Are We Going Back? What National Research Shows About 72-Hour Return Calls

By: Remle P. Crowe, PhD, NREMT, Senior Director of Research and Data Enablement

Earlier this year at the National Association of EMS Physicians annual meeting in San Diego, our team had the tremendous honor of receiving the Best Scientific Presentation award for our study, “A National Description of 72-Hour Return EMS Encounters and Outcomes Following Non-Transport.” 

Non-transport encounters have always carried a unique kind of pressure. Clinicians and medical directors alike know the feeling as a signature is obtained to leave a patient at home and quietly wondering, “Was this the right call? Will we be back?” From both a medical and legal standpoint, these cases can be some of the toughest decisions we make in the field.

Historically, answering those questions at a national level was nearly impossible. EMS data has long been encounter-based, creating a new record for every call without an easy way to follow the same patient over time. Tracking whether a patient re-entered the system after a non-transport required a level of linkage most datasets simply couldn’t support. 

That changed with the arrival of the ESO Longitudinal Record. For the first time, we had the technology to follow patients across encounters and across systems, giving us the ability to finally ask a truly patient-centered question: How often do patients call back within 72 hours after a non-transport, and what happens when they do? 

A Patient-Centered Approach to Non-Transport Terminology: Moving Beyond “Refusal”

While we’re focusing on a patient-centered approach to research, it’s worth pausing to consider a patient-centered approach to the words we use. You may notice I haven’t used the term “refusal” to describe these encounters, and that’s intentional. Words matter, and “refusal” carries stigma while oversimplifying what are often nuanced clinical and interpersonal situations. It implies a patient simply said no, when in many cases the care may not have been fully offered, the options not clearly explained, or the most appropriate clinical decision may genuinely be non-transport. As treatment-in-place, telehealth, and alternative pathways continue to expand, non-transport will increasingly be a safe and appropriate outcome. What we need is shared decision-making, not terminology that places blame or shuts down clinical curiosity. 

What We Found 

Across 22.5 million EMS encounters from 2018–2022, nearly one in four ended in non-transport. That alone underscores how important it is to understand these outcomes.  

But here’s where it gets really interesting: 

6% returned to EMS within 72 hours. That’s nearly 300,000 return encounters. 

Most return encounters led to transport. 

• 71% were transported 

• 28% were again non-transported 

• 1% were dead on scene 

And when we linked transported patients to hospital outcomes, the picture grew sharper: 

41% were admitted to the hospital. 

This is a strikingly high admission rate, and it wasn’t random. Certain characteristics during the index non-transport encounter strongly predicted later hospitalization. 

Which patients were at highest risk? 

Certain characteristics from the index non-transport encounter predicted a higher likelihood of hospital admission at the return encounter: 

• Male sex 

• Older age 

• Clinical impressions involving: 

• • Cardiac/pulmonary issues 

• • Neurological concerns 

• • Infection/sepsis  

• Abnormal vital signs, especially: 

• • Tachycardia 

• • Hypotension 

• • Hypoxemia 

These are the kinds of factors that clinicians know intuitively matter but seeing them quantified across millions of encounters validates what many EMS leaders have observed at the agency level. Put simply: When patients had concerning vital signs or high-risk medical impressions at the initial visit, they were more likely to need significant care shortly afterward. 

Why This Matters for EMS

Non-transport decisions are some of the most complex calls we make. They’re not just clinical; they involve operational realities, patient autonomy, and a fair amount of gut-checking. Having national data on who is most likely to deteriorate after a non-transport gives EMS leaders and clinicians something we’ve never really had before: evidence to guide those decisions.

This kind of information can help agencies: 

• Strengthen non-transport protocols 

• Improve scene-level safety assessments 

• Target education toward higher-risk patient categories 

• Build follow-up programs or alternate care pathways 

• Support clinicians with data instead of relying solely on intuition 

One of the most important takeaways from the study was the role of abnormal vital signs. Patients with tachycardia, hypotension, or hypoxemia during the initial encounter were far more likely to be hospitalized if they returned within 72 hours. That finding underscores what many clinicians already know: high-quality vitals and clear documentation matter — especially when numbers don’t quite match the patient’s appearance. 

This aligns with the National EMS Quality Alliance’s TTR-01 measure, which tracks the percentage of 9-1-1 calls ending in non-transport where a basic set of vital signs is documented. Good fundamentals still make a difference, and now we have national evidence to back it up. 

The Power of a Patient-Centered Dataset 

One of the most important parts of this project wasn’t just the findings — it was the fact that we were finally able to follow patients, not just encounters. Using masked identifiers built from Levenshtein-weighted demographic matching, we could track when the same person re-entered the system, even across different agencies. For EMS research, that’s a major step forward. 

For years, EMS leaders have talked about wanting a more complete picture of what happens before, during, and after our involvement in a patient’s care. Not just call-by-call, but over time and across settings. That’s exactly the kind of connected, patient-centered approach envisioned in EMS Agenda 2050, where data follows the patient and supports truly people-centered care. 

This study shows what becomes possible when we invest in data linkage and collaborative research: we can move beyond snapshots and start understanding patterns, risks, and outcomes in a way that actually reflects the patient journey. 

And this is just the beginning. With longitudinal tracking, we can finally take on bigger questions — about safety, equity, long-term outcomes, alternate destination models, and how new approaches to care are shaping the lives of the people we serve. 

A Proud Moment for the Team — and for EMS Research

Winning Best Research at NAEMSP is meaningful not just for the recognition, but because it highlights the type of work our profession needs right now: patient-centered, national in scope, rigorous, and directly applicable to real-world practice. 

I’m incredibly grateful to my coauthors, Dr. Antonio Fernandez, Alison Treichel, Edward Preusser, Dr. Scott Bourn, and Dr. Brent Myers, and to every agency participating in the ESO Data Collaborative. This study represents the combined efforts of clinicians, data teams, and researchers who believe that better information leads to better care. 

Most importantly, it showcases what EMS does best: learn, adapt, and use evidence to drive continuous improvement for the patients and communities we serve. 

Left to Right: Dr. Doug Kupas (President of NAEMSP), Dr. Remle Crowe (Senior Director of Research and Data Enablement at ESO), Dr. Jose Cabañas (Immediate Past President of NAEMSP), Dr. Amber Rice (Chair of the NAEMSP Research Committee) 

Looking Ahead

The work doesn’t stop here. Our team is already digging deeper into specific clinical categories, the influence of social and economic factors, and what repeat non-transport patterns can tell us about patient safety and system performance. Each new insight moves us closer to delivering care that is safer, more equitable, and more effective for the communities we serve. 

But for the moment, it’s worth pausing to recognize what this project represents, a major step forward in patient-centered research and an expanded understanding of non-transport at a national level. 

Here’s to more data, more discovery, and the next chapter of EMS research. 

Read the full abstract 

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