Poster 067. A Description of the Systemwide Application of Transcutaneous Cardiac Pacing in an Urban EMS System

Abstract

Purpose: To determine the outcome of patients whose request for EMS was identified as a nonlife-threatening emergency and dispatched as intermediate priority (IP). Methods: This was a retrospective review of randomly selected medical records conducted from 01 December 1993 through 31 October 1994. Cases included those for which IP was assigned to a request for EMS by emergency medical dispatchers using a standardized ambulance dispatch protocol. Emergency medical services requests from nursing homes and other health-care facilities were excluded. Results: During the study period, a total of 14,445 EMS requests were received. Of these 926 (6.4%) were dispatched as IP. Three hundred forty-three cases were selected for review. Data were available for 296 cases. Eight (2.7%) cases received advanced life support (ALS) at the scene, 12 (4.1%) received ALS en route to the hospital, and 16 (5.4%) received ALS within the first 30 minutes of emergency department (ED) arrival. Two patients (0.7%) presented in cardiac arrest upon EMS arrival and did not survive. Both of these cases involved major dispatch protocol violations. Except for these cardiac arrest patients, none required resuscitation. Of the patients, 294 (99.3%) survived to hospital admission or ED discharge. Of the patients, 220 (74.3%) were discharged from the ED. Of the 74 (25%) patients admitted, 66 (89.2%) were admitted to noncritical-care units, six (8.1%) were admitted to critical-care units, and two (2.7%) were admitted to the operating room. Conclusion: In our system, IP EMS dispatches were relatively infrequent. While many of these patients ultimately were admitted to the hospital, few required prehospital ALS or critical-care admission. Properly applied dispatch protocols may identify safely those patients who do not have immediately lifethreatening conditions.

Deriving Costs and Effectiveness Data for U.S. Army Training-Garrison Pre-Hospital U.S. Army Emergency Medical Services

“…Indeed, some research even suggests that delays due to on-site prehospitalization EMS interventions may be related to high mortality rates, though the rate does not necessarily contraindicate the importance of the intervention [33]. Put differently, research shows that PH-EMS best serves by arriving to patients' locations, stabilizing patients, and transporting them quickly to a hospital/trauma facility [20,[34][35][36][37][38]. This is especially true in the case of trauma, which has classically constituted the majority of PH-EMS medical emergencies [39][40][41].…”

Emergency medical services agenda for the future

“…The cost-effectiveness of very few interventions delivered by EMS is known. 46,64,138 Models for determining EMS system effectiveness and cost-effectiveness are lacking.…”