Anesthesiologists in prehospital care make a difference to certain groups of patients

Objectives: Emergency medical service systems in Norway are based on equity and equality. A toll free number (113) and criteria based dispatch are crucial components. The establishment of an emergency medical system (EMS) manned by an air and ground emergency physician (EP) has challenged the role of the general practitioner (GP) in emergency medical care. We investigated whether there were any geographical differences in the use of 113, alerts to GPs by the emergency medical dispatch centres (EMDCs), and of the presence of GPs on scene in medical emergencies leading to a turnout of the EP manned EMS. Methods: This was a prospective, observational cohort study of 385 000 inhabitants covered by the two EMDCs of Rogaland county, Norway, including 1035 on scene missions of the EP manned EMS during the period 1998-99. Results: The proportion of emergency calls routed through 113 was significantly lower, the proportion of alerts to GPs significantly higher, and the proportions of GPs on scene significantly higher in rural than urban areas. Conclusion: We found geographical differences in the involvement of GPs in pre-hospital emergency medical situations, probably caused by a specialised emergency medical service system including an EMDC and an air and ground EP manned EMS. There were geographical differences in public use of the toll free 113, and alerts to GPs by the EMDCs, which is likely to result from geographical conditions and proximity to medical resources. Future organisation of the EMS has to reflect this to prevent unplanned and unwanted autonomously emerging EMS systems.

Section: Discussionmentioning

confidence: 99%

Have the implementation of a new specialised emergency medical service influenced the pattern of general practitioners involvement in pre-hospital medical emergencies? A study of geographic variations in alerting, dispatch, and response

Vaardal

2005

“…3 In Aarhus, an anaesthesiologist staffed mobile emergency care unit (MECU) is called in addition to an ambulance to life threatening cases, including acute coronary syndrome (ACS). 4 The MECU enables us to achieve an early provisional diagnosis.We wanted to study the accuracy of dispatch of the MECU to acute coronary syndrome (ACS) cases. ACS was used as an example of a life threatening emergency.…”

mentioning

confidence: 99%

A study of police operated dispatch to acute coronary syndrome cases arising from 112 emergency calls in Aarhus county, Denmark

Andersen

2006

Background: The accuracy of the Danish police operated "112" emergency call system was studied. Dispatch of the anaesthesiologist staffed mobile emergency care unit (MECU) to acute coronary syndrome (ACS) cases was used as an indicator of accuracy of dispatch to life threatening emergencies. Methods: This was an observational cohort study of patients given a 112 system report of heart attack and patients with a provisional diagnosis of ACS made on scene by the MECU. Sensitivity, specificity, and positive predictive value with 95% confidence intervals (CI) were calculated. Results: There were 341 reports of ''heart attack'' and 205 patients with ACS. Sensitivity was 75% (95% CI 68% to 80%) specificity 90% (89% to 92%) and positive predictive value 45% (40% to 50%). Conclusion: The accuracy of 112 dispatch of the MECU was found to be moderate. We suggest more training of dispatch staff and medical supervision.T he common emergency phone number in Denmark is "112".1 The police operate the 112 alert, except in Copenhagen; this is unique among European countries. 2Studies on dispatch of emergency medical services (EMS) are few, and a systematic review found only 20 studies containing original data. 3In Aarhus, an anaesthesiologist staffed mobile emergency care unit (MECU) is called in addition to an ambulance to life threatening cases, including acute coronary syndrome (ACS). 4 The MECU enables us to achieve an early provisional diagnosis.We wanted to study the accuracy of dispatch of the MECU to acute coronary syndrome (ACS) cases. ACS was used as an example of a life threatening emergency. METHODSFollowing consultation with the ethics committee, permission was not required for the project to proceed. The study was designed as an observational cohort study based on consecutive data collected in Aarhus (330 000 inhabitants) during a 6 month period in 2002. Inclusion criteria were: (a) patients with a chief complaint of ''heart attack'' on calling 112, and (b) patients with an on scene provisional diagnosis of ACS.The report of ''heart attack'' as the main complaint from the emergency 112 call was compared with the provisional diagnosis of ACS made by the MECU physician. A 12 lead electrocardiogram was performed on scene. Sensitivity, specificity, and positive predictive value were calculated with 95% confidence intervals (CI). RESULTSThere were 341 reports from 112 of ''heart attack'', and 2154 MECU responses during the study period, with ACS diagnosed in 205 patients (9.5%) (table 1). Sensitivity was 75% (95% CI 68% to 80%) specificity 90% (89% to 92%) and positive predictive value 45% (40% to 50%).There were 188 false positive cases with provisional diagnoses (table 2) and 52 false negative cases with the 112 reports (table 3). DISCUSSIONThis is the first study to present data from police operated 112 alarm centres in a country with 112 as the single unique number for all emergencies. The MECU enabled us to retrieve a provisional diagnosis made by a physician on scene, giving us an early evaluation and provisional ...

“…The staffing of ambulances with physicians who are trained to care for cardiopulmonary unstable patients and who are well accustomed to perform invasive procedures in this setting might improve the quality of care in prehospital emergency medicine 1 2 11. Klemen and Grmec12 studied the care for severe traumatic brain injury and compared the outcomes of patients treated by EMT or emergency physicians, and showed that patients treated by emergency physicians had a reduced rate of death on admission, hospital mortality in more severely injured patients and better functional neurological outcomes.…”

Section: Discussionmentioning

confidence: 99%

Duration of mission time in prehospital emergency medicine: effects of emergency severity and physicians level of education

Schuster

Pints

Fiege

2010