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Treat and release

Date Last Search Run: Feb 01, 2022
Table last updated: Oct 25, 2021
Data last added: Sep 27, 2021

1 (strong evidence exists)      
2 (fair evidence exists)  
3 (weak evidence exists)  


Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Bounce back Patient PH-Paramedic Anderson S., Hogskilde PD., Wetterslev J., et al. Appropriateness of leaving emergency medical service treated hypoglycemic patients at home: A retrospective study. Acta Anaesthesiol Scand 2002; 46(4):464-8. Medline
II Supportive (Green) Repeat ambulance call, recurrence of hypoglycemia Process PH-Paramedic Cain E., Ackroyd-Stolarz S., Alexiadia P., Murray D. Prehospital hypoglycemia: the safety of not transporting treated patients. Prehospital Emergency Care 2003; 7:458-65. Medline
II Supportive (Green) Relapse within 3 days Process PH-Paramedic Carter AJ., Keane PS., Dreyer JF. Transport refusal by hypoglycemic patients after on-scene intravenous dextrose. Acad Emerg Med 2002; 9(8):855-7. Medline
II Supportive (Green) Relapse Patient PH-Paramedic Socransky SJ., Pirrallo RG., Rubin JM. Out-of-hospital treatment of hypoglycemia: Refusal of transport and patient outcome. Acad Emerg Med 1998; 5(11):1080-1085. Medline
III Supportive (Green) Transport to hospital Patient PH-Paramedic Khunti K., Fisher H., Paul S., Iqbal M., Davies MJ., Siriwardena AN. Severe hypoglycaemia requiring emergency medical assistance by ambulance services in the East Midlands: A retrospective study. Prim Care Diabetes 2013; 7(2):159-65. Medline
III Supportive (Green) Safety Process PH-Paramedic Lerner EB., Billittier AJ 4th., Lance DR., Janicke DM., Teuscher JA. Can paramedics safely treat and discharge hypoglycemic patients in the field? Am J Emerg Med 2003; 21(2):115-20. Medline
III Supportive (Green) Efficacy Patient PH-Paramedic Mattila Elina M., Kuisma Markku J., Sund Kaj P., Voipio-Pulkki. Out-of-hospital hypoglycaemia is safely and cost-effectively treated by paramedics. European Journal of Emergency Medicine 2004; 11(2):70-4. Medline
III Supportive (Green) Recurrence of symptoms Patient PH-Paramedic Mechem CC., Kreshak AA., Barger J., Shofer FS. The short-term outcome of hypoglycemic diabetic patients who refuse ambulance transport after out of hospital therapy. Acad Emerg Med 1998; 5(8):768-72. Medline
III Supportive (Green) Patient preference Patient PH-Paramedic Steinmetz J., Nielsen SL., Rasmussen LS. Hypoglycaemia in patients with diabetes: do they prefer prehospital treatment or admission to hospital? Eur J Emerg Med 2006; 13(5):319-320. Medline
III Supportive (Green) Triage Process PH-Paramedic Strote J., Simmons R., Eisenberg M. EMT treatment of hypoglycemia without transport. Am J Emerg Med 2008; 26:291-5. Medline
III Supportive (Green) Success Patient PH-Paramedic Weston C., Stephens M. Hypoglycemic attacks treated by ambulance personnel with extended training. Br Med J 1990; 300:908-909. Medline
III Neutral (Yellow) Risk of repeat hypoglycemic events Patient PH-Paramedic Fitzpatrick D., Duncan EA. Improving post-hypoglycaemic patient safety in the prehospital environment: A systematic review. Emerg Med J 2009; 26(7):472-8. Medline

Opiate overdose
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) 48 hour mortality Patient ED-Paramedic & MD Greene JA, Deveau BJ, Dol JS, Butler MB.Incidence of mortality due to rebound toxicity after 'treat and release' practices in prehospital opioid overdose care: a systematic review. Emerg Med J 2019; 36(4):219-224. Medline
II Neutral (Yellow) Efficacy Patient PH-Paramedic Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O'Reilly C, et al. Management of Suspected Opioid Overdose With Naloxone in Out-of-Hospital Settings: A Systematic Review. Ann Intern Med 2017; 167(12) 867-75. Medline
II Neutral (Yellow) One-week mortality after pre-hospital discharge Patient PH-Paramedic Heyerdahl F., Hovda KE., Bjornaas MA., Nore AK., Figueiredo JC., Ekeberg O., Jacobsen D. Pre-hospital treatment of acute poisonings in oslo. BMC Emergency Medicine 2008; 8:15-227X-8-15. Medline
II Neutral (Yellow) Mortality Process PH-Paramedic McLeod KE, Slaunwhite AK, Zhao B, Moe J, Purssell R, Gan W, et al. Comparing mortality and healthcare utilization in the year following a paramedic-attended non-fatal overdose among people who were and were not transported to hospital: A prospective cohort study using linked administrative health data. Drug Alcohol Depend 2020:108381. Medline
II Neutral (Yellow) Relapse risk Patient PH-Paramedic Zozula A, Neth MR, Hogan AN, Stolz U, McMullan J. Non-transport after Prehospital Naloxone Administration Is Associated with Higher Risk of Subsequent Non-fatal Overdose. Prehosp Emerg Care 2021:1-11. Medline
III Supportive (Green) Mortality Patient PH-Paramedic Boyd JJ., Kuisma MJ., Alaspaa AO., Vuori E., Repo JV., Randell TT. Recurrent opioid toxicity after pre-hospital care of presumed heroin overdose patients. Acta Anaesthesiol Scand 2006; 50: 1266-70. Medline
III Supportive (Green) Safety Patient PH-Paramedic Levine M., Sanko S., Eckstein M. Assessing the risk of prehospital administration of naloxone with subsequent refusal of care. Prehosp Emerg Care 2016; 20:566–9. Medline
III Supportive (Green) Death and/or readmission Patient PH-Paramedic Seidler D., Stuhlinger GH., Fischer G., et al. After antagonization of acute opiate overdose: A survey at hospitals in Vienna. Addiction 1996; 91(10):1479-1487. Medline
III Supportive (Green) Safety Process PH-Paramedic Vilke G., Buhanan J., Dunford J., Chan T. Are Heroin Overdose Deaths Related to Patient Release After Prehospital Treatment with Naloxone? Prehospital Emergency Care 1999; 3(3):183-186. Medline
III Supportive (Green) Mortality Patient PH-Paramedic Vilke GM., Sloane C., Smith AM., Chan TC. Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine 2003; 10(8):893-896. Medline
III Supportive (Green) Survival Patient PH-Paramedic Wampler DA., Molina DK., McManus J., Laws P., Manifold CA. No deaths associated with patient refusal of transport after naloxone-reversed opioid overdose. Prehosp Emerg Care 2011; 15(3):320-324. Medline
III Neutral (Yellow) Adverse Event Patient ED-MD Christenson J., Etherington J., Grafstein E., et al. Early discharge of patients with presumed opioid overdose: Development of a clinical prediction rule. Acad Emerg Med 2000; 7(10):1110-8. Medline
III Neutral (Yellow) Rebound toxicity Patient PH-Paramedic Rudolph SS., Jehu G., Nielsen SL., Nielsen K., Siersma V., Rasmussen LS. Prehospital treatment of opioid overdose in copenhagen--is it safe to discharge on-scene? Resuscitation 2011; 82(11):1414-8. Medline

Palliative Care
Level Direction Primary Outcome Patient/Process Setting Reference

POCUS for COPD evaluation
Level Direction Primary Outcome Patient/Process Setting Reference
III Neutral (Yellow) Feasibility Process PH-Paramedic Nadim G, Laursen CB, Pietersen PI, Wittrock D, Sørensen MK, Nielsen LB, et al. Prehospital emergency medical technicians can perform ultrasonography and blood analysis in prehospital evaluation of patients with chronic obstructive pulmonary disease: a feasibility study. BMC Health Serv Res 2021; 21(1):290. Medline

Predictive Tools
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) NEWS score in non-transported patients with subsequent OHCA Process PH-Paramedic Deakin CD, Quartermain A, Ellery J.,Do Patients Suffering an Out-of-Hospital Cardiac Arrest Present to the Ambulance Service With Symptoms in the Preceding 48hrs? 2019Eur Heart J Qual Care Clin Outcomes. Ahead of print Medline
II Supportive (Green) Hospital admission and all cause mortality Process Other Spangler D, Hermansson T, Smekal D, Blomberg H,. A validation of machine learning-based risk scores in the prehospital setting. PLoS One. 2019 Dec 13;14(12):e0226518 Medline

SVT post-conversion
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Relapse Patient PH-Paramedic Minhas R., Vogelaar G., Wang D., et al. A prehospital treat-and-release protocol for supraventricular tachycardia. CJEM 2015; 17(4):395-402. Medline

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