Severe head injury: Patients with severe head injury should be transported urgently to the emergency department to prevent secondary brain injury due to hypoxia and/or hypotension 2.
- High-acuity patients: Paramedics should prioritize transporting high-acuity patients to the emergency department, as they require immediate medical attention 3.
- Patients with predictors of hospital admission: The decision tree analysis identified age and aetiology as predictors of hospital admission, and patients with these characteristics should be transported to the emergency department 3.
Conditions that do not Require Urgent Transport
On the other hand, the studies suggest that the following conditions may not require urgent transport to the emergency department:
- Low- and medium-acuity patients: These patients do not require ambulance management and can be treated in primary care settings 4.
- Patients suitable for primary care pathways: Paramedics reported that at least half of the patients they conveyed to the emergency department were suitable for primary care pathways, and these patients can be referred to primary care settings instead of being transported to the emergency department 4.
Barriers to Appropriate Transport Decisions
The studies also identified barriers to making appropriate transport decisions, including:
- Limited access to primary care pathways: This was the most common barrier reported by paramedics, making it difficult for them to refer patients to primary care settings instead of transporting them to the emergency department 4.
- Fear of internal complaints, litigation, or organisational pressure: Paramedics also reported fear of internal complaints, litigation, or organisational pressure to convey patients to the emergency department, even if they were suitable for primary care pathways 4.