National Pattern of Emergency Medical Services Transport for Nonemergent Emergency Department Visits in the United States

Nonemergent emergency department (ED) visits account for a substantial share of ED utilization. We aimed to characterize patient demographics, presenting complaints, and diagnostic and therapeutic interventions among nonemergent ED visits transported by emergency medical services (EMS) in the United States.

We conducted a retrospective analysis of the National Hospital Ambulatory Medical Care Survey (2016–2022) examining nonemergent emergency department visits (ESI 4–5) transported by EMS. The primary outcome was ED resource utilization among these visits. Patient demographics included age, sex, race, ethnicity, and residence. Clinical variables included presenting complaints, diagnostic testing, medications administered, disposition, and 72-hour return visits. Descriptive statistics and temporal trend analyses were performed.

A total of 13,880,015 nonemergent emergency department (ED) visits were analyzed. The mean patient age was 53 ± 21 years, and 51% of patients were female. Most patients resided in private residences (84.7%). The racial distribution was 69.5% White, 27.6% Black, and 1.4% Asian. The most common presenting complaints included abdominal pain, back pain, chest pain, and musculoskeletal pain. Diagnostic testing was frequently performed: 62% of patients underwent imaging studies (OR 1.9, 95% CI 1.6–2.2), 36% received a complete blood count (OR 2.6, 95% CI 2.1–3.3), and 30% underwent a comprehensive metabolic panel. Medications were administered in the ED or prescribed at discharge in 60.4% of visits. The majority of encounters resulted in discharge home (87%), whereas 1.5% of patients left without being seen and 2.2% left against medical advice. Return visits within 72 hours occurred in 10.2% of cases, and 12.5% of patients were admitted. Hospital diversion status was noted in 53% of encounters. From 2016 to 2022, nonemergent EMS-transported ED visits demonstrated a significant downward temporal trend, reaching a nadir during the COVID-19 period, followed by partial recovery in 2022.

Nonemergent EMS-transported ED visits primarily involve middle-aged adults with pain-related complaints and frequently require diagnostic testing and medications, although most are managed without admission. These findings may inform resource allocation and development of alternative care pathways for low-acuity patients.