Characteristics of midsized urban EMS systems

Braun, Odelia; McCallion, Russ; Fazackerley, J.

doi:10.1016/s0196-0644(05)82186-9

Cited by 70 publications

(26 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7,11,12 The ability of dispatchers to identify patients in cardiac arrest and provide CPR instructions over the phone is well documented, 7,19 and priority dispatch concepts have also been expanded to include discrimination between BLS and ALS situations. 7,[10][11][12][13][14][15]25 Earlier research efforts from this institution and others have demonstrated that a computer-aided priority dispatch algorithm can safely and reliably help dispatchers distinguish between ALS and BLS incidents. 7,10,14,15,20,25 Such systems can be of value, particularly in busy urban EMS systems.…”

Section: Discussionmentioning

confidence: 99%

“…7,10 Recognizing that only a small percentage of calls ever utilize advanced life support (ALS) skills, modern priority dispatch systems have been developed that either triage the need for a rapid, ''lights and siren'' response (which may pose some additional traffic risk) or, in other cases, simply limit paramedic deployment to those emergencies that probably will require advanced skills. 7,[10][11][12][13][14][15][16][17][18][19][20][21] By sending nonparamedic ambulances staffed by BLS-providing emergency medical technicians (EMTs) to the lower-priority calls, EMS systems can function with fewer paramedics. 1,6,7,22 With fewer paramedics, each paramedic gains more experience with those true emergency situations for which he or she needs to be focused, thereby improving his or her clinical performance in these situations.…”

mentioning

confidence: 99%

“…1,6,7,22 With fewer paramedics, each paramedic gains more experience with those true emergency situations for which he or she needs to be focused, thereby improving his or her clinical performance in these situations. 6,7,13,[16][17][18] In addition, by making the pool of paramedic ambulances (or other ALS response units) more available, one can actually improve response intervals to the more critical cases. 7,22 In many systems, rapidly-responding fire suppression apparatus or police vehicles, staffed with crews who can provide BLS, are used to supplement the initial ambulance response.…”

mentioning

confidence: 99%

See 2 more Smart Citations

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

Key

Pepe²,

Persse

et al. 2003

Acad Emergency Med

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Key

Pepe²,

Persse

et al. 2003

Acad Emergency Med

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 87%

“…This means that, on average, each ambulance serves about 123,000 people and each base must cover an average of 155 km 2 . This contrasts, for instance, with the US, where by the 1990s there was about 1 ambulance per 51,000 inhabitants (Braun et al, 1990). This work is motivated by the lack of resources and their sub-optimal use, which is evident when we consider that the average response time of RCT ambulances was approximately 14 min with an SD of 7 min.…”

mentioning

confidence: 97%

Modeling Uncertainty for the Double Standard Model Using a Fuzzy Inference System

2018

View full text Add to dashboard Cite

This paper studies the issue of uncertainty in the ambulance location problem to cover the maximum number of demand points in a city. The work is based on the double standard model (DSM), a popular coverage model where two radii are considered to cover a percentage of the demand points twice. Uncertainty is introduced in the expected travel time between an ambulance and a demand point, before computing the optimal placement of ambulances in potential bases by solving the linear program posed by the DSM. The following three approaches are considered: (1) solving the DSM without uncertainty; (2) uncertainty in the travel time is based on triangular fuzzy set; and (3) a fuzzy inference system (FIS) with a rule base derived from the problem properties, which is the main contribution of this work. Results show that considering uncertainty can have a significant effect on the solutions for the DSM, with the solutions produced with the FIS approach achieving a higher total coverage of the demand. In conclusion, the proposed strategy could provide a reliable and effective tool to support decision making in the ambulance location problem by considering uncertainty in the ambulance travel times.Keywords: ambulances, emergency medical services, bases, double standard model, triangular fuzzy set, fuzzy inference system inTrODUcTiOn In recent years, the development of computational support systems for emergency medical services (EMS) has attracted a growing amount of attention from researchers. In EMSs, a crucial factor that must be considered is response time. For example, let us consider cardiac arrest, the American Heart Association concluded that in the first 4-6 min after a person suffers a cardiac arrest she (he) can begin to suffer from permanent brain damage or even brain death. However, normal heart rhythm can be restored if advanced life support (ALS) is provided early. Studies have shown that the probability of a patient surviving is reduced by 7-10% with each passing minute in which defibrillation and ALS are not provided, and resuscitation is mostly unsuccessful after 10 min (EMSWorld.com, 2014).Another example is traffic accident, where the number of deaths was estimated to be 1.25 million in 2013. Half of all fatalities caused by traffic accidents are pedestrians, cyclists, and motorcyclists. Death rates from such accidents are considerably higher in developing countries (OMG, 2015). Therefore, appropriate and timely response times to such incidents are indispensable in highly urban areas.In 2013, the Red Cross of Tijuana (RCT) covered about 98% of the EMS requests (Cruz Roja de Tijuana, 2012), providing medical attention to 37,000 emergency calls. It does this with 13 ambulances that are distributed in 8 bases that cover a population of approximately 1.6 million people in an area of 1,243 km 2 (INEGI, 2010). This means that, on average, each ambulance serves about 123,000 people and each base must cover an average of 155 km 2 . This contrasts, for instance, with the US, where by the 1990s there was about 1 am...

show abstract

Do Emergency Medical System Response Times Matter for Health Outcomes?

Wilde

2012

Health Economics

121

View full text Add to dashboard Cite

The introduction of technology aimed at reducing the response times of emergency medical services has been one of the principal innovations in crisis care over the last several decades. These substantial investments have typically been justified by an assumed link between shorter response times and improved health outcomes. However, current medical research does not generally show a relationship between response time and mortality. In this study, we explain the discrepancy between conventional wisdom and mortality; existing medical research fails to account for the endogeneity of incident severity and response times. Analyzing detailed call-level information from the state of Utah's Bureau of Emergency Medical Services, we measure the impact of response time on mortality and hospital utilization using the distance of the incident from the nearest EMS agency headquarters as an instrument for response time. We find that response times significantly affect mortality and the likelihood of being admitted to the hospital, but not procedures or utilization within the hospital.

show abstract

Characteristics of midsized urban EMS systems

Cited by 70 publications

References 21 publications

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

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

Modeling Uncertainty for the Double Standard Model Using a Fuzzy Inference System

Do Emergency Medical System Response Times Matter for Health Outcomes?

Contact Info

Product

Resources

About