Emergency (108) calls to the ambulance service in the state of Gujarat (India) that do not result in the patient being transported to hospital: an epidemiological study

Abstract

Objective: To describe the demographic and clinical characteristics of patients who are not transported to hospital after an emergency (108) call to Gujarat EMRI emergency response center, the reason for non-transportation, and the priority assigned when the ambulance is dispatched. Methods: All non-transported patients from 1 December 2008 to 28 February 2009 were identified from the ambulance service command and control data. Epidemiological and clinical data were then obtained from the patient care record completed by the attending emergency medical technician (EMT) and compared with the initial critical code that determined the urgency of the ambulance response. Results: Data were obtained for 22186 patients who were not shifted during the study period. Less than one per cent of these calls were labeled critical (the most urgent category) at the time the call was received. Trauma (vehicular) accounted for 30.3% and pregnancy related emergency cases 16.1% of all non-transported calls. This group of patients were predominantly young adults (between 20 to 30 yrs old) and the majority (more than 99%) were identified as less urgent (non critical) at telephone triage. The mean time that an ambulance was committed to each non-transported call was 2hrs 67 minutes per day. Conclusions: This study shows that trauma (vehicular) account for a significant proportion of non-transported 108 calls inspite of assigning high priority when the call is first received. There could be major gains if some of these patients could be triaged to an alternative response, both in terms of increasing the ability of the ambulance service to respond faster to clinically more urgent calls and improving the cost effectiveness of the health service. Classifying calls into critical and non critical for dispatch system has been shown to be sensitive but this study suggests that its specificity may be poor, resulting in rapid responses to relatively minor problems. More research is required to determine such prioritisation can reliably and safely identify 108 calls where an alternative to an emergency ambulance would be a more appropriate response.