Emergency Ambulance Utilization in Harlem, New York (July 1985)

Abstract

Emergency ambulance service in Harlem, New York was studied to determine the degree to which misuse exists. Data were collected prospectively from a paramedic (ALS) ambulance and a basic life support (BLS) ambulance dispatched from Harlem Hospital. The results show that only 29.5% of the 136 calls dispatched to the ALS unit had congruent dispatch and actual priorities (r = 0.05), and only 59.6% of the 255 calls handled by both units were recommended for the unit with the proper level of the skill. 69.9% of calls assigned to the ALS unit were found not to need emergency transport (ET), the most common reason being the “unfounded” call, which represented 35.3% of the sample. ALS intervention was needed on only 20.6% of calls dispatched to the ALS unit. Paramedics were able to correctly access the need for ET 95.6% of the time, but were only willing to refuse transport 35.2% of times in which they felt it was unnecessary. Within the population studied, there exists a significant subset of nonemergency calls which could be more efficiently triaged, both at the level of dispatch and by EMS personnel on the scene. Author Perspective: This research was performed from July 1 to July 26, 1985 to fulfill the requirements of a Community Medicine rotation when the investigator was a student at the Mount Sinai School of Medicine in New York City (presently the Ican School of Medicine at Mount Sinai). Dr. Alexander E. Kuehl was the Vice President of New York City Health and Hospitals Corporation, Emergency Medical Service at the time (prior to New York City EMS moving under the Fire Department) and served as preceptor for the project. This work has not been previously published; however, the investigator was an invited presenter at the “Third International Urban Emergency Medical Service System Symposium” in September 1985 at the World Trade Center in New York City. The oral presentations at the symposium were entitled: “Paramedic Attitudes Concerning On-The-Scene Triage” and “Emergency Ambulance Utilization in Harlem.” To complete the work for this 30-day rotation, the investigator performed daily ambulance ride-alongs in Harlem, New York for 15 consecutive days and collected data prospectively from paramedics. EMTs staffing an ambulance during the same time frame provided concurrent information by survey. Some EMS terminology is now outdated; however, the terms have not been updated in order to preserve the historical perspective of the article. While the data are now historical, having been collected nearly 40 years ago, this research provides useful insights into current EMS initiatives, notably: (1) accuracy of assigned dispatch priority, (2) need for emergency transport to an emergency department, and (3) willingness of paramedics to refuse transport in cases where it is deemed unnecessary. The research questions represent many of the challenges that persist in today’s EMS world with some being particularly relevant with the advent of Community Paramedicine. Emergency Ambulance Utilization in Harlem truly illustrates “what’s old is new again!”