Risk of adverse outcome in patients referred by emergency medical services in Switzerland

Bosia, Tito; Malinovska, Alexandra; Weigel, Karin; Schmid, Fabrizia; Nickel, Christian H.; Bingisser, Roland

doi:10.4414/smw.2017.14554

Cited by 5 publications

(3 citation statements)

References 27 publications

(44 reference statements)

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“…Emergency medical services (EMS) hold a predominant position in maintaining the population's access to health care. In Switzerland, over 20% of admissions in an emergency department occur via ambulance [9,10]. EMS provide continuous (24 h a day) and diversified care (diseases and traumas) to the entire population [8].…”

Section: Introductionmentioning

confidence: 99%

Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines

et al. 2023

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Background The pandemic has impacted both patients infected by the SARS-CoV-2 virus and patients who seek emergency assistance due to other health issues. Changes in emergency demands are expected to have occurred during the pandemic, the objective of this investigation is to characterize the changes in ambulance emergency demands during the first year of the COVID-19 pandemic in the Vaud State of Switzerland. The goal of this research is to identify the collateral effects of the COVID-19 pandemic on emergency demands. To do so, this study quantifies the differences in health issues, level of severity, and patients’ sociodemographic characteristics (age, location, gender) prior to and during the outbreak. Method This is a retrospective, descriptive and comparative statistical analysis of all ambulance emergency missions from 2018 to 2020 (n = 107,150) in the State of Vaud in Switzerland. Variables analyzed were the number of ambulance missions, patient age and gender, health issues, severity (NACA scores), number of non-transports, mission times and locations. Variables were compared between prepandemic and pandemic situations across years and months. Comparative analysis used bivariate analysis, χ2 test, Student’s t test, and Mann‒Whitney U test. Results The pandemic has had two major impacts on the population’s emergency demands. The first appears to be due to COVID-19, with an increase in respiratory distress cases that doubled in November 2020. The second relates to the implementation of lockdown and quarantine measures for the population and the closures of restaurants and bars. These might explain the decrease in both the number of traumas and intoxications, reaching more than 25% and 28%, respectively. An increase in prehospital emergency demands by the older population, which accounted for 53% of all demands in 2020, is measured. Conclusion Collateral effects occurred during 2020 and were not only due to the pandemic but also due to protective measures deployed relative to the population. This work suggests that more targeted reflections and interventions concerning the most vulnerable group, the population of people 65 and older, should be of high priority. Gaining generalizable knowledge from the COVID-19 pandemic in prehospital settings is critical for the management of future pandemics or other unexpected disasters.

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Section: Introductionmentioning

confidence: 99%

Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines

et al. 2023

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“…Over 20% of emergency department admissions occur via the use of prehospital services [ 14 ]. To control congestion in emergency departments due to cases that do not require urgent care, and therefore to reduce the admission rate, it is necessary to revise procedures and to rethink allocation of prehospital healthcare providers [ 15 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

Identification of new demands regarding prehospital care based on 35,188 missions in 2018

et al. 2021

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Background Population ageing and increased prevalence of chronic diseases result in the emergence of new demands in prehospital care. The prehospital system is facing an increase of cases without acute threat to life (so-called “non-urgent”), which generates tension due to a higher number of admissions to emergency departments and a greater use of prehospital resources. Our aim is to understand this transition in prehospital activities and to delineate the primary missions performed by paramedics in 2018 with a focus on the population concerned, the severity of cases encountered and the typology of health issues. Method The study is retrospective, and descriptive, using a statistical description of 35,188 primary missions realized in 2018 in the State of Vaud (Switzerland). The characteristics taken into consideration are the age and gender of patients, as well as the health issue, the severity of cases based on National Advisory Committee for Aeronautics score (NACA score), and the time and place of intervention. Results The results describe the primary missions in the State of Vaud in 2018 and show that 87% of missions concern “non-urgent” situations (without acute threat to life). Over half of patients are 65 or older, the highest proportion of health issues, 49%, are medical and only 23% of missions are for traumas. Mission related to mental health issues reach 7% and those for intoxication 6%. Most missions take place between 7:00 am and 6:00 pm (67%), and around 12% of missions lead to the non-transport of the patient. Conclusion The prehospital sector is confronted with a major transition in terms of patient care. An increase of non-urgent cases is observed, associated with the care of persons aged 65 or more. Our results question the adequacy between the needs in terms of prehospital care and the paramedic profession as it is currently defined, as well as the place of this profession within the health network. Reflecting upon the role of paramedics with respect to the socio-demographic evolution of populations appears necessary, to analyse the adequacy of the paramedics’ skills to respond to the current needs.

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“…Some studies have found that immigrants attend EDs more often than host populations—but these findings have not been consistent [ 15 , 16 ]. Several studies have analyzed the health of immigrant patients in Switzerland and have reported specific health-related problems [ 6 , 8 , 9 , 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Increased Urgent Care Center Visits by Southeast European Migrants: A Retrospective, Controlled Trial from Switzerland

Klukowska-Roetzler

Eracleous²,

Mûller

et al. 2018

IJERPH

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We investigated whether immigrants from Southeast Europe (SE) and Swiss patients have different reasons for visiting the emergency department (ED). Our retrospective data analysis for the years 2013–2017 describes the pattern of ED consultations for immigrants from SE living in Switzerland (Canton Bern), in comparison with Swiss nationals, with a focus on type of referral and reason for admission. A total of 153,320 Swiss citizens and 12,852 immigrants from SE were included in the study. The mean age was 51.30 (SD = 21.13) years for the Swiss patients and 39.70 (SD = 15.87) years for the SE patients. For some countries of origin (Albania, Bosnia and Herzegovina, and Turkey), there were highly statistically significant differences in sex distribution, with a predominance of males. SE immigrants had a greater proportion of patients in the lower triage level (level 3: SE: 67.3% vs. Swiss: 56.0%) and a greater proportion of patients in the high triage level than the Swiss population (level 1: SE: 3.4% vs. Swiss: 8.8%). SE patients of working age (16–65 years) were six times more often admitted by ambulance than older (≥65 years) SE patients, whereas this ratio was similar in the Swiss population. In both groups, the fast track service was primarily used for patients of working age (<65) and more than three times more often in the SE than the Swiss group (SE: 39.1%, Swiss: 12.6%). We identified some indications for access to primary care in emergency departments for immigrants and highlighted the need for attention to the role of organizational characteristics of primary health care in Switzerland. We highlighted the need for professional support to improve the quality of healthcare for immigrants. In the future, we will need more primary care services and general practitioners with a migrant background.

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Risk of adverse outcome in patients referred by emergency medical services in Switzerland

Abstract: Patients referred by EMS have higher odds of admission to hospital and ICU, a longer ED LOS, and higher short- and long-term mortalities than the general ED population.

Cited by 5 publications

References 27 publications

Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines

Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines

Identification of new demands regarding prehospital care based on 35,188 missions in 2018

Increased Urgent Care Center Visits by Southeast European Migrants: A Retrospective, Controlled Trial from Switzerland

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