Patients discharged to police custody after paramedic evaluation: an observational cohort study.

Background: In Finland, more than a third of the patients attended by the emergency medical services (EMS) are discharged on scene without ambulance transport, with reported recontact of <10% and 24-hour to 48-hour mortality of 0.3%-3.5%. In cases of disturbing or violent behaviour or suspected criminal activity, patients can also be discharged directly to police custody, with or without consultation with a prehospital physician. This study reports the incidence of patient deterioration in these situations.

Methods: All EMS calls between 2013 and 2021 with patient discharge to police custody were collected from electronic prehospital patient records and combined with data from the national causes of death registry. Patient and EMS call-related factors were studied to identify associations with EMS recontact, ambulance transport or death within 48 hours after discharge to police custody.

Results: A total of 2184 patients were discharged directly to police custody by EMS, of whom 6% (132) involved a prehospital physician's consultation. The most common reasons for ambulance dispatch were intoxications (n=497, 22.8%), falls (n=439, 20.1%) and assaults (n=188, 8.6%). The mean (SD) age was 44.1 (16.2) years, 78.2% were male, and 1736 patients (79.5%) were reported to be under the influence of alcohol. A new EMS contact within 48 hours occurred in 192 (8.8%) cases; 26 patients were still in police custody at the time. Ambulance transport was required in 126 (5.8%) cases; 19 of these were for patients still in custody. Consultation with a prehospital physician was associated with EMS recontact (OR 2.79, 95% CI 1.76 to 4.40) and ambulance transport (OR 3.51, 95% CI 2.12 to 5.82). Three (0.14%) patients died in custody; none had a prehospital physician consultation. Alcohol use was not associated with a new EMS contact after discharge or patient death.

Conclusion: Violent behaviour and the use of alcohol and drugs were common in patients who were discharged to police custody. Despite this, discharge to police custody was not found to have a higher EMS recontact or mortality rate than non-conveyance in general.