Potentially inappropriate utilization of emergency medical services (EMS) across rural and urban area

The Emergency Medical Services (EMS) systems of our nation vary in type, level, and purpose. Their existence often goes unnoticed, and thus the problems experienced by this industry have been inadequately addressed. Various statistics show over 13% of all hospital Emergency Department (ED) visits involve ambulance transportation, of which a proportion are likely medically unnecessary. Scientific evidence suggests some EMS utilization is for potentially inappropriate reasons. Such utilization negatively affects the financial viability and workforce of these services.;To address this issue, both EMS and ED data have been analyzed. Previous research of inappropriate utilization typically used data from one or more hospital facilities. Additionally, previous research failed to account differences in inappropriate utilization across rural and urban areas. The current study sought to address several gaps in previous research. To address these gaps, three algorithms were developed to identify the proportion of EMS runs that may be inappropriate. Descriptive and multivariable logistic analyses were performed on data from January 1, 2001 to March 31, 2003. It was hypothesized that the odds of potentially inappropriate utilization is higher in rural versus urban areas. Additionally, it was hypothesized that minorities, females, persons insured by Medicaid, and persons with no health insurance have a higher odds of potentially inappropriate utilization compared to their counterparts.;Results indicate the odds of potentially inappropriate utilization are 50% higher in rural areas as compared to urban areas. Individuals between the ages of 0 and 4 and 65 and above were found to have higher odds of potentially inappropriate compared to other age groups. Additionally, minorities, persons covered by Medicaid and the uninsured have higher odds of potentially inappropriate utilization of EMS services compared to whites and commercially insured persons.;Results must be interpreted with caution. Findings vary by algorithm, thus interpretations vary. Recommendations for addressing potentially inappropriate utilization include conducting more research on this issue of inappropriate utilization, developing public education programs targeting the public and educating them on what may constitute an emergency, pilot testing new dispatch and on-scene protocols, and expansion of the current level of pre-hospital personnel scope of practice.