BackgroundThere is a great variety in how emergency medical communication centers (EMCC) are organized in different countries and sometimes, even within countries. Organizational changes in the EMCC have often occurred because of outside world changes, limited resources and the need to control costs, but historically there is often a lack of structured evaluation of these organization changes. The aim of this study was to evaluate if the performance in emergency medical dispatching changed in a smaller community outside Helsinki after the emergency medical call centre organization reform in Finland.MethodsA retrospective observational study was conducted in the EMCC in southern Finland. The data from the former system, which had municipality-based centers, covered the years 2002-2005 and was collected from several databases. From the new EMCC, data was collected from January 1 to May 31, 2006. Identified performance indicators were used to evaluate and compare the old and new EMCC organizations.ResultsA total of 67 610 emergency calls were analyzed. Of these, 54 026 were from the municipality-based centers and 13 584 were from the new EMCC. Compared to the old municipality-based centers the new EMCC dispatched the highest priority to 7.4 percent of the calls compared to 3.6 percent in the old system. The high priority cases not detected by dispatchers increased significantly (p < 0.001) in the new EMCC organization, and the identification rate of unexpected deaths in the dispatched ambulance assignments was not significantly (p = 0.270) lower compared to the old municipality-based center data.ConclusionAfter implementation of a new EMCC organization in Finland the percentage and number of high priority calls increased. There was a trend, but no statistically significant increase in the emergency medical dispatchers' ability to detect patients with life-threatening conditions despite structured education, regular evaluation and standardization of protocols in the new EMCC organization.

Background Geographical service areas are used as descriptive system indicators in Emergency Medical Service (EMS) related studies and reporting templates. The actual service area may differ significantly from administrative areas; this may lead to inaccuracy in determining indicator values, such as population or mission density, thus making it biased when comparing results between different areas and organizations. The aim of this study was to introduce a univocal, repeatable and easily adaptable method to determine the actual service area of a helicopter emergency medical service (HEMS) unit for statistical, quality measurement and research purposes using widely available geographical information (GIS) and statistical analysis tools. Methods The method was first tested with Tampere HEMS unit. All accepted missions in 2017 were extracted from FinnHEMS database (FHDB). We calculated distance from HEMS base to each accepted mission location. Missions were reordered based on the distance and 99th and 95th percentiles were calculated for mission distances. Convex hulls including 100, 99 and 95% of the missions, and the population and area covered by these missions, were then calculated. The method was repeated for all Finnish HEMS bases. Results Approximately 90% of Tampere HEMS unit’s accepted missions took place within 100 km from the base. 10.9% of the missions occurred outside of the administrative service area. 95% convex hull areas are most in line with the everyday experience of where the units actually operate. In Tampere, the 95% convex hull area corresponds to 76,5% of the administrative area’s population and to 89,8% of its area. Calculating the 95% convex hull areas for all Finnish HEMS units results in service areas that overlap at some points, and some areas of the country fall outside of all HEMS service areas. Conclusions Administrative areas do not correspond to the actual service areas of HEMS units. The service area of a HEMS unit defined by administrative boundaries may differ significantly from actual operations. Using historical mission data to create a convex hull that incorporates mission locations could offer a standardized and comparable solution for determining actual HEMS unit service areas, which can be used for statistical comparison, quality measurement and system development.

Background: Stroke causes death, disability and increases the use of healthcare resources worldwide. The outcome of intravenous thrombolysis and mechanical endovascular thrombectomy highly depends on the delay from symptom onset to initiation of definitive treatment. The purpose of this study was to compare the various patient transportation strategies to minimize pre-hospital delays. Methods: Emergency medical services (EMS) mission locations and ambulance response times in Finland with urgent stroke-suspected dispatch codes were collected from Emergency Response Centre (ERC) records between 1 January 2016 and 31 December 2016. Four transport scenarios were simulated for each mission, comparing ground and helicopter transportation to hospital with different treatment capabilities. Results: In 2016, a total of 20,513 urgent stroke-suspected missions occurred in Finland. Of these, we were able to locate and calculate a route to scenario-based hospitals in 98.7% (20,240) of the missions. For ground transport, the estimated median pre-hospital time to a thrombolysis-capable and thrombectomycapable hospital were 54.5 min (95% confidence interval (CI), 31.7-111.4) and 94.4 min (95% CI, 33.3-195.8), respectively. Should patients be transported on the ground to thrombectomy-capable hospitals only, the prehospital time would increase in 11,003 (54.4%) of missions, most of which were in rural areas. With the fastest possible transportation method, the estimated mean transport time to a thrombectomy-capable hospital was 80.84 min (median, 80.80 min; 95% CI, 33.3-143.1). Helicopter transportation was the fastest method in 68.8% (13,921) of missions, and the time saved was greater than 30 min in 27.1% (5475) of missions. In rural areas, helicopter transportation was the fastest option in nearly all missions if dispatched simultaneously with ground ambulance. Conclusion: Helicopter transportation may significantly decrease pre-hospital delays for stroke patients, especially in rural areas, but the selection of an optimal transportation method or chain of methods should be determined caseby-case.

Background Mass gathering (MG) events may cause delayed emergency responses via various mechanisms and strain the resources of local emergency services. Therefore, preparedness, including adequate pre-planning and sufficient resourcing during MG events, is vital. The aim of this retrospective register study was to investigate the impact of MG events on the workload of rescue and emergency medical service (EMS) personnel during events to enable more precise and sufficient deployment of these authorities’ operative resources. Methods The data from Finland covered of 25,124 EMS and rescue service missions during a three-year period (2015–2017), including data from nine MG events and reference material for the same weekdays two weeks before and after the event. The data were analysed through statistical and geospatial analyses. Results Our findings showed that missions increased in most events included in this study. Analysis of the missions’ reasons showed that the categories of violence, traffic accidents and other accidents and injuries increased during events, with violence-related missions showing the highest relative risk (RR 1.87, 95% CI 1.43–2.44). In the four-grade (A–D) urgency grading, the analysis showed an increase in category C missions and a decrease in non-urgent category D missions. The analysis indicated an increase in missions during the evening and night-time. The geospatial analysis revealed dense hotspots of missions in the vicinity of the event area. Conclusion The workload for EMS and rescue service personnel increases during MG events. Most of the increase is allocated to EMS staff, peaking in evening and night hours. The geospatial analysis showed hotspots of missions on the outskirts of the actual event area during events; thus, the workload can also increase for those authority resources that are not directly allocated to the event. Detailed information regarding workloads is valuable for the authorities that are responsible for resource planning and preparedness for MG events. Replicating the study internationally would improve the methodology for the future.

Background: Several Emergency Medical Systems use a criteria-based prioritization system for ambulance response. The emergency medical priority dispatching of ambulances was introduced in the 1980s. In a system of this kind, the operators at the medical emergency dispatch centers have to assess the patients’ symptoms and the need for ambulance response. The prioritization of the ambulance response is based on the seriousness of the patient’s symptoms, his/her current condition and, in the case of trauma, the trauma mechanism. The priority system is supposed to optimize the use of the ambulance service and to match and meet the patients’ needs with an adequate response from the ambulances. The aim of this study was to describe the dispatching and utilization of the ambulance service in a part of Finland. Results: There was a substantial divergence between the initial priority assigned and the patients’ medical status at the scene. The ambulance staff confirmed the need for ambulance transport for 65% of all the patients who were assigned an ambulance by the dispatch center. Conclusions: Using a criteria-based dispatch protocol, the dispatch operator works with a wider safety margin in the priority assessments for ambulance response than was actually confirmed by the ambulance personnel at the scene. In this sample, there may be some overuse of the ambulance service. According to the assessments made by the ambulance staff, 35% of the patients did not require ambulance transport. The emergency system has to accept and work with safety margins. At the same time, there must be a balance between a safety margin and a waste of limited resources