Meeting national response time targets for priority 1 incidents in an urban emergency medical services system in South Africa: More ambulances won’t help

Stein, Christopher; Wallis, Lee; Adetunji, Olufemi

doi:10.7196/samjnew.8087

Cited by 13 publications

(19 citation statements)

References 13 publications

(14 reference statements)

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“…Secondly, ambulance personnel should be educated and mandated to preferentially transport patients to PCI-capable facilities if within the referral areas. Redundancies should be considered as ambulances will be out of commission for a longer period, and might place strain within an already resource-limited ambulance context [ 18 ]. The use of helicopter emergency medical services (HEMS) could increase the proportion of patients with timely PCI access [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

The application of optimisation modelling and geospatial analysis to propose a coronary care network model for patients with ST-elevation myocardial infarction

Stassen

Olsson

Kurland

2020

African Journal of Emergency Medicine

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Background The incidence of myocardial infarction is increasing in South Africa. Prompt treatment is indicated to reduce mortality. One way of expediting treatment is to set up regional referral recommendations that can guide prehospital providers on the best reperfusion strategy for a particular patient. A coronary care network model for patients who present with ST-elevation myocardial infarction is proposed, using the North West province, of South Africa as a case study. Methods Geospatial analysis with network optimisation modelling was applied, to determine which strategy (prehospital thrombolysis, in-hospital thrombolysis or percutaneous coronary intervention) was most appropriate for patients presenting within each of the municipal wards of the North West province. Results An efficient and swift recommendation for the optimal reperfusion strategy is obtained using the current model, even in the instance of a large amount of ward data with additional constraints. For most municipal wards (204, 53%) percutaneous coronary intervention is the preferred reperfusion strategy based on proximity. For the remainder of the wards prehospital (138, 36%) or in-hospital (44, 11%) thrombolysis is recommended. Conclusion A scalable and efficient method of determining the optimal reperfusion strategy for a patient presenting with ST-elevation myocardial infarction in the North West province, is presented. This approach can serve as a model which can be applied to other settings and can form the basis of regional coronary care network development priorities and resource allocations.

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Section: Discussionmentioning

confidence: 99%

The application of optimisation modelling and geospatial analysis to propose a coronary care network model for patients with ST-elevation myocardial infarction

Stassen

Olsson

Kurland

2020

African Journal of Emergency Medicine

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“…One method for decreasing response time is increasing the number of available ambulances, although in one South African study, only increasing the number of ambulances did not help meet the urban priority response time goals [22]. In another South African study, emergency ambulance location had a greater effect on the response time performance [23].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of ambulance utilized patients in Addis Ababa, Ethiopia

Sultan

Abebe

Tsadik

et al. 2018

BMC Health Serv Res

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BackgroundWell organized and appropriately utilized pre-hospital emergency services play a critical role in augmenting emergency care systems. The primary objective of this study was to understand the demographic and clinical profile of patients who used ambulances in Addis Ababa. The secondary objectives were to assess ambulance response time, transport time and reasons for referral amongst inter-facility transported patients in Addis Ababa.MethodsThe study was designed as a cross-sectional retrospective chart review of ambulance transported patients using ambulance station records from Addis Ababa Fire and Emergency Prevention and Control Authority. With IRB approval, simple random sampling and manual review of six months of clinical records was performed. Data were collected by trained data collectors and descriptive analysis was done using SPSS version 20.ResultsFemale patients used ambulance services more often than males (female to male ratio of 3:1) and the mean age of the patients was 26 years. The most commonly transported age group was 16–30 years, followed by 31–50 years and neonatal patients (i.e. < 1 month). The majority of the patients had pregnancy related illnesses (n = 492, 61.4%), followed by general medical issues (n = 210, 26.2%) and injury secondary to trauma (n = 99, 12.3%). Most patients (n = 702, 87.6%) were transported for inter-facility transfers, while only 12.4% (n = 99) were primary responses (i.e. from the scene). Prolonged labor was the most common reason (n = 103, 23.4%) for inter-facility transfer of pregnant patients, followed by premature rupture of the amniotic membrane (n = 60, 13.6%). The mean dispatch to scene time interval was 10.1 min, and mean scene to facility time interval was 17.2 min.ConclusionInter-facility transfers accounted for the largest proportion of ambulance utilization and dispatch in Addis Ababa. Ambulance transport time was twice as long compared to international recommendations of less than eight minutes for emergent transports. The most common reasons for ambulance dispatch were Obstetric. We recommend urgent action to decrease the transport times and to dedicate further pre-hospital resources to address the high burden of inter-facility transfers.

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“…Work done by Fischer and colleagues in 2000, explains that meeting the set response time target would require substantial cost. [ 10 , 11 ]. Even though the response time target has not been met.…”

Section: Introductionmentioning

confidence: 99%

Emergency response time and pre-hospital trauma survival rate of the national ambulance service, Greater Accra (January – December 2014)

Mahama¹,

Kenu

Bandoh

et al. 2018

BMC Emerg Med

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BackgroundEvery year, about 1.2 million people die through road traffic crashes worldwide. Majority of these deaths occur in Africa where most of their emergency medical services are underdeveloped. In 2004, Ghana established the National Ambulance Council to provide timely and efficient pre-hospital emergency medical care to the sick and injured. Pre-hospital emergency medical service is essential for accident victims since it has the potential of saving lives. The study sought to determine the relationship between pre-hospital trauma survival rate and response time to emergencies and factors associated to pre-hospital trauma survival in Accra, Ghana.MethodsThe study was a cross sectional study which reviewed pre-hospital care forms of trauma patients from the fourteen ambulance stations in the Greater Accra region from January to December 2014. Data were extracted from these forms and the response time estimated. Conscious patients who were alert were categorized as responsive under the AVPU scale. The proportion of patients who survived pre-hospital trauma and the time pre-hospital trauma cases were responded to was estimated. Multiple logistic regression analysis was conducted to determine which variables were associated with survival.ResultsA total of 652 pre-hospital care forms were reviewed. About 87% survived pre-hospital trauma. The average response time to patients was (16.9 ± 0.7) minutes and the median transportation time of the patient was 82 min. Level of consciousness of a patient and response time of patients transported was found to be significantly associated with pre-hospital trauma survival.ConclusionThere was a high trauma patient survival rate among victims attended to by an NAS. The average response time in Greater Accra region in the 14 ambulance stations is 16.9 min which is not different from the 17 min recorded in 2013 by NAS. Factors that were associated with pre-hospital survival were alertness in the level of consciousness and response time less than 17 min.

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Meeting national response time targets for priority 1 incidents in an urban emergency medical services system in South Africa: More ambulances won’t help

Cited by 13 publications

References 13 publications

The application of optimisation modelling and geospatial analysis to propose a coronary care network model for patients with ST-elevation myocardial infarction

The application of optimisation modelling and geospatial analysis to propose a coronary care network model for patients with ST-elevation myocardial infarction

Epidemiology of ambulance utilized patients in Addis Ababa, Ethiopia

Emergency response time and pre-hospital trauma survival rate of the national ambulance service, Greater Accra (January – December 2014)

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