Abstract
BackgroundPopulation 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.MethodThe 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.ResultsThe 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.ConclusionThe 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.
Highlights
Population ageing and increased prevalence of chronic diseases result in the emergence of new demands in prehospital care
The results describe the primary missions in the State of Vaud in 2018 and show that 87% of missions concern “non-urgent” situations
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
Summary
Population ageing and increased prevalence of chronic diseases result in the emergence of new demands in prehospital care. Between 2010 and 2016, the total number of paramedic missions went from 40,075 to 48,431 [4] This increase has been proposed to be linked to higher use of hospital emergency departments by senior patients [3, 5, 6], by non-life-threatening conditions [7,8,9] and by mental health issues [6]. Hospitals suffer from the repercussions of the number of ambulance transports, as admissions in emergency departments constantly increase and waiting times are extended This increase has a direct impact on the quality of services of care and can have important consequences, like a higher number of deaths in emergency departments [10, 11]. New strategies must be found to restrict the financial impacts on health, especially in relation to population aging and to the increase in chronic diseases [13]
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