Results:

Over the 8-year study period, a total of 16,905 EMS transports (range = 1-80; median = 2) was made for the 6,582 adults with reported HF; the majority of multiple transports (i.e., 5-80) were made for 795 adults (12.1%). Adults were mostly women (57.6%) and Black (57.7%) and were on average 63.7 ± 14.5 years of age. Chief complaints across all transports were respiratory problems (26.6%), feeling sick (23%), and chest pain (17%). During transports, 38,079 treatments were administered, including administering medications (37.1%), establishing intravenous/intraosseous access (23.2%), administering oxygen (20.8%), and delivering intravenous fluid (11.4%). The most frequently administered medications were nitroglycerin (26.9%), albuterol (23%), aspirin (16.5%), ipratropium bromide (15.9%), ondansetron (5.8%), and fentanyl (4.8%). Among the selected a priori predictor variables, shortness of breath, chest pain, and low level of consciousness (low Glascow Coma Scale scores) were associated with greater odds of having multiple transports. Co-variates significantly associated with greater odds of having multiple EMS transports were age, gender, race, and hospital site; adults of younger age, female gender, and Black race were more likely to have multiple transports. In this study, significant predictors of multiple EMS transports include shortness of breath, chest pain, and increased oxygen saturation. For instance, adults who had shortness of breath during the index EMS transport had 13.1% more transports compared with adults who were otherwise similar. Age, gender, and hospital site were significant co-variates associated with multiple EMS transports.