# Emergency Medical Services Time on Scene and Non-Transport: Role of Communication Barriers

## TL;DR

This study examines how communication barriers affect EMS time on scene and non-transport decisions, finding that such barriers lead to longer on-scene times but lower non-transport rates.

## Contribution

The study quantifies the relationship between communication barriers, EMS time on scene, and non-transport decisions using a large national dataset.

## Key findings

- Encounters with communication barriers had longer on-scene times when non-transport occurred.
- Non-transport rates were lower for patients with communication barriers compared to those without.
- EMS spent 32% more time on scene when communication barriers were present and transport was declined.

## Abstract

Clear communication is essential for emergency medical services (EMS) clinicians to assess a situation and make appropriate transport decisions. When barriers are present that impede communication between emergency responders and patients, EMS clinicians report difficulty navigating these encounters. As communication barriers potentially delay definitive care, it remains unclear the amount of time that EMS clinicians spend on scene during these encounters and how often they result in non-transport. In this study we sought to characterize the association between the presence of communication barriers, time spent on scene, and non-transport.

We conducted an observational analysis using 2022 data from the ESO Data Collaborative, a deidentified national prehospital electronic health record dataset. Encounters were restricted to 9-1-1 responses in which the responding ambulance was first on scene, the patient was alive, ≥ 18 year of age, and able to refuse transport. The primary outcomes were time on scene and non-transport. We used logistic regression models to estimate non-transport by communication barrier (including non-English language preference, speech disability, deaf or hard of hearing, and blind or low vision) and control for key patient and encounter characteristics.

Of 3,477,008 EMS responses, 233,084 (6.7%) resulted in non-transport and 99,263 (2.9%) had a communication barrier identified. Among encounters with a communication barrier identified, EMS clinicians spent more time on scene with patients who were not transported (21.0 minutes) compared to patients who were transported for definitive care (15.9 minutes). Compared to those without an identified barrier, encounters with a patient who had a non-English language preference (odds ratio [OR] 0.51, confidence interval [CI] 0.49–0.53, P < .001), patients who had a speech disability (OR 0.36, CI 0.33–0.40, P < .001), were deaf or hard of hearing (OR 0.71, CI 0.66–0.76, P < .001), or were blind or had low vision (OR 0.80, CI 0.69–0.92, P < .001) were less likely to result in non-transport, with non-transport rates of 3.6%, 1.9%, 4.0%, and 4.4% respectively.

Encounters with communication barriers were less likely to end in non-transport. When communication barriers were identified, EMS clinicians spent 32% (5.1 minutes) longer on scene on encounters that resulted in non-transport, showing that EMS clinicians may be dedicating additional time and resources caring for this population.