Delivery Of Emergency Medical Care Research Articles

Coronavirus Disease 2019 Infections Among Emergency Health Care Personnel: Impact on Delivery of United States Emergency Medical Care, 2020

ObjectiveIn the early months of the COVID-19 pandemic and prior to vaccine availability, there were concerns that infected emergency department (ED) healthcare personnel (HCP) could present a threat to the delivery of emergency medical care. We examined how the pandemic affected staffing levels and whether COVID-19 positive staff were potentially infectious at work in a cohort of U.S. ED HCP in 2020. MethodsThe COVID-19 Evaluation of Risks in Emergency Departments (Project COVERED) project was a multicenter prospective cohort study of U.S. ED HCP conducted from May to December 2020. During surveillance, HCP completed weekly electronic surveys and underwent periodic serology and nasal RT-PCR testing for SARS-CoV-2, and investigators captured weekly data on healthcare facility COVID prevalence and HCP staffing. Surveys asked about symptoms, potential exposures, work attendance, personal protective equipment (PPE) use, and behaviors. ResultsWe enrolled 1,673 HCP who completed 29,825 person-weeks of surveillance. Eighty-nine (5.3%) HCP documented 90 (0.3%; 95% CI 0.2-0.4%) person-weeks of missed work related to documented or concerns for COVID-19 infection. HCP experienced symptoms of COVID-19 during 1,256 (4.2%) person-weeks and worked at least one shift while symptomatic during 1,042 (83.0%) of these periods. Seventy-five (4.5%) participants tested positive for SARS-CoV-2 during the surveillance period, including 43 (57.3%) who indicated they never experienced symptoms; 74 (98.7%; 95% CI 90.7%-99.9%) infected HCP worked at least one shift during the initial period of infection, and 71 (94.7%) continued working until laboratory confirmation of their infection. Physician staffing was not associated with the facility or community COVID-19 levels within any time frame studied (Kendall tau’s 0.02, 0.056, and 0.081 for no shift, one-week time-shift, and two-week time shift, respectively). ConclusionDuring the first wave of the pandemic, COVID-19 infections in ED HCP were infrequent, and the time lost from the workforce was minimal. HCP frequently reported for work while infected with SARS-CoV-2 prior to lab confirmation. ED staffing levels were poorly correlated with facility and community COVID-19 burden.

Effect of Mixed Reality on Delivery of Emergency Medical Care in a Simulated Environment

Mixed-reality (MR) technology has the potential to enhance care delivery, but there remains a paucity of evidence for its efficacy and feasibility. To assess the efficacy and feasibility of MR technology to enhance emergency care delivery in a simulated environment. This pilot randomized crossover trial was conducted from September to November 2021 at a single center in a high-fidelity simulated environment with participants block randomized to standard care (SC) or MR-supported care (MR-SC) groups. Participants were 22 resident-grade physicians working in acute medical and surgical specialties prospectively recruited from a single UK Academic Health Sciences Centre. Data were analyzed from September to December 2022. Participants resuscitated a simulated patient who was acutely unwell, including undertaking invasive procedures. Participants completed 2 scenarios and were randomly assigned to SC or MR-SC for the first scenario prior to crossover. The HoloLens 2 MR device provided interactive holographic content and bidirectional audiovisual communication with senior physicians in the MR-SC group. The primary outcome was error rate assessed via the Imperial College Error Capture (ICECAP) multidimensional error-capture tool. Secondary outcomes included teamwork (Observational Teamwork Assessment for Surgery [OTAS]; range, 0-6 and Teamwork Skills Assessment for Ward Care [T-SAW-C]; range, 1-5), scenario completion, stress and cognitive load (NASA Task Load Index [NASA-TLX; range 0-100]), and MR device user acceptability. A total of 22 physicians (15 males [68.2%]; median [range] age, 28 [25-34] years) were recruited. MR technology significantly reduced the mean (SD) number of errors per scenario compared with SC (5.16 [3.34] vs 8.30 [3.09] errors; P = .003), with substantial reductions in procedural (0.79 [0.75] vs 1.52 [1.20] errors; P = .02), technical (1.95 [1.40] vs 3.65 [2.03] errors; P = .01), and safety (0.37 [0.96] vs 0.96 [0.85] errors; P = .04) domains. MR resulted in significantly greater scenario completion rates vs SC (22 scenarios [100%] vs 14 scenarios [63.6%]; P = .003). It also led to significant improvements in the overall quality of teamwork and interactions vs SC as measured by mean (SD) OTAS (25.41 [6.30] vs 16.33 [5.49]; P < .001) and T-SAW-C (27.35 [6.89] vs 18.37 [6.09]; P < .001) scores. As reported via mean (range) NASA-TLX score, there were significant reductions for MR-SC vs SC in participant temporal demands (38 [20-50] vs 46 [30-70]; P = .03) and significant improvements in self-reported task performance (50 [30-60] vs 39 [10-70]; P = .01). Overall, 19 participants (86.4%) reported that they were more confident in making clinical decisions and undertaking clinical procedures with MR support. This study found that the use of MR technology reduced error, improved teamwork, and enhanced practitioner confidence when used to support the delivery of simulated emergency medical care. ClinicalTrials.gov Identifier: NCT05870137.

Immediate Medical Care Rendered by U.S. Law Enforcement Officers After Officer-Involved Shootings – An Open-Access Public Domain Video Analysis

Introduction:After officer-involved shootings, rapid delivery of emergency medical care is critical but may be delayed due to scene safety concerns. The purpose of this study was to describe medical care rendered by law enforcement officers (LEO) after lethal force incidents.Method:Retrospective analysis of open-source video footage of officer-involved shootings (OIS) occurring between 2/15/2013 and 12/31/2020. Frequency and nature of care provided, time until LEO and emergency medical services (EMS) care, and mortality outcomes were evaluated. The study was deemed exempt by the Mayo Clinic Institutional Review Board.Results:342 videos were included in the final analysis. LEOs rendered care in 172 (50.3%) incidents. The average elapsed time from the time of injury to LEO-provided care was 155.8 + 198.8 seconds. Hemorrhage control was the most common intervention performed. An average of 214.2 seconds elapsed between LEO care and EMS arrival. No mortality difference was identified between LEO vs EMS care (p = 0.1631). Subjects with truncal wounds were more likely to die than those with extremity wounds (p &lt; 0.00001).Conclusion:LEO rendered medical care in half of all OIS incidents, initiating care on average 3.5 minutes prior to EMS arrival. Although no significant mortality difference was noted for LEO versus EMS care, this finding must be interpreted cautiously, as specific interventions, such as extremity hemorrhage control, may have impacted select patients. Future studies are needed to determine optimal LEO care for these patients.

Immediate Medical Care Rendered by US Law Enforcement Officers after Officer-Involved Shootings - An Open-Access Public Domain Video Analysis.

After officer-involved shootings (OIS), rapid delivery of emergency medical care is critical but may be delayed due to scene safety concerns. The purpose of this study was to describe medical care rendered by law enforcement officers (LEOs) after lethal force incidents. Retrospective analysis of open-source video footage of OIS occurring from February 15, 2013 through December 31, 2020. Frequency and nature of care provided, time until LEO and Emergency Medical Services (EMS) care, and mortality outcomes were evaluated. The study was deemed exempt by the Mayo Clinic Institutional Review Board. Three hundred forty-two (342) videos were included in the final analysis; LEOs rendered care in 172 (50.3%) incidents. Average elapsed time from time-of-injury (TOI) to LEO-provided care was 155.8 (SD = 198.8) seconds. Hemorrhage control was the most common intervention performed. An average of 214.2 seconds elapsed between LEO care and EMS arrival. No mortality difference was identified between LEO versus EMS care (P = .1631). Subjects with truncal wounds were more likely to die than those with extremity wounds (P < .00001). It was found that LEOs rendered medical care in one-half of all OIS incidents, initiating care on average 3.5 minutes prior to EMS arrival. Although no significant mortality difference was noted for LEO versus EMS care, this finding must be interpreted cautiously, as specific interventions, such as extremity hemorrhage control, may have impacted select patients. Future studies are needed to determine optimal LEO care for these patients.

Emergency Physician Observations and Attitudes on Law Enforcement Activities in the Emergency Department.

Law enforcement officers (LEO) interact with patients and clinicians in the emergency department (ED) for many reasons. There is no current consensus on what should comprise, or how to best enact, guidelines that ideally balance LEO activities in the service of public safety with patient health, autonomy, and privacy. The purpose of this study was to explore how a national sample of emergency physicians (EP) perceives activities of LEOs during the delivery of emergency medical care. Members of the Emergency Medicine Practice Research Network (EMPRN) were recruited via an email-delivered, anonymous survey that elicited experiences, perceptions, and knowledge of policies that guide interactions with LEOs in the ED. The survey included multiple-choice items, which we analyzed descriptively, and open-ended questions, which we analyzed using qualitative content analysis. Of 765 EPs in the EMPRN, 141 (18.4%) completed the survey. Respondents represented diverse locations and years in practice. A total of 113 (82%) respondents were White, and 114 (81%) were male. Over a third reported LEO presence in the ED on a daily basis. A majority (62%) perceived LEO presence as helpful for clinicians and clinical practice. When asked about the factors deemed highly important in allowing LEOs to access patients during care, 75% reported patients' potential as a threat to public safety. A small minority of respondents (12%) considered the patients' consent or preference to interact with LEOs. While 86% of EPs felt that information-gathering by LEO was appropriate in the ED setting, only 13% were aware of policy to guide these decisions. Perceived barriers to implementation of policy in this area included: issues of enforcement; leadership; education; operational challenges; and potential negative consequences. Future research is warranted to explore how policies and practices that guide intersections between emergency medical care and law enforcement impact patients, clinicians, and the communities that health systems serve.

Policed Patients: How the Presence of Law Enforcement in the Emergency Department Impacts Medical Care

We sought to examine how physicians understand the role of law enforcement in the emergency department (ED) and to identify how the presence of law enforcement officers may impact the delivery of emergency medical care. In this qualitative study, we conducted semistructured interviews with 20 emergency physicians practicing in county EDs across 3 health care systems in Northern California between November 2017 and September 2018. Participants were recruited using snowball sampling and included 10 board-certified physicians and 10 resident physicians. We analyzed the interview content using grounded theory, where concepts from interview data were coded, grouped by theme, and compared over consecutive interviews to identify recurrent themes. Participants reported interacting frequently with law enforcement officers while treating patients. Most participants characterized their experiences with law enforcement as "mixed" or "variable." Positive interactions with officers, who were described as helpful and collegial, contrasted with instances in which respondents felt police presence led to interruptions in treatment, breaches in health privacy, and potentially diminished patient trust. Participants reported that, at times, the authority of officers in the ED felt unclear and ill-defined, leading to contentious interactions between officers and health care personnel. Lack of clear definition of the role of law enforcement officers in the ED may lead to contentious interactions with emergency physicians. Further research on the medical impacts of police presence in health care settings and on best practices for mitigating negative impacts is needed.

Оказание скорой медицинской помощи пострадавшим в дорожно-транспортных происшествиях на федеральной автодороге М-8 «Холмогоры» в Архангельской области

Оказание скорой медицинской помощи пострадавшим в дорожно-транспортных происшествиях на федеральной автодороге М-8 «Холмогоры» в Архангельской области

A national survey of telemedicine use by US emergency departments

Objective Telemedicine has the potential to improve the delivery of emergency medical care: however, the extent of its adoption in United States (US) emergency departments is not known. Our objective was to characterise the prevalence of telemedicine use among all US emergency departments, describe clinical applications for which it is most commonly used, and identify emergency department characteristics associated with its use. Methods As part of the National Emergency Department Inventory-USA survey, we queried all 5375 US emergency departments open in 2016. Multivariable logistic regression analyses identified characteristics associated with emergency department receipt of telemedicine services. Results Overall, 4507 emergency departments (84%) responded to our survey, with 4031 responding to both telemedicine questions (75%). Although 1694 emergency departments (42%) reported no telemedicine in 2016, most did: 1923 (48%) emergency departments received telemedicine services, 149 (4%) emergency departments received telemedicine services and were in hospitals that provided telemedicine, and 265 emergency departments (7%) did not receive telemedicine but were in hospitals that provided telemedicine services. Among emergency departments receiving telemedicine, the most common applications were stroke/neurology (76%), psychiatry (38%), and paediatrics (15%). In multivariable analysis, telemedicine-receiving emergency departments had higher annual total visit volume for adults and lower annual total visit volume by children; were less likely to be academic or freestanding; and varied by region. In multivariable analysis, emergency departments in telemedicine-providing hospitals had higher annual total visit volume for adults and children, were more likely to be academic and were less likely to be freestanding. Conclusion In 2016, telemedicine was used in most US emergency departments (58%), especially for stroke/neurology and psychiatry. Future research is needed to understand the value of telemedicine for different clinical applications, and the barriers to its implementation.

Insight Into Health Care Services: A Characterization of Emergency Room Visits and Economic Hazards in the United States.

This study explores the impact of economic hazard areas on hospital-based emergency departments to determine whether economically hazardous environments, characterized by the change of population, income per capita, and unemployment rate, experience a higher number of emergency room visits than areas of lower rated economic hazard risk in the United States. A cross-sectional design was used of a nationally constructed data set of hospital-based emergency departments of over 6,000 hospitals in the United States. We identified our quality outcome measure as the emergency room visits rate within a hospital service area. We created the variable by dividing the number of emergency room visits by the population of the hospital services area in which the emergency room was located. Results indicate that there is a difference in the incident rate ratio of emergency room visits between environments considered to be experiencing greater amounts of hazard, compared to lower amounts of hazard. Hospital administrators and health policy-makers need to work in conjunction to focus efforts on public safety as a key objective in the delivery of emergency medical care. One crucial effort that hospital administrators need to focus on is improving emergency room capacity and efficiency as part of the disaster preparedness plan (Disaster Med Public Health Prep. 2019;13:470-475).

MORPHOLOGICAL CHANGES OF UTERINE TISSUES AFTER EMBOLIZATION OF UTERINE ARTERIES IN PATIENTS WITH LEIOMYOMA

The article presents the results of a morphological study in 35 operated patients with uterine leiomyoma (lm) of various sizes and localizations, admitted with uterine bleeding. We studied morphological changes which occured in tumors and uterine tissues of patients with lm after therapy with agents and devices for embolization of uterine arteries (eua). The analysis of structural changes in the uterine arteries and body in patients with lm anduterine bleeding made it possible to clarify the mechanism of hemostasis. The obtained morphological data confirmed the validity of eua with a haemostatic purpose for patients with lm and uterine bleeding in the delivery of emergency medical care.

Potential role for psychological skills training in emergency medicine: Part 1 - Introduction and background.

Psychological skills training (PST) is the systematic acquisition and practice of different psychological techniques to improve cognitive and technical performance. This training consists of three phases: education, skills acquisition and practice. Some of the psychological skills developed in this training include relaxation techniques, focusing and concentration skills, positive 'self-suggestion' and visualisation exercises. Since the middle of the 20th century, PST has been successfully applied by athletes, performing artists, business executives, military personnel and other professionals in high-risk occupations. Research in these areas has demonstrated the breadth and depth of the training's effectiveness. Despite the benefits realised in other professions, medicine has only recently begun to explore certain elements of PST. The present paper reviews the history and evidence behind the concept of PST. In addition, it presents some aspects of PST that have already been incorporated into medical training as well as implications for developing more comprehensive programmes to improve delivery of emergency medical care.

Basic principles of intensive care for patients with polytrauma at an early stage. Ways to optimize

Treatment of patients with polytrauma is complex and still unsolved problem. The mortality in polytrauma in both developing and developed countries, in spite of the progress of medical science is still at a high level, but its outcome is largely dependent on the timeliness and adequacy of treatment and preventive measures.The aim of this study was to analyze the state of systems and emergency medical care to patients with polytrauma in developed countries and the possibility of implementation of the protocols in the Ukraine.Results. The basic principles of the organization of emergency for patients with polytrauma in the prehospital and early hospital stage are considered, key areas of intensive care of these patients at an early stage of specialized care are analyzed. Shortcomings of emergency medical care for patients with polytrauma in hospitals of Ukraine and ways of their correction and reform are shown that can improve the quality of care for patients with polytrauma and increase the survival rate of these patients.Conclusions. Organization of EMC for patients with severe trauma should be based on three main principles:1. The minimum amount of time from the time of trauma to the necessary delivery of emergency medical care in the prehospital phase.2. Creation of specialized trauma centers to provide timely specialized and skilled care for patients with severe trauma at the hospital stage.3. Ensuring continuity of pre-hospital and hospital stages of EMC and in specialized centers

International emergency medicine: Past and future

Much has been written about the development of emergency medicine (EM) and its impact on the medical system as a whole. It is still described as ‘new’ and very much seen as a specialty that is evolving, rather than a static domain of knowledge and skills with rigid boundaries. In reality, the fundamentals of emergency treatment in mitigating the effects of acute illness and injury go back to ancient times. This is evidenced by descriptions of the urgent management of acute pain with analgesics, splinting of injured limbs, and more sophisticated procedures, such as the removal of kidney stones and craniotomies. The treatments at that time were limited, but the application of these skills brought relief to many people (and a little pain). The practitioners were generalists and did not limit themselves to emergency treatment alone. Over the past half-century, there has been an acceleration of development in emergency medical treatments and a massive explosion in emergency medical system enhancement. This has resulted in a unique body of knowledge and skills, with the evolution of a new medical specialty specific to the delivery of emergency medical care. It is worth reflecting on the drivers for EM specialisation, where the specialty has come from, and what we can expect as the complexity of medical care increases with technological innovation and social changes associated with increasing connectivity.

P03-552 - Improving emergency medical care for psychiatric inpatients

IntroductionAt the European Psychiatric Association's International Congress 2010, we reported on psychiatric staff confidence regarding emergency medical care in our poster: “How Well Prepared is a Psychiatric Ward for Dealing with a Medical Emergency?”. This work highlighted areas for improvement, including staff confidence and familiarity with equipment. Consequently, several aspects of practice were enhanced, including addressing training shortfalls alongside adopting a uniform layout for emergency trolleys. In order to identify improvement, the process was re-audited with a new qualitative component to gather staff opinion.ObjectivesOur primary objective was to examine whether our interventions had improved staff confidence with regard emergency medical care. Our secondary objectives included exploring staff attitudes toward delivery of such care and to identify further areas for improvement.AimsOur primary aim was to evaluate the impact of our interventions on delivery of emergency medical careMethodsOur original questionnaire survey was repeated and the results compared with those obtained previously. Additionally, a series of semi-structured qualitative interviews will be performed with staff to compliment the questionnaires.ResultsResults will be available in February 2011.ConclusionsGiven that psychiatric patients often suffer from significant physical health problems, it is imperative that staff are comfortable in delivering initial emergency medical care. We anticipate our results will demonstrate modest improvement. Clinical governance is an ongoing process, therefore the most important conclusions to be drawn will be our recommendations for future work, which will encompass the next step in our efforts to improve delivery of emergency medical care.

Research Priorities for Administrative Challenges of Integrated Networks of Care

In 2006, the Institute of Medicine (IOM) advanced the concept of "coordinated, regionalized, and accountable emergency care systems" to address significant problems with the delivery of emergency medical care in the United States. Achieving this vision requires the thoughtful implementation of well-aligned, system-level structures and processes that enhance access to emergency care and improve patient outcomes at a sustainable cost. Currently, the delivery of emergency medical care is supported by numerous administrative systems, including economic; reimbursement; legal and regulatory structures; licensure, credentialing, and accreditation processes; medicolegal systems; and quality reporting mechanisms. In addition, many regionalized systems may not optimize patient outcomes because of current administrative barriers that make it difficult for providers to deliver the best care. However, certain administrative barriers may also threaten the sustainability of integration efforts or prevent them altogether. This article identifies significant administrative challenges to integrating networks of emergency care in four specific areas: reimbursement, medical-legal, quality reporting mechanisms, and regulatory aspects. The authors propose a research agenda for indentifying optimal approaches that support consistent access to quality emergency care with improved outcomes for patients, at a sustainable cost. Researching administrative challenges will involve careful examination of the numerous natural experiments in the recent past and will be crucial to understand the impact as we embark on a new era of health reform.

Viewpoint: Canʼt Get No Satisfaction? The Real Truth Behind Patient Satisfaction Surveys

Viewpoint: Canʼt Get No Satisfaction? The Real Truth Behind Patient Satisfaction Surveys

Knowledge and Attitudes of the Out-Of-Hospital Emergency Care Consumers in Santo Domingo, Dominican Republic

Prehospital emergency services are a vital public service, and consumer access to the system is an important factor in their use. The Dominican Republic recently experienced "the epidemiological transition" leading to increased morbidity and mortality secondary to traumatic and cardiac conditions--thus, increasing the need for prompt and adequate delivery of emergency medical care. A survey was administered to 90 subjects from diverse backgrounds, all living in Santo Domingo. Survey items included questions on emergency medical services (EMS) systems knowledge (i.e., access numbers), confidence in the system, first-aid education and prior experience with the EMS system. Chi-square was used to measure statistical significance for categorical variables and Student's t-test for continuous variables (JMP 2.0 software was used for statistical processing). A total of 90 subjects were surveyed. The average age of respondents was 36 +/- 12 years SD. More than one-fifth (22.2%) of respondents did not know the established universal emergency number (9-1-1), and 37.8% responded that they would access a different telephone number in case of a medical emergency. Important deficiencies and access-to-care concerns were interpreted from the results. An adequate understanding of the current state of prehospital care could lead to creation of policies by system administrators to further improve the delivery of emergency medical care. This study will assist system administrators in future design and policy issues.

Implementation Strategies for Emergency Medical Services Within Stroke Systems of Care

Stroke remains the third leading cause of death and a leading cause of long-term disability among Americans, despite advances in stroke prevention, diagnosis, treatment, and rehabilitation. Approximately 700 000 individuals suffer a new or recurrent stroke each year.1 Advances over the past decade in acute stroke care, including the introduction of fibrinolytic and other short-term therapies, have highlighted the critical roles of emergency medical services (EMS) agencies and emergency medical services systems (EMSS) in optimizing stroke care.2–7 In this context, the term “EMS” refers to the full scope of prehospital services necessary for the acute care of patients with stroke, including 9-1-1 activation and dispatch, emergency medical response, triage and stabilization in the field, and transport by ground or air ambulance to a hospital or between facilities. The term “EMSS” refers to the delivery systems for EMS that may be organized on a local, regional, statewide, or nationwide basis.8 EMSS involves the organization of public and private resources for the delivery of emergency medical care. These systems include the community, emergency medical and healthcare personnel, public safety agencies, emergency facilities, and critical care units. The dissemination of public information and education, provision of professional training, and development of disaster planning and standardized record keeping also are key elements of EMSS. Additionally, EMSS must address issues related to communication, transportation, access to care, patient transfer, mutual aid (the sharing of resources across EMSS), and system review and evaluation.9 The successful integration of one (and often multiple) EMSS is critical to ensuring the effectiveness of a stroke system of care. The American Stroke Association (ASA), a division of the American Heart Association (AHA), is dedicated to improving stroke prevention, treatment, and rehabilitation through research, education, advocacy, and the development of scientifically based standards and guidelines. In 2004, the …

Impact of a Triage Liaison Physician on Emergency Department Overcrowding and Throughput: A Randomized Controlled Trial

Triage liaison physicians (TLPs) have been employed in overcrowded emergency departments (EDs); however, their effectiveness remains unclear. To evaluate the implementation of TLP shifts at an academic tertiary care adult ED using comprehensive outcome reporting. A six-week TLP clinical research project was conducted between December 9, 2005, and February 9, 2006. A TLP was deployed for nine hours (11 AM to 8 PM) daily to initiate patient management, assist triage nurses, answer all medical consult or transfer calls, and manage ED administrative matters. The study was divided into three two-week blocks; within each block, seven days were randomized to TLP shifts and the other seven to control shifts. Outcomes included patient length of stay, proportion of patients who left without complete assessment, staff satisfaction, and episodes of ambulance diversion. TLPs assessed a median of 14 patients per shift (interquartile range, 13-17), received 15 telephone calls per shift (interquartile range, 14-20), and spent 17-81 minutes per shift consulting on the telephone. The number of patients and their age, gender, and triage score during the TLP and control shifts were similar. Overall, length of stay was decreased by 36 minutes compared with control days (4:21 vs. 4:57; p = 0.001). Left without complete assessment cases decreased from 6.6% to 5.4% (a 20% relative decrease) during the TLP coverage. The ambulance wait time and number of episodes of ambulance diversion were similar on TLP and control days. A TLP improved important outcomes in an overcrowded ED and could improve delivery of emergency medical care in similar tertiary care EDs.

Physician Response Unit—A feasibility study of an initiative to enhance the delivery of pre-hospital emergency medical care

To describe the rationale, development and initial results of a collaborative pre-hospital pilot project designed to enhance the emergency care needs of an inner city population. Retrospective descriptive analysis of emergency calls attended by a rapid response car staffed by a pre-hospital care physician and ambulance service technician or paramedic. Seven hundred and forty-eight consecutive patients over a 13-month period are described. Six hundred and thirty-eight (82%) patients underwent clinical consultation with a physician within 8 min of emergency call. The Physician Response Unit (PRU) also provided an additional vehicle responding to emergency calls, reaching the national 8 min target response time in 638 (82%) of all cases. Two hundred and eighty-nine (39%) of the patients attended had medical therapy initiated by the PRU physician. Nearly two-thirds of this group, 189 (65%), received medical therapy outside current ambulance service protocols. A physician medical escort was provided for 142 (25%) of patients attending hospital. Of all patients seen 577 (77%) attended the emergency department via ambulance, and 136 (18%) patients were assessed, treated and prevented from attending the emergency department. The PRU provided clinical care beyond that delivered by the ambulance service. It also contributed positively to local ambulance service response times. The service was able to prevent unnecessary ambulance journeys and attendance at hospital. It demonstrates that traditional working practices can be altered to improve the delivery of emergency medical care.