Involvement in emergency situations by primary care doctors on-call in Norway - a prospective population-based observational study

Abstract

BackgroundPrimary care doctors on-call in the emergency primary health care services in Norway are, together with the ambulances, the primary resources for handling emergencies outside hospitals. There is a lack of reliable data for Norway on how often the primary care doctors are alerted and on their responses in the most urgent emergency cases. The aim of this study was to investigate how doctors on-call are involved in red responses (highest priority), using three different emergency medical communication centres (EMCC) as catchment area for a prospective population-based study.MethodsIn the period from October to December 2007 three dispatch centres covering approximately 816 000 inhabitants prospectively recorded all acute emergency cases. Ambulance records, air ambulance records and records from the doctors on-call were collected. NACA score was used to define the severity of the emergencies.Results5 105 cases were classified as red responses during the period. We have complete basic recordings (AMIS forms) from all and resaved ambulance records, air ambulance records and records from doctors on-call in 89% of the cases. Ambulances were alerted in 96% and doctors on-call in 47% of the cases, but there were large differences between the three EMCCs. Doctors on-call responded with call-out in 42% of the alerted cases. 28% of all patients were taken to a casualty clinic, 46% were admitted to hospital by a doctor and 24% were taken directly to hospital by ambulances. In total, primary care doctors on-call took active part in 42% of all red response cases, and together with GPs' daytime activity the primary health care services were involved in 50% of the cases. 29% of the cases were classified as life-threatening. Call-out by doctors on-call were found to be more frequent in life-threatening situations compared with not life-threatening situations.ConclusionDoctors on-call and GPs on daytime were involved in half of all red responses. There were large differences between the EMCCs in the frequency of doctors alerted. The inhabitants in the three EMMCs were thus offered different levels of professional competency in emergency situations outside hospitals.

The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study

“…Given our findings, it is a paradox that there are EMCCs that seldom alerts GPs, and that GP participation is low [5]. The GPs in casualty clinics have different reasons for not responding to call outs.…”

“…The availability of the HEMS is also vulnerable to weather and competing missions [4]. A study of three Norwegian dispatch centers in 2007 found that the HEMS was alerted for approximately 8 percent of the “red responses” [5]. Therefore, pre-hospital emergency medicine in Norway is based on the local ambulance and GP on call, with the HEMS as an important supplement [3].…”

“…Another study from 2009 found that pre-hospital involvement by casualty clinic GPs is important for optimal patient care [7]. Despite the recommendation by national committees that GPs should take part in these call outs [3], the GP is only alerted by the EMCC in 47% of these incidents [5]. The frequency of alerting GPs vary between EMCCs, the cause of this is unknown.…”

Rural GPs’ attitudes toward participating in emergency medicine: a qualitative study

“…[6] A study among EMTs found that they perceived themselves as being more competent than others in handling prehospital emergencies. [7] GPs were described as being the most problematic occupational group to cooperate with during emergencies.…”

Akuttmedisinsk turnusarbeid i Finnmark

“…The purpose of the study was to try to obtain a better understanding of why duty doctors in the municipal health service do not always participate in emergency call-outs (9,10). Because the study is qualitative and not intended for generalisation, the findings cannot simply be transferred to other accident and emergency doctors.…”