Demand For Ambulance Services Research Articles

Forecasting daily emergency ambulance service demand using biometeorological indexes.

This study aims to study the effectiveness of using biometeorological indexes in the development of a daily emergency ambulance service demand forecast system for Taipei City, Taiwan, compared to typical weather factors. Around 370,000 emergency ambulance service patient records were aggregated into a daily emergency ambulance service demand time series as the study's dependent variable. To assess the effectiveness of biometeorological indexes in making a 1 to 7-day forecast of daily emergency ambulance service demand, five forecast models were developed to make the comparison. The model with average temperature as the only predictor performed the best consistently from 1 to 7-day forecasts. The models with net effective temperature and apparent temperature as their only predictors ranked second and third, respectively. It is surprising that the model with both average temperature and relative humidity as predictors only ranked fourth. The unexpected outperformance of average temperature over net effective temperature and apparent temperature in forecasting daily emergency ambulance service demand suggested the need to develop updated locational-specific biometeorological indexes so that the benefit of the indexes can be fully utilized. Although adopting popular biometeorological indexes that are already available would be cheap and convenient, the benefit from these general indexes may not be guaranteed.

The past, present, and future of first aid and health education: a case study in Hong Kong

PurposeThe demand for ambulance services in Hong Kong is increasing and first aid plays an important role in saving lives. The government recognized first aid training courses offered by four organizations. This study aims to review and discuss the past, present and future of first aid and health training in Hong Kong.Design/methodology/approachThis study adopted a case study approach to investigate the operations and development of the first aid and health training in one of the largest training providers in Hong Kong. Publicly available secondary data, including annual reports, websites, newspapers and social media, were collected and analysed. Using the thematic analysis procedure, researchers familiarised the data collected, generated initial codes, searched for themes, reviewed themes, defined themes and reported the results.FindingsThrough data analysis, researchers identified six themes which help to address the research questions regarding the types of first aid and health training courses, quality issue, awareness of first aid in the community and the future delivery of first aid training.Practical implicationsThis study provided two implications on both micro and macro levels. At the micro level, training providers can enhance training quality by adopting technology. At the macro level, training providers can continue to advocate and facilitate the integration of first aid into the formal education curriculum. The last section addressed the limitations of this study and provided future research directions.Originality/valueThis study provided insights about the development of the first aid and health education and training. Health-care training providers and policymakers could benchmark the findings from this study and develop appropriate measures for promoting health education.

Optimized Ambulance Allocation Using Hybrid PSOGA for Improving the Ambulance Service

Emergency Medical Service (EMS) is an integral part of the healthcare system that works dedicatedly to save the lives of people. The prime responsibility of any EMS provider is to offer a timely response to the person in need. The timely assistance increases the chances of survivability of a person. In India, escalating count of road accidents has increased the demand for ambulance services to provide pre-hospital treatment or transportation of victims to the hospital. This paper presents a new optimization strategy of Hybrid Particle Swarm Optimization and Genetic Algorithm (HPSOGA) for ambulance allocation to reduce the ambulance response time. Considering a set of assumptions, the authors have applied the new strategy for allocating 50 ambulances to 11 base stations in Southern Delhi. The working environment of EMS which includes stochastic requests, travel time, and dynamic traffic conditions have been taken into account to attain accurate results. The new optimization strategy of HPSOGA has been implemented in a MATLAB environment to find an optimized allocation plan with minimum response time. With the proposed algorithm the authors have been able to reduce the average response time by 11.61%. The paper also presents the comparison of HPSOGA, Genetic Algorithm (GA), and Particle Swarm Optimization (PSO) for the stated problem. The algorithms are compared in terms of objective value (response time), convergence rate, and constancy repeatability to conclude that HPSOGA performs better than the other two algorithms.

How ambulance commanders manage a mass casualty incident

PurposeMass casualty incidents are characterised by an immediate, unforeseen and unquantifiable surge in demand for ambulance services which soon becomes apparent and will exceed any “local” resources available. Casualties require the correct treatment, promptly, at an appropriate resource without incurring any further harm. In the absence of firm operational guidelines, this paper provides templates for ambulance commanders both at call centre and on-site to approach the management of mass casualty incidents.Design/methodology/approachDesk research indicated that there were both guidelines on how various elements of the emergency services should work together plus academic papers on techniques to adopt in mass casualty situations. Standing orders or written protocols for ambulance commanders, however, provide little or no specific guidance or an outline plan upon how they should command in a mass casualty situation. Following analysis of relevant public enquiry reports and discussions with ambulance commanders and using the materials from desk research, a four-stage approach was devised for testing using retrospective analysis from field and desktop exercises.FindingsTo have confidence, each commander needs simple digital real-time templates from which they understand their role and how the overall plan defines priorities with the greatest need. A plan should cover call-centre and on-site operations including a basic operational checklist from start to finish; resource structure and inter-relationships; sources and availability of resources plus information and control procedures to impose limited quality control procedures.Originality/valueThe design and implementation of digital templates to provide minute-by-minute visibility to all commanders which have not been recorded before. Such templates give commanders confidence to determine, locate and call forward relevant resources to attend casualties in order of priority of need. Time-lapsed records are useful not just in the minute-by-minute decision processes but also for critical organisational learning and in any post-event review by either a coroner or lawyers at a public enquiry.

Changes in demand for emergency ambulances during a nationwide lockdown that resulted in elimination of COVID-19: an observational study from New Zealand

ObjectiveTo examine the impact of a 5-week national lockdown on ambulance service demand during the COVID-19 pandemic in New Zealand.DesignA descriptive cross-sectional, observational study.SettingHigh-quality data from ambulance electronic clinical records,...

The effects of weather on daily emergency ambulance service demand in Taipei: a comparison with Hong Kong.

Numerous studies have examined the effects of weather on emergency ambulance service (EAS) demand. Given Taipei’s unique physical and social environments, empirical evidence collected from other regions may not be applicable. Collecting more information about the characteristics of vulnerable groups and the effects of weather could help the EAS managing authority in formulating cost-effective EAS policies. This study aims to look at the effects of weather on EAS demand in Taipei and to make a comparison with Hong Kong, which is also an Asian city and has a similar cultural context. The study analyzed over 370,000 EAS usage records from the Taipei City Fire Department. These records were aggregated into time series data according to patients’ characteristics and then regressed on meteorological data via multivariate forward regression. The effect size differences of the variance explained by different groups of EAS users’ regression models were compared. Afterward, the results of the regression analysis from Taipei were compared with those from a Hong Kong study. Elderly and critical patients in both cities showed significantly more sensitivity to weather than other patients. Further analysis showed that non-trauma cases were related to weather in Taipei. Although both cities had similar results, the Taipei study clearly showed that elderly and critical patients were more sensitive to weather than other patient subgroups. Health education programs should focus on the vulnerable groups identified in this study in order to increase their awareness and help them protect themselves before the onset of adverse weather conditions. By generating results that are directly applicable to Taipei, the formulation of inappropriate EAS policies can be prevented.

Which factors most influence demand for ambulances in South West England?

Ambulance demand in South West England is increasing year-on-year, but the driving forces behind such increases are poorly understood. We developed a system dynamics model to simulate the factors that influence a call being made for an ambulance. We used data from the South West Ambulance Service NHS Foundation Trust (SWAST), the Office of National Statistics (ONS) and quantitative relationship data in both national and international literature to parameterise the model. We compared predicted ambulance demand over 12 months in the base case model with scenarios in which each influencing factor was removed in turn. The model predicts that the prevalence of regular falls among older people most influences the level of demand for ambulances. The model also predicts that the number of users of adult mental health services could be a significant contributor to ambulance demand. Additional focus on, and investment in, falls prevention strategies could help to significantly alleviate increasing levels of demand for ambulance services in South West England. Additionally, efforts to understand why those with mental health needs tend to use ambulances more than those without such needs could also be beneficial.

Demand for Emergency Services Trends in New South Wales Years 2010–2014 (DESTINY): Age and Clinical Factors Associated with Ambulance Transportation to Emergency Departments

Objectives: The study aimed to analyze ambulance transportations to Emergency Departments (EDs) in New South Wales (NSW) and to identify temporal changes in demographics, acuity, and clinical diagnoses. Methods: This was a retrospective analysis of a population based registry of ED presentations in New South Wales. The NSW Emergency Department data collection (EDCC) collects patient level data on presentations to designated EDs across NSW. Patients that presented to EDs by ambulance between January 2010 and December 2014 were included. Patients dead on arrival, transferred from another hospital, or planned ED presentations were excluded. Results: A total of 10.8 million ED attendances were identified of which 2.6 million (23%) were transported to ED by ambulance. The crude rate of ambulance transportations to EDs across all ages increased by 3.0% per annum over the five years with the highest rate observed in those 85 years and over (620.5 presentations per 1,000 population). There was an increase in the proportion of category 1 and 2 (life-threatening or potentially life-threatening) cases from 18.1% to 24.0%. Conclusion: Demand for ambulance services appears to be driven by older patients presenting with higher acuity problems. Alternative models of acute care for elderly patients need to be planned and implemented to address these changes.

Temporal trends in falls cases seen by EMS in Melbourne: The effect of residence on time of day and day of week patterns.

Injury due to falls is a major public health problem, especially for older people. We aimed to determine the accuracy of the ambulance call taker triage algorithm relative to paramedic assessment, and characterise variation in ambulance service demand for falls cases involving older adults over time and by residence type. We obtained all ambulance case records for January 2008 to December 2011 for adults aged 65 or over in Melbourne, Australia. Data elements comprised age, gender, date and time of emergency call, dispatch category, location of incident and the patient's clinical condition as ascertained by paramedics. We compared cases coded as falls by the call taker triage algorithm with those identified by paramedics. We also examined temporal variation (hour of day and day of week) in ambulance service demand for cases involving older adults, and compared community-dwelling cases and those from Residential Aged Care Facilities (RACFs). We used negative binomial regression to compare counts and trigonometric regression to compare temporal variation patterns. Over the four-year study period 77,891 falls cases involved older adults (6.5% of overall ambulance demand). Eighty-seven per cent of paramedic-assessed falls cases were correctly identified by the triage system. The RACF population was older (median age 87 years, IQR 82-91 vs. 82 years, IQR 76-87), had higher hospital transport rates (89.5% vs. 75.8%) and a higher incidence of falls at any age than the community-dwelling population. The temporal pattern for fall cases for all residence types peaked between 6:00 and 12:00, but fall cases from RACFs showed an additional peak in the evening between 17:00 and 20:00. Falls by older people are the second-biggest contributor to ambulance demand in Melbourne, consuming significant operational resources. Using call taker triage data instead of paramedic case records to calculate falls cases may underestimate the true incidence of falls by up to 13%. Temporal patterns can inform ambulance service policy and practice, falls referral and prevention programmes to optimise service delivery which will lessen the number of future falls cases.

A novel approach for managing the growing demand for ambulance services by low-acuity patients.

Objective The aim of the present study was to describe the Ambulance Victoria (AV) secondary telephone triage service, called the Referral Service (RS), for low-priority patients calling triple zero. This service provides alternatives to ambulance dispatch, such as doctor or nurse home visits. Methods A descriptive epidemiological review of all the cases managed between 2009 and 2012 was conducted, using data from AV case records, the Victorian Admitted Episodes Dataset and the Australian Bureau of Statistics. Cases were reviewed for patient demographics, condition, final disposition and RS outcome. Results In all, 107148 cases were included in the study, accounting for 10.3% of the total calls for ambulance attendance. Median patient age was 54 years and 55% were female. Geographically based socioeconomic status was associated with the rate of calls to the RS (r=-0.72; 95% confidence interval CI -0.104, -0.049; P<0.001). Abdominal pain and back symptoms were the most common patient problems. Although 68% of patients were referred to the emergency department, only 27.6% of the total cases were by emergency ambulance; the remainder were diverted to non-emergency ambulance or the patient's own private transport. The remaining 32% of cases were referred to alternative service providers or given home care advice. Conclusions This paper describes the use of an ongoing secondary triage service, providing an effective strategy for managing emergency ambulance demand. What is known about the topic? Some calls to emergency services telephone numbers for ambulance assistance consist of cases deemed to be low-acuity that could potentially be better managed in the primary care setting. The demand on ambulance resources is increasing each year. Secondary telephone triage systems have been trialled in ambulance services in the US and UK with minimal success in terms of overall impact on ambulance resourcing. What does this paper add? This study describes a model of secondary telephone triage in the ambulance setting that has provided an effective way to divert patients to more suitable forms of health care to meet their needs. What are the implications for practitioners? The implications for practitioners are vast. Some of the issues that currently face paramedics include: fatigue because of high workloads; skills decay because of a lack of exposure to patients requiring intervention with skills the paramedics have, as well as a lack of time for paramedics to practice these skills during their downtime; and decreasing job satisfaction linked to both these factors. Implications for patients include quicker response times because more ambulances will be available to respond and increased patient safety because of decreased fatigue and higher skill levels in paramedics.

Changes and trends of pre-hospital emergency disease spectrum in Beijing in 2003–12: a retrospective study

BackgroundPre-hospital emergency call is a crucial indicator of emergency disease spectrum. Since Beijing has changed substantially in economy and population, analysis of the trend of the emergency disease spectrum can greatly contribute to pre-hospital emergency planning. MethodsIn this 10-year retrospective study, pre-hospital emergency records of Beijing Emergency Medical Center, the only pre-hospital emergency system of Beijing Government, in 2003–12 were collected. Medical Priority Dispatch System was used to classify the call demands. Linear regression models were used to examine the trends. This study was exempt from ethical approval. Findings2 410 575 cases were collected. Non-pre-hospital requests, which were identified when the crew arrived, were excluded. Uncompleted and unidentified cases were further excluded, and 2 278 415 cases (94·5%) were included in the analysis. The number of pre-hospital emergency call demands soared from 150 656 in 2003 to 309 297 in 2012 (205·3%; p=0·158). The top five call demands throughout the decade were trauma-related demands (25·4%, including falls [5·0%], traffic or transportation incidents [7·2%], and traumatic injuries [13·1%]), general injuries (17·7%), heart problems (11·4%), unconsciousness or fainting (10·0%), and breathing problems (8·1%). These were also the top five fastest growing call demands. InterpretationCompared with the population growth in 2003–12 (145·4%), pre-hospital emergency calls increased much more, which shows a growing demand for ambulance service. By contrast with cities in developed countries, the proportion of trauma-related cases was constantly the highest among call demands, much higher than that in San Francisco (15·7%) in 2009, and is continuously increasing. This could be a result of accelerated city construction and rapid rise in vehicle quantity (244·8%). On the basis of the changes and trends of pre-hospital emergency disease spectrum, specific training programmes for emergency medical service staff and improvement in related medical devices are recommended. FundingResearch Special Fund for Public Welfare Industry of Health from the National Health and Family Planning Commission of China.

Modelling the cost of providing ambulance services

The aim of this paper is to study how regional demography and accessibility patterns influence the cost of providing ambulance services. A secondary aim is to project future costs and demand for ambulance services based on population projections. We use data from south-east Norway, an area with both urban and rural areas. Our results show that accessibility patterns, urbanisation and demography are important factors in determining costs. Furthermore, an ageing population and an ongoing process of urbanisation will have an impact on both the demand for ambulance transport and the cost of providing these services.

Rising Ambulance Life‐Threatening Call Demand in High and Low Socioeconomic Areas

AbstractAmbulance service demand is increasing in the United Kingdom. A common speculative view makes a link between this rise in demand, deprivation, and certain medical conditions. This study explored factors influencing English ambulance service demand in two areas of differing socioeconomic status. Adopting a causal comparative design, the study compared the numbers of life‐threatening calls that Yorkshire Ambulance Service receives and serves in two geographical areas within the Hull and East Riding area. The area of lower socioeconomic status generated significantly more life‐threatening calls than the area of higher socioeconomic status; these calls often supported younger patients (mean age 59 years versus 71 years) for breathing difficulties (29% versus 14.5%) more commonly. Tackling inequality will require a whole‐systems approach, effective leadership, and recognition of the benefits of understanding difference. A key relationship will entail engaging with seldom heard communities.

Weather factors in the short-term forecasting of daily ambulance calls

The daily ambulance demand for Hong Kong is rising, and it has been shown that weather factors (temperature and humidity) play a role in the demand for ambulance services. This study aimed at developing short-term forecasting models of daily ambulance calls using the 7-day weather forecast data as predictors. We employed the autoregressive integrated moving average (ARIMA) method to analyze over 1.3 million cases of emergency attendance in May 2006 through April 2009 and the 7-day weather forecast data for the same period. Our results showed that the ARIMA model could offer reasonably accurate forecasts of daily ambulance calls at 1–7 days ahead of time and with improved accuracy by including weather factors. Specifically, the inclusion of average temperature alone in our ARIMA model improved the predictability of the 1-day forecast when compared to that of a simple ARIMA model (8.8 % decrease in the root mean square error, RMSE = 53 vs 58). The improvement in the 7-day forecast with average temperature as a predictor was more pronounced, with a 10 % drop in prediction error (RMSE = 62 vs 69). These findings suggested that weather forecast data can improve the 1- to 7-day forecasts of daily ambulance demand. As weather forecast data are readily accessible from Hong Kong Observatory’s official website, there is virtually no cost to including them in the ARIMA models, which yield better prediction for forward planning and deployment of ambulance manpower.

Universal access to ambulance does not increase overall demand for ambulance services in Queensland, Australia

To determine the impact of the introduction of universal access to ambulance services via the implementation of the Community Ambulance Cover (CAC) program in Queensland in 2003-04. The study involved a 10-year (2000-01 to 2009-10) retrospective analysis of routinely collected data reported by the Queensland Ambulance Service (QAS) and by the Council of Ambulance Authorities. The data were analysed for the impact of policy changes that resulted in universal access to ambulance services in Queensland. QAS is a statewide, publically funded ambulance service. In Queensland, ambulance utilisation rate (AUR) per 1000 persons grew by 41% over the decade or 3.9% per annum (10-year mean=149.8, 95% CI: 137.3-162.3). The AUR mean after CAC was significantly higher for urgent incidents than for non-urgent ones. However projection modelling demonstrates that URs after the introduction of CAC were significantly lower than the projected utilisation for the same period. The introduction of universal access under the Community Ambulance Cover program in Queensland has not had any significant independent long-term impact on demand overall. There has been a reduction in the long-term growth rate, which may have been contributed to by an 'appropriate use' public awareness program.

Weather and Age-Gender Effects on the Projection of Future Emergency Ambulance Demand in Hong Kong

An accurate projection for ambulance demand is essential to enable better resource planning for the future that strives to either maintain current levels of services or reconsider future standards and expectations. More than 2 million cases of emergency room attendance in 2008 were obtained from the Hong Kong Hospital Authority to project the demand for its ambulance services in 2036. The projection of ambulance demand in 2036 was computed in consideration of changes in the age-gender structure between 2008 and 2036. The quadratic relation between average daily temperature and daily ambulance demand in 2036 was further explored by including and excluding age-gender demographic changes. Without accounting for changes in the age-gender structure, the 2036 ambulance demand for age groups of 65 and above were consistently underestimated (by 38%-65%), whereas those of younger age groups were overestimated (by 6%-37%). Moreover, changes in the 2008 to 2036 age-gender structure also shift upward and emphasize relationships between average daily temperature and daily ambulance demand at both ends of the quadratic U-shaped curve. Our study reveals a potential societal implication of ageing population on the demand for ambulance services.

Rising Ambulance Life‐Threatening Call Demand in High and Low Socioeconomic Areas

AbstractAmbulance service demand is increasing in the United Kingdom. A common speculative view makes a link between this rise in demand, deprivation, and certain medical conditions. This study explored factors influencing English ambulance service demand in two areas of differing socioeconomic status. Adopting a causal comparative design, the study compared the numbers of life‐threatening calls that Yorkshire Ambulance Service receives and serves in two geographical areas within the Hull and East Riding area. The area of lower socioeconomic status generated significantly more life‐threatening calls than the area of higher socioeconomic status; these calls often supported younger patients (mean age 59 years versus 71 years) for breathing difficulties (29% versus 14.5%) more commonly. Tackling inequality will require a whole‐systems approach, effective leadership, and recognition of the benefits of understanding difference. A key relationship will entail engaging with seldom heard communities.

Weather inference and daily demand for emergency ambulance services

AimTo examine weather effects on the daily demand for ambulance services in Hong Kong.MethodsOver 6 million cases of emergency attendance from May 2006 through April 2009 (3 years) were obtained...

The impact of a supervised injecting facility on ambulance call‐outs in Sydney, Australia

Supervised injecting facilities (SIFs) are effective in reducing the harms associated with injecting drug use among their clientele, but do SIFs ease the burden on ambulance services of attending to overdoses in the community? This study addresses this question, which is yet to be answered, in the growing body of international evidence supporting SIFs efficacy. Ecological study of patterns in ambulance attendances at opioid-related overdoses, before and after the opening of a SIF in Sydney, Australia. A SIF opened as a pilot in Sydney's 'red light' district with the aim of accommodating a high throughput of injecting drug users (IDUs) for supervised injecting episodes, recovery and the management of overdoses. A total of 20,409 ambulance attendances at opioid-related overdoses before and after the opening of the Sydney SIF. Average monthly ambulance attendances at suspected opioid-related overdoses, before (36 months) and after (60 months) the opening of the Sydney Medically Supervised Injecting Centre (MSIC), in the vicinity of the centre and in the rest of New South Wales (NSW). The burden on ambulance services of attending to opioid-related overdoses declined significantly in the vicinity of the Sydney SIF after it opened, compared to the rest of NSW. This effect was greatest during operating hours and in the immediate MSIC area, suggesting that SIFs may be most effective in reducing the impact of opioid-related overdose in their immediate vicinity. By providing environments in which IDUs receive supervised injection and overdose management and education SIF can reduce the demand for ambulance services, thereby freeing them to attend other medical emergencies within the community.

Unexpected, periodic and permanent increase in medical inpatient care: Man-made or new disease?

For many years medical admissions to acute hospitals have been increasing at a rate far higher than expected from demographic change. Factors such as emergency re-admission, GP thresholds, breakdown of the family unit and deficiencies in community and social care have been suggested to explain this widening gap. Solutions to the problem have revolved around demand management strategies. While such strategies do result in a relative reduction in demand they are unable to prevent the underlying long-term behaviour. Analysis of daily admissions in Scotland, England and at individual hospitals over the past 25 years shows that the admissions tend to increase in a step-like manner at an interval of three to six years. This causes a typical 10% step-increase in physician work-load and inpatient medical costs and across England adds over 1,200,000 occupied bed days of additional bed demand into the health service within the space of around three months. There are knock-on effects to demand for ambulance services, accident and emergency attendance and GP referral. The step-increase is characterised by a cluster of diagnoses, increases with age and effects women more than men. Such behaviour has similarities to an infectious outbreak and the evidence for this and alternative hypotheses are discussed.