Can First Responders Be Sent to Selected 9-1-1 Emergency Medical Services Calls without an Ambulance?

Abstract

Objectives: To evaluate the feasibility and safety of initially dispatching only first responders (FRs) to selected low-risk 9-1-1 requests for emergency medical services. First responders are rapidly-responding fire crews on apparatus without transport capabilities, with firefighters trained to at least a FR level and in most cases to the basic emergency medical technician (EMT) level. Low-risk 9-1-1 requests include automatic medical alerts (ALERTs), motor vehicle incidents (MVIs) for which the caller was unable to answer any medical dispatch questions designed to prioritize the call, and 9-1-1 call disconnects (D/Cs). Methods: A beforeand-after study of patient dispositions was conducted using historical controls for comparison. During the historical control phase of six months, one year prior to the study phase, basic life support ambulances (staffed with two basic EMTs) were dispatched to selected low-risk 9-1-1 incidents. During the six-month study phase, a fire FR crew equipped with automated external defibrillators (AEDs) was sent initially without an ambulance to these incidents. Results: For ALERTs (n ¼ 290 in historical group vs. 330 in study group), there was no statistical difference in the transport rate (7% vs 10%), but there was a statistically significant increase in the follow-up use of advanced life support (ALS) (1% vs 4%, p ¼ 0.009). No patient in the ALERTs historical group required airway management, while one patient in the study group received endotracheal intubation. No patient required defibrillation in either group. Analysis of the MVIs showed a significant decrease (p \ 0.0001) in the patient transport rate from 39% of controls to 33% of study patients, but no change in the follow-up use of ALS interventions (2% for each group). For both the ALERTs and MVIs, the FR's mean response time was faster than ambulances (p \ 0.0001). Among the 9-1-1 D/Cs with FRs only (n ¼ 1,028), 15% were transported and 43 (4%) received subsequent ALS care. Four of these patients (0.4%) received intubation and two (0.2%) required defibrillation. However, no patient was judged to have had adverse outcomes as a result of the dispatch protocol change. Conclusions: Fire apparatus crews trained in the use of AEDs can safely be used to initially respond alone (without ambulances) to selected, low-risk 9-1-1 calls. This tactic improves response intervals while reducing ambulance responses to these incidents.

A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review

“…The designs of the included studies concerned two systematic reviews [10, 26], four experimental designs: one cluster-randomized controlled trial [27], one quasi-experimental [28], and two pre-test post-test [29, 30], 52 observational designs: 27 retrospective [8, 9, 31–55], 23 prospective [56–78], and two cross-sectional [79, 80], one mixed method design [81], and eight qualitative designs [82–89] (Table 1 and Table 2). …”

Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes

“…25 Articles were from the UK (n = 6), the United States (n = 6), Canada (n = 2), and Iran (n = 1). Eleven of these EMS systems were paramedicbased, 12,13,15,16,18,[21][22][23][24][25][26] two were physician-based with basic emergency medical technicians, 3,27 and in one report the type of EMS system was unclear. 28 The following interventions were studied: transferring 911 callers to nurse-advice lines (n = 6), EMS dispatch providing advice or self-care instructions (n = 4), alternative EMS response being dispatched (n = 3), and identification of low acuity calls that do not require EMS response (n = 2).…”

“…• EMS response intervals 12,25 • EMS job cycle time 17,24,25,66 • EMS time on scene 46,66 • Episode of care time 66 • Time to contact with definitive care (ED or primary care) 43,66 • Time to ED triage 56 • Length of hospital stay 66 • Time from call to discharge 59 • Choose time points in which data entry for these fields by dispatch, EMS clinicians or hospital staff is mandatory, to minimize missing data.…”

“…29 • Number of nontransports 14,17,24,29,43,45,46,50,52,66 • A non-transport may be defined as paramedics not transporting the patient from scene. There could be various reasons.…”

“…• ALS interventions administered 24 • Number of investigations 43,60 • Paramedic compliance with protocols 57,66 • Decision support algorithms used and followed 66…”