Effect of Gender on Prehospital Refusal of Medical Aid

Abstract

Background

“Refusal of medical aid” (RMA) is the term commonly used by emergency medical technicians (EMTs) when someone calls 911 for care (usually the patient or a family member) but, after the initial encounter with the EMTs, the patient refuses emergency medical services transport to the hospital. Some intervention may have been performed, such as taking vital signs or an electrocardiogram, before the RMA. Although there have been multiple studies of the characteristics and outcomes of patients who RMA, little analysis has been done of the role of EMTs in these cases.

Objective

To analyze the association between EMT gender and the patient’s decision to refuse medical aid in the prehospital setting.

Methods

The study was performed using data from one hospital-based ambulance service in an urban setting that participates in the 911 system. This was a case control study that examined the data from consecutive patients who refused medical aid for a 1-year period compared to a control group of non-RMA patients.

Results

There was a significantly higher representation of all-male EMT teams in the RMA group (p < 0.0001). Using propensity score-matching methodology to control for other factors, all-male EMT teams were 4.75 times more likely to generate an RMA as compared to all-female and mixed-gender EMT teams (95% confidence interval 1.63–13.96, p = 0.0046).

Conclusion

We found that the gender of the EMTs was one of the most important factors associated with RMA, with a much higher frequency of RMAs occurring when both members of the team were male.

Introduction

Due to the potential for an adverse outcome, especially in older patients, refusal of medical aid (RMA) for emergency medical services (EMS) transport to a hospital is problematic and should be discouraged as much as possible. In one study, 2% of RMA patients (10 of 431) were subsequently hospitalized; 70% of these patients were over the age of 65 years (1). In another study specifically looking at RMA patients aged 65 years and older, 70% of patients sought follow-up medical care (70 of 100) and there was a 32% hospital admission rate. Thirty-nine percent of these admitted patients ended up in an intensive care unit (2). If we can identify factors influencing RMAs, we can better suggest interventions that may decrease them in the long term.

We sought to better understand the factors associated with a patient’s decision to RMA in the prehospital setting, particularly focusing on emergency medical technician (EMT) gender. The association between EMT gender and the patient’s decision to RMA has not, to our knowledge, been previously studied. However, there have been several studies suggesting that health care providers in other settings are perceived differently by patients based on their gender. Both male and female patients prefer female health care providers regardless of the provider’s bedside manner in studies involving obstetricians, therapists, dentists, and nurses 3, 4, 5, 6. It is possible that in the prehospital setting, patients might also prefer being treated by a female EMT, and for this reason be less likely to RMA. Our study sought to determine if there was an association between EMT gender and calls resulting in an RMA rather than a transport.