Emergency Medical Calls Research Articles

3 Non-epileptic seizures in the emergency department: an audit

Objective Non-epileptic seizures (NES) commonly present via the emergency department (ED) and may lead to inappropriate and/or costly treatment. This baseline audit aimed to determine the prevalence of NES presenting to the ED of the Royal Sussex County Hospital, a tertiary centre in Brighton, over the course of one year. It also recorded whether these patients were being flagged on the electronic patient records (EPR) system and what management they received. Method A list of all patients presenting to the ED over a 1 year period with any of the keywords ‘seizure’ ‘fit’ ‘epilepsy’ in the presenting complaint was generated using the EPR system. We classified the seizures as epilepsy, NES, mixed, secondary, or awaiting diagnosis by: searching electronic discharge summaries and electronic psychiatry patient records, cross-checking with neurology and neuropsychiatry services, and notes review. Once the NES patients were identified, we quantified the number who had been flagged on the EPR and recorded the management they received during their hospital admission. Results Out of 1242 presentations of seizures to the ED over the course of a year, 101 were NES (8.1%). This accounted for 42 of 908 patients who presented with seizures (4.6%). 13 of these patients were flagged on the EPR system. 43% of this group of NES patients attended the ED more than once over the course of the year. There were 31 admissions of NES patients over the year (45.2% with a known diagnosis of NES at admission, 54.8% without a firm diagnosis), ranging from 1 to 33 days in length. Those with a firm diagnosis of NES at the time of admission had an average length of stay of 2 days and had no emergency calls put out; those without a firm diagnosis had an average length of stay of 6 days and 3% had between 1 and 4 medical emergency calls during their admission. Conclusions Non-epileptic seizures make up an important proportion of seizure presentations to the ED, and these patients commonly re-present. It is important that such patients are flagged with a clear management plan in place if the diagnosis of NES is established, and if needed neurological and neuropsychiatric assessment is not delayed in order to minimise harmful interventions and length of stay.

Short-term association between road traffic noise and healthcare demand generated by Parkinson's disease in Madrid, Spain

ObjectiveTo analyse whether there is a short-term association between road traffic noise in the city of Madrid and Parkinson's disease (PD)-related demand for healthcare. MethodsTime-series analysis (2008–2009) using variables of analysis linked to emergency and daily PD-related demand for healthcare (ICD-10: G20–G21), namely, PD-hospital admissions (HAs), PD-outpatient visits (OVs) and PD-emergency medical calls in Madrid. The noise pollution measurements used were Leqd, equivalent sound level for the daytime hours (from 8 a.m. to 10 p.m.), and Leqn, equivalent sound level for night time hours (from 10 p.m. to 8 a.m.) in dB(A). We controlled for temperature, pollution, trends and seasons, and used the Poisson regression model to calculate relative risk (RR). ResultsThe association between Leqd and HAs was found to be linear. Leqd and Leqn at lag 0.1 and temperature at lags 1 and 5 were the only environmental variables associated with increased PD-related healthcare demand. The RR (lag 0) for Leqd and HA was 1.07 (1.04–1.09), the RR (lag 0) for Leqd and OV was 1.28 (1.12–1.45), and the RR (lags 0.1) for Leqn and emergency medical calls was 1.46 (1.06–2.01). ConclusionThe above results indicate that road traffic noise is a risk factor for PD exacerbation. Measures to reduce noise-exposure levels could result in a lower PD-related healthcare demand.

Supporting Family Caregivers of Persons With Dementia in the Community: Description of the 'Memory Care Home Solutions' Program and Its Impacts.

Background and ObjectivesMost persons with dementia live at home, cared for by families with limited access to supportive services. We describe “Memory Care Home Solutions” (MCHS), a community-based dementia care program, and evaluate enrollees’ characteristics, strategies provided and implemented, and impact on adverse health-related events (emergency medical calls, emergency room visits, hospitalizations, falls) of persons with dementia.Research Design and MethodsRetrospective observational study of MCHS’ Basic (5 contacts) and Enhanced (additional 4 occupational therapy contacts) services for enrolled caregivers (September 1, 2014 to March 31, 2016). In both programs, caregivers received dementia education, care strategies, and social support. For Enhanced, caregivers had additional opportunities to practice care strategies. Caregivers were interviewed by interventionists at intake, 3 and 6 months (in-person or telephone).ResultsOf 717 enrolled caregivers, most were female (73.1%), nonspouses (58.2%), Caucasian (70.8%), 63.02 (standard deviation [SD] = 13.20) years old, and caring for persons with dementia of low income (54.1%, <$39,000). Caregivers reported managing on average 11.64 (SD = 4.64) behavioral symptoms and high functional dependence (6 instrumental activities of daily living [IADLs]; 2 activities of daily living [ADLs]). Caregivers opting for Enhanced (N = 314, 44.9%) were older (p = .025), spouses (p = .002), reported greater distress with behaviors (p = .051), and managed higher dependence (ADLs, p = .018; IADLs, p = .002) than caregivers in Basic (N = 403, 56.2%). Of 1,462 strategies offered, 68.9% were implemented with no differences in implementation rate between the 2 programs. Of 279 families with follow-up, 53.4% (N = 149) reported ≥1 adverse health-related events over 3-months pre-enrollment. By 3-months post-enrollment, 27.2% (N = 76) reported ≥1 adverse events; reflecting a 51.0% reduction in caregivers reporting events (p < .0005). African Americans, Whites, spouses, and nonspouses benefited similarly.Discussion and ImplicationsMCHS offers brief supportive services, resulting in fewer adverse health-related events of persons with dementia. Families managing high functional dependence opted for more assistance from occupational therapists. Evaluating real-world programs yields new understandings of caregiver service preferences for staff planning.

Sepsis related medical emergency calls and mortality: correlation with qSOFA score

Sepsis related medical emergency calls and mortality: correlation with qSOFA score

Speeding up laboratory test reporting in Medical Emergency and Cardiac Arrest calls: a quality improvement project

Many hospitals deploy Medical Emergency (MET) and Cardiac Arrest teams to improve the management and treatment of patients who become critically ill. In many cases, blood results are key in...

HEALTHCARE RESOURCES UTILIZATION AND TEMPORARY DISABILITY IN POPULATION AGED 50-64 ACCORDING TO THE EPIDEMIOLOGICAL ESSE-RF STUDY

Aim . To analyze health care resource utilization and temporary disability in people of pre-retirement age in the Russian population. Material and methods . The analysis was carried out on the basis of the ESSE-RF study materials (13 regions of the RF). Standard epidemiological survey methods and evaluation criteria were used. The analysis included results of a survey of the ESSE-RF study participants about health care resource utilization and temporary disability (TD) during 12 months before the survey. The following characteristics were ascertained: a number and reasons of outpatient visits for medical assistance, hospital admissions (including duration of in-hospital treatment), emergency calls and temporary disability (a number of days and cases), their mean number per one study participant, mean number of cases and days of TD per 100 working participants, associations with social-demographic parameters, risk factors, chronic non-communicable diseases, stress and anxiety levels by the Hospital Anxiety and Depression Scale (HADS). Results . A total of 8334 people aged 50-64 years were examined: men – 2784 (33%) and women – 5550 (67%). A share of the hospitalized (at least one time) was 11% in the age group of 50-54 years, 12% – in the age group of 55-59 years and by the age of 60-64 this indicator increased to 15%. 20% of the participants at least one time were admitted to hospital and/or called an ambulance. A share of people who had utilized health care resources at least one time was increasing with age. Unemployed people were hospitalized more frequently than employed ones. Number of chronic non-communicable diseases correlated with the probability of hospitalization and/or emergency call. Categories 2 and 3 of disability, presence of diabetes mellitus, ischemic heart disease and hypertension were statistically significantly associated with the probability of hospitalization and/or emergency call. Smoking did not increase the probability of hospitalization and/or emergency call in comparison with absence of this risk factor, at that, people who had given up smoking were 1.3 times more likely to be hospitalized than non-smokers. People with low and moderate alcohol consumption were hospitalized and called an ambulance significantly less often than those who abstained from alcohol. Clinically significant anxiety increased the probability of hospital admission and/or emergency call as compared to people without this factor by the HADS. Subclinical and clinically significant anxiety, mean and high levels of stress were associated with the probability of hospitalization and/or emergency call. Number of TD days turned out to be rather low - 0.3 day per 1 working man and 0.4 day - per 1 working woman, this index did not significantly differ with age. Conclusion . So, pre-retirement age (50-64 years) is characterized by increase in health care resource utilization due to health state worsening. At the same time significant share of people of this age (40%) did not seek medical help. These 40% of pre-retirement age people can be possible reserve for health state improvement by means of their active involvement in preventive activity of primary health care system (the study had been conducted before the preventive medical examination program starting).

RESOURCE MAINTENANCE TREATMENT OF ARTERIAL HYPERTENSION IN OUTPATIENT CLINICS

Due to the significant financial costs associated with the management of arterial hypertension (HTN), the optimization of health care resource distribution is required. Objective. To study the resource maintenance treatment of HTN in outpatient clinics. design and methods. The study included two stages. Firstly, we selected a sample of primary HTN patients based on the screening of primary medical records (n = 1766). Secondly, we performed a telephone survey 6 months after the inclusion (n = 1419). Results. Outpatients are characterized by a high frequency of visits to the doctor: 2,9 physician’s counseling, 2,6 cardiologist’s counseling, 0.21 cases of medical emergencies, 0.08 hospitalizations per 1 patient for 6 months on average. Significant use of health care resources was found in the following groups: patients aged 60 years and older, who periodically or regularly measure blood pressure (BP), regularly take antihypertensive therapy (AHT), those who have drug incentives, do not use fixed combinations, with uncontrolled BP, coronary heart disease (СHD), who take 3 or more antihypertensive drugs, who changed or withdrew the recommended AHT. Although achieving target BP is associated with a reduced likelihood of medical emergency calls and outpatient physician’s counseling, there was not difference in the number of hospitalizations between the groups with achieved target BP and the group with uncontrolled HTN. Total direct costs for 6 months composed 9 283,13 rubles per one study participant. Factors associated with a higher total direct costs included age 60 years or older, a high level of self-monitoring of BP, regular intake of AHT, the opportunity of drug incentives, the presence of СHD, uncontrolled HTN, multiple combination antihypertensive therapy (3 drugs and more), no use of fixed combinations, changes or withdrawal of recommended AHT. Conclusions. Our analysis of resource provision and cost-effectiveness of HTN treatment allowed to identify the groups of patients with inappropriate resource expenses. These data demonstrate the need for targeted interventions in order to reduce the economic burden of HTN.

Effectiveness at hospital of integrated care units (Functional Unit of Chronic patient; FUCP) in primary care (PC)

Objectives: Evaluate the impact of the FUCP intervention on hospital admissions and visits to hospital emergency room of high risk patients (with Clinical Risk Groups higher or equal to 5 CRG and with 2 or more hospitalizations) in the last 12 months in a healthcare center.Methodology: Before-after comparative retrospective cohort study of CCP and descriptive analysis using STATA package. Patients diagnosed with heart failure (HF) and / or chronic obstructive pulmonary disease (COPD) with CRG higher or equal to 5 and with 2 or more hospitalizations are identified, labelled and monitored by the FUCP as Complex Chronic Patient (CCP). All these patients are provided with one-to-one attention to meet their socio-healthcare needs (case management) transversally, acute treatment in the event of decompensation, control after decompensation and proactivity. The follow-up of this patients includes medical record, hospitalization and emergency room lists, PC visits and calls. The number of visits to the emergency department the year before entering the program is compared to hospital admissions of CCP with the intervention of the FUCP (2012 vs 2013).Results: Nominal target population of 286 patients; of which 110 (38.46%) followed controls and direct care intervention by this Unit through direct intervention (DI) for their pathology and 176 (61.54%) for indirect intervention (II). A comprehensive and multidisciplinary assessment was performed.Previous admissions to the performance of the FUCP in 2012: 541. There were 228 admissions of patients with heart failure and / or COPD and 313 patients with other pathologies.Hospital admissions during the intervention of the FUCP 2013: 206. 96 admissions of patients with heart failure and / or COPD direct intervention (DI) and 110 admissions of patients with other diseases indirect intervention(II).The decrease in admissions was 57.89% for DI and 64.87% for II. The total reduction was 61.82%. The visits to hospital emergency decreased to 44.33% and 42.81% respectively; the total being 43.55%.Mean for hospital admissions per patient (2012) was 2,55 (CI95%; 2,15-2,95) vs 1,82 admissions del 2013 (CI95%; 1,42-2,22). T-test of reduction statistically significant (p=0,0203), checked out by Wilcoxon for twin data (z=2,614, p=0,0089)Mean for emergency room admissions per patient was decreased from 3,51 (CI95% 2.872213-4.159037) to 2,26 (IC95%; 1.749959-2.781291). Statistically different (p=0,0007 for t-test and p=0,0002 for Wilcoxon test).Comments and conclusions: The multidisciplinary and integrated work from the PC in coordination with the hospital and health and social services is effective in the CCP. Facilitating access to health care, continuing care and early case management on the onset of decompensation reduces hospital admissions and visits to the hospital emergency room. Individualized care of these patients in PC achieves similar results to those by Day Hospital units.

Dispatch guideline adherence and response interval-a study of emergency medical calls in Norway.

BackgroundThe Emergency Medical Communication Centre (EMCC) operators in Norway report using the Norwegian Index for Medical Emergency Assistance (Index), a criteria-based dispatch guideline, in about 75 % of medical emergency calls. The main purpose of a dispatch guideline is to assist the operator in securing a correct response as quickly as possible. The effect of using the guideline on EMCC response interval is as yet unknown. We wanted to ascertain an objective measure of guideline adherence, and explore a possible effect on emergency medical dispatch (EMD) response interval.MethodsObservational cross-sectional study based on digital telephone recordings and EMCC records; 299 random calls ending in acute and urgent responses from seven strategically selected EMCCs were included. Ability to confirm location and patient consciousness within an acceptable time interval and structural use of criteria cards were indicators used to create an overall guideline adherence variable. We then explored the relationship between different levels of guideline adherence and EMD response interval.ResultsThe overall guideline adherence was 80 %. Location and patient consciousness were confirmed within 1 min in 83 % of the calls. The criteria cards were used systematically as intended in 64 % of the cases. Total median response interval was 2:28, with 2:01 for acute calls and 4:10 for urgent calls (p < 0.0005). Lower guideline adherence was associated with higher EMD response interval (p < 0.0005).ConclusionThe measured guideline adherence was higher than previously reported by the operators themselves. Patient consciousness was rapidly confirmed in the majority of cases. Failure to use Index criteria as intended result in delayed ambulance dispatch and a potential risk of undertriage.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-016-0105-2) contains supplementary material, which is available to authorized users.

Barriers to recognition of out-of-hospital cardiac arrest during emergency medical calls: a qualitative inductive thematic analysis.

BackgroundThe chance of surviving out-of-hospital cardiac arrest (OHCA) depends on early and correct recognition of cardiac arrest by the emergency medical dispatcher during the emergency call. When cardiac arrest is identified, telephone guided cardiopulmonary resuscitation (CPR) and referral to an automated external defibrillator should be initiated. Previous studies have investigated barriers to recognition of OHCA, and found the caller’s description of sign of life, the type of caller, caller’s emotional state, an inadequate dialogue during the emergency call, and patient’s agonal breathing as influential factors. Though many of these factors are included in the algorithms used by medical dispatchers, many OHCA still remain not recognised. Qualitative studies investigating the communication between the caller and dispatcher are very scarce. There is a lack of knowledge about what influences the dispatchers’ recognition of OHCA, focusing on the communication during the emergency call.The purpose of this study is to identify factors affecting medical dispatchers’ recognition of OHCA during emergency calls in a qualitative analysis of calls.MethodsAn investigator triangulated inductive thematic analysis of recordings of out-of-hospital cardiac arrest emergency calls from December 2012. Participants were the callers (bystanders) and the emergency medical dispatchers. Data were analysed using a hermeneutic approach.ResultsBased on the concept of data saturation, 13 recordings of not recognised cardiac arrest and 8 recordings of recognised cardiac arrests were analysed. Three main themes, six subthemes and an embedded theme emerged from the analysis: caller’s physical distance (caller near patient, caller not near patient), caller’s emotional distance (keeping calm, losing control), caller is a healthcare professional (responsibility is handed over to the caller, caller assumes responsibility), and the embedded theme: caller assesses the patient.ConclusionThe physical and emotional proximity of the caller (bystander) as well as the caller’s professional background affect the dispatcher’s chances of correct recognition and handling of cardiac arrest. The dispatcher should acknowledge the triple roles of conducting patient assessment, instructing the caller, and reassuring the emotionally affected caller.

Increased Medical Emergency Calls During A Severe Air Pollution Episode In 2013 In Jinan, China

Introduction: In winter 2012-13, severe haze pollution affected major cities in central and eastern China, including Jinan. We investigated whether total medical emergency calls and calls for Central Nervous Systems Syndromes (CNS) increased during this episode and whether emergency calls were associated with particles with aerodynamic diameter ≤10um (PM10) in Jinan, China. Methods: Data on daily medical emergency calls (total and CNS calls) were obtained from Jinan Medical Emergency Center. CNS include dizziness, coma, convulsion, stroke, epilepsy, headache and paralysis. Analysis includes 2 time periods: 1) Dec 1, 2011- Feb 29, 2012 (lower pollution period), and 2) Dec 1, 2012- Feb 28, 2013 (high pollution period). Poisson time series models were used to estimate the change in emergency calls associated with heavy pollution period using an indicator variable, and with day-to-day variation in PM10 levels using a continuous variable. The models were adjusted for temporal trends, temperature, relative humidity and day of the week. Associations were estimated for multiple lag structures. Results: Air pollution levels were high in both the lower and higher air pollution periods with PM10 at 123 ug/m3 and 238 ug/m3, respectively. Compared to lower pollution period, daily number of total calls were significantly higher in the high pollution period (adjusted OR: 1.08; 95% CI: 1.05, 1.11), while the increase of CNS calls was marginally significant. We found positive associations between total calls and PM10 concentrations on lag 0- to lag 5- day. The strongest association was observed for lag 3-day [OR: 1.03; 95% CI: 1.01, 1.05, per IQR increment (121 ug/m3)]. The associations for calls for CNS showed similar patterns. Discussion: Air pollution levels are alarmingly high in winter in Jinan. Results indicate that substantial health benefits would result from efforts to prevent future severe episodes of haze pollution.

Challenges in out-of-hospital cardiac arrest – A study combining closed-circuit television (CCTV) and medical emergency calls

The aim of this study was to explore challenges in recognition and initial treatment of out-of-hospital cardiac arrest (OHCA) by using closed-circuit television (CCTV) recordings combined with audio recordings from emergency medical calls. MethodAll OHCA captured by CCTV in the Capital Region of Denmark, 15 June 2013–14 June 2014, were included. Using a qualitative approach based on thematic analysis, we focused on the interval from the victim's collapse to the arrival of the ambulance. ResultsBased on the 21 CCTV recordings collected, the main challenges in OHCA seemed to be situation awareness, communication and attitude/approach. Situation awareness among bystanders and the emergency medical dispatchers (dispatcher) differed. CCTV showed that bystanders other than the caller, were often physically closer to the victim and initiated cardiopulmonary resuscitation (CPR). Hence, information from the dispatcher had to pass through the caller to the other bystanders. Many bystanders passed by or left, leaving the resuscitation to only a few. In addition, we observed that the callers did not delegate tasks that could have been performed more effectively by other bystanders, for example, receiving the ambulance or retrieving an Automated External Defibrillator (AED). ConclusionCCTV combined with audio recordings from emergency calls can provide unique insights into the challenges of recognition and initial treatment of OHCA and can improve understanding of the situation. The main barriers to effective intervention were situation awareness, communication and attitude/approach. Potentially, some of these challenges could be minimized if the dispatcher was able to see the victim and the bystanders at the scene.A team approach, with the dispatcher responsible for the role as team leader of a remote resuscitation team of a caller and bystanders, may potentially improve treatment of OHCA.

Injury risks of EMS responders: evidence from the National Fire Fighter Near-Miss Reporting System

ObjectivesWe analysed near-miss and injury events reported to the National Fire Fighter Near-Miss Reporting System (NFFNMRS) to investigate the workplace hazards and safety concerns of Emergency Medical Services (EMS) responders...

The effect of space weather on human heart diseases in subauroral latitudes

In this work the relationship between emergency medical calls for myocardial infarction in Yakutsk (subauroral geomagnetic latitudes) and parameters of the space weather near maximum (1992) and minimum (1998) geomagnetic activity is studied. The comparison of the seasonal behavior of the number of calls with the simultaneous seasonal behavior of deaths from myocardial infarctions at low latitudes (Bulgaria) exhibited significant differences. Namely, in Bulgaria, the maximum and minimum of infarctions were observed in winter and in summer, respectively; in Yakutsk, several observed maximums coincided with the sharp and considerable increase in planetary geomagnetic activity. An analysis of experimental results made it possible to suppose that, in subauroral latitudes, unlike low latitudes, a major role in the increase in the number of infarctions is played by the increase in geomagnetic activity, namely, by the appearance of night magnetospheric substorms, which are also observed in subauroral latitudes in magnetically disturbed times. Substorms are always accompanied by irregular geomagnetic Pi1 pulsations with periods of 0.5–3 Hz. These pulsations can be biotropic, like stable quasi-sinusoidal geomagnetic Pc1 pulsations in middle and low latitudes.

Decompressive craniectomy for neurological emergencies—An update for nurses

Methods: Acute admissions, excluding those managed entirely by theEmergencyDepartmentor aday treatment area, to a400-bed tertiary referral hospital between01/01/2008and31/12/2011were identified from administrative data. Data for the first admission by each patient was merged with emergency call (Respond Medical Emergency Team or Respond Blue) data. Outcomes were hospital discharge destination and death, either in hospital or notified to the hospital, in the six months following the date of admission. Results: There were 43,385 admission episodes. During 1208 (2.8%) of these one or more medical emergency calls occurred. Median time to the first call was 3.2 days (IQR 1.2–9.0) and 91 (8%) involved cardiac arrest. Emergency call patients more often died in hospital (22% vs. 1%, P<0.01), were more often discharged to ongoing care (38% vs. 15%, P<0.01) and more often died in the six months after admission (29% vs. 5%, P<0.01). Adjusting for age, male gender, Charlson comorbidity score and Medical Unit admission, the emergency call patients had an odds ratio for death in the six months after admission of 5.9 (95%CI 5.1–6.9, P<0.01). Conclusions: Medical emergency calls were associated with substantially higher mortality in the six months after admission. If the clinical deterioration that precipitates emergency calls could be prevented, mortality might be reduced.

The mortality associated with hospital medical emergency calls (Respond Medical Emergency Team or Respond Blue)

The mortality associated with hospital medical emergency calls (Respond Medical Emergency Team or Respond Blue)

Mortality of Non-Transported EMS Patients

Annually, approximately 37% of emergency ambulance calls in Helsinki emergency medical services (EMS) concluded in a nontransport decision. According to clinical experience, nontransport decisions have been estimated to be safe and also economically beneficial. However, mortality of nontransported patients after call has not been studied. The Helsinki Dispatching Center serves the capital city of Helsinki (population 588,500). The dispatching center prioritizes emergency medical calls into four urgency categories from A to D. In this study, we analyzed category A, B, and C calls concluded with a nontransport decision. EMS system provided by the Rescue Department consists of eight Basic Life Support ambulances, which are manned by emergency medical technicians (EMTs), three Advanced Life Support ambulances manned with paramedics, and one medical supervisor unit. One physician-staffed mobile intensive care unit serves on a 24/7 basis.

Variations in contact patterns and dispatch guideline adherence between Norwegian emergency medical communication centres - a cross-sectional study

BackgroundThe 19 Norwegian Emergency medical communication centres (EMCCs) use Norwegian Index for medical emergency assistance (Index) as dispatch guidelines. Little is known about the use of Index, nor its validity. We aimed to document the epidemiology of contacts made to the public emergency medical phone number and the operators’ self-reported use of Index as a first step towards a validation study.MethodsWe registered all medical emergency calls to the EMCCs during a 72 h period in a national cross sectional study. We subsequently sent a questionnaire to all EMCC operators in Norway, asking how they use Index. A combined outcome variable “use of Index” was computed through a Likert scale, range 1–5. Regression models were used to examine factors influencing use.Results2 298 contacts were included. National contact rate was 56/1 000 inhabitants per year, range between EMCCs 34 – 119. Acute contact (life-threatening situations) rate was 21/1 000 per year, range between EMCCs 5 – 31. Index criteria 6 – ’Unresolved problem’ accounts for 20% of the 113 contacts, range between EMCCs 10 – 42%. The mean use of Index was 3.95 (SD 0.39), corresponding to “more than 75% of emergency calls”. There were differences in use of Index on EMCC level, range 3.7 – 4.4, and a multi regression model explained 23.4% of the variation in use. Operators working rotation with ground ambulance services reported reduced use of Index compared to operators not working in rotation, while distinct EMCC focus on Index increased use of Index compared to EMCCs with no focus on Index. Use of electronic records and operators experience were the main reasons given for not using Index.ConclusionsThere is a large variation between the EMCCs with regard to both contact patterns and use of Index. There is a relatively high overall self-reported use of Index by the operators, with variations on both individual and EMCC level.

The Impact of Heat Waves on Transport Volumes in an Urban Emergency Medical Services System: A Retrospective Review

Heat waves pose a serious public health risk to particular patient populations, especially in urban areas. Emergency Medical Services (EMS) in many urban areas constitute the first line of regional preparation and response to major heat wave events; however, little is known on heat wave operational impact to the EMS system, such as call volume or demand. To examine the effect of heat wave periods on overall urban EMS system call volume and transport volume as well as the nature of the call types. Retrospective review of all emergency medical calls to an urban, two-tiered EMS system performed over a 5-year period from 2006-2010. Heat wave days (HWD) defined as two or more consecutive days of hot weather >32.2°C (90°F) were compared with similar non-heat wave days (nHWD) of the previous year to also include two calendar days prior to and after the heat wave. National Weather Service (NWS) temperature data, daily EMS call volume data, and call type codes were collected and underwent descriptive analysis. Thirty-one HWD were identified and compared with 93 nHWD. The mean maximum temperature for HWD was 34°C (93.2°F) compared with 25.3°C (77.6°F) for nHWD (P < .001). Average daily medical emergency calls (318.4 vs 296.3, P < .001) and actual patients transported per day (247.5 vs 198.3, P < .001) were significantly higher during HWD. There was no difference in daily medical emergency call volume or EMS transports between weekdays or weekend days. No significant differences on various call types were observed between HWD and nHWD except for "heat" related calls (7.7 vs 0.5, P < .001). Emergency Medical Services call volumes were significantly increased during heat waves, however there was minimal change in the types of calls received.

The Effect of Language Barriers on Dispatching EMS Response

Objective. The objective of this study was to investigate the effect of language barriers during medical 9-1-1 calls, on the time to dispatch and level of medical aid (Basic or Advanced Life Support). Methods. All 9-1-1 medical calls to two large call centers during one week for each of the months of August, October, December 2010 and February 2011, were reviewed for a notation of language barrier (LB). Non-language barrier calls were identified from the same time period such that there were an equal proportion of LB and non-LB calls by dispatch code and dispatcher. A total of 272 language barrier calls were identified. The computer-assisted dispatch (CAD) reports for the LB and non-LB calls were abstracted by research staff using a standard form, including: Start time of call, time to dispatch of BLS, time to dispatch of ALS, dispatch code, interpretation service use, on-scene upgrade to ALS, and on-scene downgrade to BLS. 9-1-1 recordings were abstracted for LB calls only to obtain information about use of interpreter services. Difference between LB and English speakers in time to assignment of BLS and ALS was examined using linear mixed effects models with log time as the outcome; language barrier, call center and dispatch code as fixed effects and dispatcher as a random effect. Results. The effect of language barrier on time to BLS assignment was, on average, 33% longer (p < 0.001) and time to ALS assignment 43% longer (P = 0.008). A majority of the effect was due to the effect of interpreter use, which increased time to BLS by 82% and 125% for ALS, when compared to non-language barrier calls. Data from the 9-1-1 recordings showed an average of 49 seconds between connecting to the service operator and connecting to the language interpreter. Language barrier calls were more likely to be up- and down-graded, only statistically significantly so for on-scene downgrades. Conclusion. Language barriers increase time to dispatch and the accuracy of the level of aid dispatched during medical emergency calls. Decreasing the time to connecting to an actual interpreter when using an interpretation service could minimize existing delays.