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Background Over the course of the COVID-19 progress, reports from many locations around the world indicated major increases in EMS call volume, which imposed great pressure on EMS dispatch centers (EMSDC) globally. No studies yet have been done to examine this phenomenon. Objective This paper examines the interrelated effects of the unprecedented global increase of EMS call, the effect of the COVID-19 crisis on responding to non-COVID-19 emergencies, and the concurrent effects of having overwhelmed dispatch centers. It tries to explain the current evidence of the bottleneck of EMS calls during the early phase of the worldwide pandemic. Eligibility criteria We examine the numbers of EMS calls internationally between March and June 2020, derived from published literature and news media. Only articles in English were selected, with certain keywords related to EMS calls, ambulance delay, stroke and cardiac arrest. Source of evidence Google Scholar was the main searching source. Results After applying the selection criteria, a total of 29 citations were chosen, and a pattern of knowledge resulted in the emergence of five themes: EMS calls during COVID-19, Reduced EMS operator response time, Ambulance response delays, Collateral mortality and morbidity among non-COVID-19 cases, and Total ambulance call time. Conclusion Over the course of COVID-19 progress, there was a global phenomenon of exponential increases in EMS calls, which is expected to impose a great pressure on EMS dispatch centers. Several factors contributing to the bottleneck of EMS calls are identified and explained.

Background Emergency medical services (EMS) response volume has been linked to weather and temporal factors in a regional EMS system. We aimed to identify if models of EMS utilization incorporating these data are generalizable through geographically disparate areas in the United States. Methods We performed a retrospective analysis of EMS dispatch data from four regions: New York City, San Francisco, Cincinnati, and Marin County for years 2016–2019. For each model, we used local weather data summarized from the prior 6 h into hourly bins. Our outcome for each model was EMS dispatches as count data. We fit and optimized a negative binomial regression model for each region, to estimate incidence rate ratios. We compared findings to a prior study performed in Western Pennsylvania. Results We included 5,940,637 EMS dispatches from New York City, 809,405 from San Francisco, 260,412 from Cincinnati, and 77,461 from Marin County. Models demonstrated consistency with the Western Pennsylvania model with respect to temperature, season, wind speed, dew point, and time of day; both in terms of direction and effect size when expressed as incidence rate ratios. Precipitation was associated with increasing dispatches in the New York City, Cincinnati, and Marin County models, but not the San Francisco model. Conclusion With minor differences, regional models demonstrated consistent associations between dispatches and time and weather variables. Findings demonstrate the generalizability of associations between these variables with respect to EMS use. Weather and temporal factors should be considered in predictive modeling to optimize EMS staffing and resource allocation.

Introduction:Emergency Medical Services (EMS) are designed to respond to and manage patients experiencing life-threatening emergencies; however, not all emergency calls are necessarily emergent and of high acuity. Emergency responses to low-acuity patients affect not only EMS, but other areas of the health care system. However, definitions of low-acuity calls are vague and subjective; therefore, it was necessary to provide a clear description of the low-acuity patient in EMS.Aim:The goal of this study was to develop descriptors for “low-acuity EMS patients” through expert consensus within the EMS environment.Methods:A Modified Delphi survey was used to develop call-out categories and descriptors of low acuity through expert opinion of practitioners within EMS. Purposive, snowball sampling was used to recruit 60 participants, of which 29 completed all three rounds. An online survey tool was used and offered both binary and free-text options to participants. Consensus of 75% was accepted on the binary options while free text offered further proposals for consideration during the survey.Results:On completion of round two, consensus was obtained on 45% (70/155) of the descriptors, and a further 30% (46/155) consensus was obtained in round three. Experts felt that respiratory distress, unconsciousness, chest pain, and severe hemorrhage cannot be considered low acuity. For other emergency response categories, specific descriptors were offered to denote a case as low acuity.Conclusion:Descriptors of low acuity in EMS are provided in both medical and trauma cases. These descriptors may not only assist in the reduction of unnecessary response and transport of patients, but also assist in identifying the most appropriate response of EMS resources to call-outs. Further development and validation are required of these descriptors in order to improve accuracy and effectiveness within the EMS dispatch environment.

Introduction Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapies. Many institutions are interested in developing their own ECPR program. However, there may be challenges in logistics and implementation. Aims The aim of our protocol was to demonstrate that an ECPR team was feasible within our healthcare system and that the identification of UPMC Presbyterian as a receiving center allowed for successful treatment within 30 min from EMS dispatch. Methods We developed out of hospital cardiac arrest (OHCA) ECPR protocols for Emergency Medical Services (EMS), EMS communications, and our in-hospital ECPR team. Inclusion criteria indentified patients with a potentially reversible arrest etiology and high probability of recoverable brain injury using a simple checklist: witnessed collapse, layperson CPR, initial shockable rhythm, and age 18–60 years. We trained local EMS crews to screen patients and reviewed the criteria with a Medic Command Physician prior to transport to our hospital. Results From October 2015 to March 31st 2018, EMS treated 1165 EMS OHCA cases, transported 664 (57%) to a local hospital, and transported 120 (10%) to our institution. Of these, five (4.1%) patients underwent ECPR. Among excluded cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. For ECPR cases, median pre-hospital CPR duration was 26 [IQR 25–40] min. Four patients (80%) received mechanical CPR. Interval from arrest to arrival on scene was 5 [IQR 4–6] min and interval from radio call to activation of ECPR was 13 [IQR 7–21] min. Interval from EMS dispatch to departure from scene was 20 [IQR 19–21] min. Time from EMS dispatch to initiation of ECPR was 63 [IQR 59–69] min. Conclusions ECPR is an infrequent occurrence in EMS practice. Most apparently eligible patients did not get ECPR, highlighting the need for ongoing programmatic development, provider education, and qualitative work exploring barriers to implementation.

Pre-hospital care is provided by emergency medical services (EMS) staff, the initial health care providers at the scene of disaster. This study aimed to describe the characteristics of EMS callers and space-time distribution of emergency requests in a large urban area. Descriptive thematic maps of EMS requests were created using an empirical Bayesian smoothing approach. Spatial, temporal and spatio-temporal clustering techniques were applied to EMS data based on Kulldorff scan statistics technique. Almost 225,000 calls were registered in the EMS dispatch centre during the study period. Approximately two-thirds of these calls were associated with an altered level of patient consciousness, and the median response time for rural and urban EMS dispatches was 12.2 and 10.1 minutes, respectively. Spatio-temporal clusters of EMS requests were mostly located in central parts of the city, particularly near the downtown area. However, high-response time clustered areas had a low overlap with these general, spatial clusters. This low convergence shows that some unknown factors, other than EMS requests, influence the high-response times. The findings of this study can help policymakers to better allocate EMS resources and implement tailored interventions to enhance EMS system in urban areas.

Widespread use of smartphones allows automatic geolocalization (i.e., transmission of location data) in countless apps. Until now, this technology has not been routinely used in connection with an emergency call in which location data play a decisive role This study evaluated a new software automatically providing emergency medical service (EMS) dispatchers with a caller's geolocation. We hypothesized that this technology will provide higher accuracy, faster dispatching of EMS and a faster beginning of thoracic compressions in a cardiac arrest scenario.Approval from the local Ethics Committee was obtained. 108 simulated emergency calls reporting a patient in cardiac arrest were conducted at 54 metropolitan locations, which were chosen according to a realistic pattern. At each location, a conventional emergency call, with an oral description of the location, was given first; subsequently, another call using an app with automatic geolocation was placed. Accuracy of localization, time to location, time to EMS dispatch and time to first thoracic compression were compared between both groups.The conventional emergency call was always successful (n = 54). Emergency call via app worked successfully in n = 46 cases (85.2%). Automatic geolocation was provided to EMS in all these n = 46 cases (100%). Deviation from estimated position to actual position was 1173.5 ± 4343.1 m for conventional and 65.6 ± 320.5 m for automatic geolocalization (p 0.001). In addition, time to localization was significantly shorter using automatic geolocalization (34.7 vs. 71.7 s, p 0.001). Time to first thoracic compression was significantly faster in the geolocalization group (83.0 vs. 122.6 s; p 0.001).This pilot study showed that automatic geolocalization leads to a significantly shorter duration of the emergency call, significantly shorter times until the beginning of thoracic compressions, and a higher precision in determining the location of an emergency.

Introduction In order to allocate resources in an effective manner, emergency medical services (EMS) systems use dispatch-based triaging to prioritise patients by acuity. Over-triage, wherein patients are assigned a higher priority level than necessary, can serve as a safety measure. However, it places strain on EMS systems, a problem believed to be experienced by South Africa's Western Cape Government EMS system, with almost half of its calls designated at the highest priority level. To begin improving dispatch within WCG EMS, we aimed to describe the current system by identifying the most common conditions dispatched, and those most perceived to be suffering from over-triage. Methods A multi-methods approach was taken: First, a quantitative chart review was used to analyse all calls assigned a dispatch priority by WCG EMS between December 2016 and November 2017. These descriptive data then informed qualitative focus groups to further investigate emergency medical dispatch (EMD). Three focus groups were conducted, each with a convenience sample of staff from: WCG EMS staff, call takers/dispatchers, and call centre managers. Data were reviewed and coded, after which the lead researcher aggregated coded transcripts and conducted thematic content analysis. Results Seventy-nine condition categories were identified from 649,544 completed patient records for the study period. Non-specific pain accounted for the greatest proportion of dispatched complaints (16.88%), followed by assault with a weapon (10.00%) and respiratory complaints (9.71%). Sixteen WCG EMS personnel took part in focus groups, highlighting challenges of the current EMD system, including time constraints, legal risks, communication, overuse of the system, and lack of training. Chest pain, collapsed/unresponsive patients, and vomiting and diarrhoea were frequently noted to be potentially over-triaged conditions. To improve this, participants suggested trainings, modifications to the electronic EMD system, additional protocols, and public education. Conclusion This study identified where over-triage is possibly occurring in the WCG EMS dispatch system, as well as potential solutions proposed by those working within the system., Highlights • There are many types of effective emergency medical dispatch (EMD) established within high-income countries’ EMS systems. • EMDs are often the first opportunity for the recognition of time-critical conditions. • Effective EMDs can improve time-to-care and patient outcomes • This study explored potential causes of, and solutions to, over-triage in the WCG EMS dispatch system.

OBJECTIVE Geographic differences in epilepsy prevalence between areas of different socioeconomic standing have been demonstrated in the United Kingdom, but knowledge from other health care systems is scarce. Our objective was to compare epilepsy prevalence and emergency medical service (EMS) assignments for seizures in areas of different socioeconomic standings in the urban area of Gothenburg. METHODS Register-based study in Gothenburg (population 690 000), the second largest city in Sweden. Epilepsy cases were identified in the comprehensive national patient register in 2014-2015. EMS assignments were identified in the EMS dispatch system in 2013-2018. Socioeconomic variables were mean income and proportion of welfare recipients. RESULTS Significant correlations were seen between epilepsy prevalence and the proportion of welfare recipients (r = .49, P = .0014) and annual income per capita (r = -.42, P = .0071). There were 7907 assignments for seizures during the study years. GPS-based analysis showed that most assignments occurred in the city center. In addition, several high-density areas correlated with areas with a high proportion of inhabitants receiving welfare. Correlation analysis showed significant associations between the number of EMS assignments per capita and the proportion of welfare recipients (r = .31, P

Aim Resuscitation of cardiac arrest involves invasive and traumatic interventions and places a large burden on limited EMS resources. Our aim was to identify prehospital cardiac arrests for which resuscitation is extremely unlikely to result in survival to hospital discharge. Methods We performed a retrospective cohort analysis of all cardiac arrests in San Mateo County, California, for which paramedics were dispatched, from January 1, 2015 to December 31, 2018, using the Cardiac Arrest Registry to Enhance Survival (CARES) database. We described characteristics of patients, arrests, and EMS responses, and used recursive partitioning to develop decision rules to identify arrests unlikely to survive to hospital discharge, or to survive with good neurologic function. Results From 2015–2018, 1750 patients received EMS dispatch for cardiac arrest in San Mateo County. We excluded 44 patients for whom resuscitation was terminated due to DNR directives. Median age was 69 years (IQR 57–81), 563 (33.0%) patients were female, 816 (47.8%) had witnessed arrests, 651 (38.2%) received bystander CPR, 421 (24.7%) had an initial shockable rhythm, and 1178 (69.1%) arrested at home. A simple rule (non-shockable initial rhythm, unwitnessed arrest, and age 80 or greater) excludes 223 (13.1%) arrests, of whom none survived to hospital discharge. Conclusion A simple decision rule (non-shockable rhythm, unwitnessed arrest, age ≥ 80) identifies arrests for which resuscitation is futile. If validated, this rule could be applied by EMS policymakers to identify cardiac arrests for which the trauma and expense of resuscitation are extremely unlikely to result in survival.

Introduction: Many reports have described a decrease in the numbers of patients seeking medical attention for typical emergencies during the COVID-19 pandemic. These reports primarily relate to urban areas with widespread community transmission. The impact of COVID-19 on non-urban areas with minimal community transmission is less well understood. Methods: Using a prospectively maintained pre-hospital quality improvement database, we reviewed our hospital EMS transports with a diagnosis of stroke from January to April 2019 (baseline) and January to April 2020 (pandemic). We compared the volume of patients, transport/presentation times, severity of presenting symptoms, and final diagnosis. Results: In January, February, March, and April 2019 10, 11, 17 and 19 patients, respectively were transported in comparison to 19, 14, 10 and 8 during the same months in 2020. From January through April 2019 there was a 53% increase in transports, compared to a 42% decrease during the same months in 2020. The slopes of these trend lines are significantly different (3.30; 95%CI 0.48 - 6.12 versus -3.70; 95%CI -5.76 - -1.64, P = 0.001). There were no significant differences in demographics, comorbidities, symptom severity, or stroke discharge diagnoses between the two time periods. However, the median interval from LKW to time of EMS dispatch was significantly longer in January to April 2020 (12 + 273 min) compared to the same time period of January through April in 2019 (7 + 115 min). Conclusion: Our data indicate not only a decrease in patient transport volumes but more alarmingly, significantly longer intervals to EMS activation for suspected stroke care. These results suggest that even in a non-urban location without widespread community transmission patients were delaying or avoiding care for severe illness such as stroke.

Context Emergency medical services (EMS) are frequently responding to calls involving patients in advanced stages of incurable diseases. Despite the competencies and potential of EMS in supporting patients and their families facing symptoms of advanced progressive illnesses, the role of EMS in providing palliative care remains unclear. Objective The following research question was formulated: What is the role of ambulance EMS, EMS dispatch centres, paramedics and emergency medical physicians in the provision of palliative care to terminally ill patients? Methods Following PRISMA-ScR guidelines, online bibliographic databases CINAHL Complete, MEDLINE Complete (EBSCO), PubMed and MEDLINE (Ovid) were searched from the initial year of database to September 2019. No language restrictions were applied. Results 31 articles were included in the qualitative synthesis and 3 main roles and one contextual factor were identified: (1) Providing complex care; (2) Adjusting patient's trajectory; (3) Being able to make decisions in a time and information limited environment; (4) Health care professionals are insufficiently supported in palliative care. Conclusion There are limited data on the incidence of EMS calls to the patients at the end-of-life and no data focusing on the EMS dispatch centres. Both paramedics and emergency physicians are aware of their role in the end-of-life care. EMS personnel are lacking special training and education in the palliative care. Cooperation between palliative care providers, the EMS providers and other out-of-hours services might improve the responsiveness of the health care system to needs and expectations of patients and their families, and possibly improve the overall health care system efficiency.

Introduction. Many reports have described a decrease in the numbers of patients seeking medical attention for typical emergencies during the COVID-19 pandemic. These reports primarily relate to urban areas with widespread community transmission. The impact of COVID-19 on nonurban areas with minimal community transmission is less well understood. Methods. Using a prospectively maintained prehospital quality improvement database, we reviewed our hospital EMS transports with a diagnosis of stroke from January to April 2019 (baseline) and January to April 2020 (pandemic). We compared the volume of patients, transport/presentation times, severity of presenting symptoms, and final diagnosis. Results. In January, February, March, and April 2019, 10, 11, 17, and 19 patients, respectively, were transported in comparison to 19, 14, 10, and 8 during the same months in 2020. From January through April 2019, there was a 53% increase in transports, compared to a 42% decrease during the same months in 2020, constituting significantly different trend-line slopes (3.30; 95% CI 0.48–6.12 versus -3.70; 95% CI -5.76–-1.64, p = 0.001 ). Patient demographics, comorbidities, and symptom severity were mostly similar over the two time periods, and the number of patients with a final diagnosis of stroke was also similar. However, the median interval from EMS dispatch to ED arrival for patients with a final diagnosis of stroke was significantly longer in January to April 2020 ( 50 ± 11.7 min ) compared to the same time period in 2019 ( 42 ± 8.2 min , p = 0.01 ). Discussion/Conclusion. Our data indicate a decrease in patient transport volumes and longer intervals to EMS activation for suspected stroke care. These results suggest that even in a nonurban location without widespread community transmission, patients may be delaying or avoiding care for severe illnesses such as stroke. Clinicians and public health officials should not ignore the potential impact of pandemic-like illnesses even in areas of relatively low disease prevalence.

Background and objectives: Heat-related illness (HRI) can have significant morbidity and mortality consequences. Research has predominately focused on HRI in the emergency department, yet health care leading up to hospital arrival can impact patient outcomes. Therefore, the purpose of this study was to describe HRI in the prehospital setting. Materials and Methods: A descriptive epidemiological design was utilized using data from the National Emergency Medical Services (EMS) Information System for the 2017&ndash, 2018 calendar years. Variables of interest in this study were: patient demographics (age, gender, race), US census division, urbanicity, dispatch timestamp, incident disposition, primary provider impression, and regional temperatures. Results: There were 34,814 HRIs reported. The majority of patients were white (n = 10,878, 55.6%), males (n = 21,818, 62.7%), and in the 25 to 64 age group (n = 18,489, 53.1%). Most HRIs occurred in the South Atlantic US census division (n = 11,732, 33.7%), during the summer (n = 23,873, 68.6%), and in urban areas (n = 27,541, 83.5%). The hottest regions were East South Central, West South Central, and South Atlantic, with peak summer temperatures in excess of 30.0 &deg, C. In the spring and summer, most regions had near normal temperatures within 0.5 &deg, C of the long-term mean. EMS dispatch was called for an HRI predominately between the hours of 11:00 a.m.&ndash, 6:59 p.m. (n = 26,344, 75.7%), with the majority (27,601, 79.3%) of HRIs considered heat exhaustion and requiring the patient to be treated and transported (n = 24,531, 70.5%). Conclusions: All age groups experienced HRI but particularly those 25 to 64 years old. Targeted education to increase public awareness of HRI in this age group may be needed. Region temperature most likely explains why certain divisions of the US have higher HRI frequency. Afternoons in the summer are when EMS agencies should be prepared for HRI activations. EMS units in high HRI frequency US divisions may need to carry additional treatment interventions for all HRI types.

Early intervention for out-of-hospital cardiac arrest (OHCA) presents a challenge for Emergency Medical Services (EMS) across Europe. Strategies designed to address this include education and training initiatives for citizens and building CPR skills capacity and awareness amongst health care professionals. However, there is a need to improve access to volunteer first responders who can commence CPR and defibrillate before the arrival of EMS. In the UK, initiatives such GoodSAM have integrated crowdsourcing technology with ambulance services to allow them autonomy in alerting responders to OHCAs which is parallel to an EMS dispatch. These services are building capacity to improve the initial ‘call for help’ and time to commence CPR and defibrillation if indicated. The next step is to identify and implement appropriate methods for public engagement, involvement and eventual networking of resources with statutory bodies such as local EMS. As crowdsourcing volunteer responders is at an early stage, there is a need to determine whether crowdsourcing is associated with patient outcomes, what its impact is on those responding to OHCA, whether it facilitates or impedes current services, and whether it is a safe and cost effective way to involve citizens to intervene in the community during cardiac arrest or other medical emergencies? Addressing such issues is likely to provide further insight into the role and effectiveness of new technologies and their potential impact on the wider community.

Background and aims Take-home naloxone, a key response to heroin overdose, may be compromised by the way in which overdose cases are coded in EMS dispatch systems as call-takers direct callers at cardiac arrest events against using any medication. We examined the ways in which confirmed heroin overdose cases attended by ambulances are coded at dispatch to determine whether incorrect coding of overdoses as cardiac arrests may limit the use of take-home naloxone. Methods We conducted a retrospective analysis of coded ambulance clinical records collected in Victoria, Australia from 2012–2017. Counts of heroin overdose cases were examined by dispatch coding (heroin overdose, cardiac/respiratory arrest and ‘other’), along with age, sex, GCS and respiratory rate. Data were analysed using chi-square and Poisson regression for quarterly counts, adjusting for age, sex and patient GCS. Results A total of 5637 heroin overdose cases were attended over the period 2012–2017 (71.4% male, 36.4% aged under 35 years). Almost half (n = 2674, 47.4%) were coded as cardiac/respiratory arrest at dispatch, with 36.8% (n = 2075) coded as heroin overdose and 15.7% (n = 886) coded as other/unknown. Discussion and conclusions Almost half of the heroin overdoses were dispatched according to a protocol that would preclude the use of take-home naloxone prior to ambulance arrival and this changed little over the period in which take-home naloxone programs were operating in Victoria, Australia. EMS should move as quickly as possible to newer versions of dispatch systems that enable the use of naloxone in cases of obvious opioid overdose that may be classified as cardiac/respiratory arrest.

Background National Early Warning Score (NEWS) has been shown to be the best early warning score to predict in-hospital mortality but there is limited information on its predictive value in a prehospital setting. The aim of the current study was to investigate the diagnostic accuracy of NEWS in a prehospital setting using large population-based databases in terms of short-term mortality. Methods We calculated the NEWS scores from retrospective prehospital electronic patient record data and analysed their possible relationship to mortality. We included all patient records for patients 18 years or older with sufficient prehospital data to calculate NEWS from 17 August 2008 to 18 December 2015 encountered by the emergency medical services (EMS) in the Hospital District of Helsinki and Uusimaa, Finland. The primary outcome measure was death within 1 day of EMS dispatch. Results 35 800 patients were included. Their mean (SD) age was 65.8 (19.9) years. The median value of NEWS was 3 (IQR 1-6). The primary outcome of death within 1 day of EMS dispatch occurred in 378 (1.1%) cases. Area under receiver operating characteristic curve (AUROC) for primary outcome of death within 1 day was 0.840 (95% CI 0.823-0.858). AUROC for 1 day mortality in trauma subgroup was 0.901 (95% CI 0.859-0.942). Conclusion Prehospital NEWS predicts mortality within 1 day of EMS dispatch with good diagnostic accuracy.

This paper proposes an Energy Management System (EMS) power dispatch algorithm for a set of various distributed energy resources (DERs) such as distributed generators (DGs) and energy storage systems (ESSs) connected to a 1-MW power grid system. The ESS is composed of a stationary Vanadium Redox Battery (VRB) and Li-ion Electric Vehicle (EV) charging parking lot at a workplace incorporating Vehicle to Grid (V2G) and Grid to Vehicle (G2V) charging capabilities considering no linear modeling of both battery technologies. The simulation study is carried out considering load profile curves of residential and commercial load connected to the system at peak of summer load. Effectiveness and simulation results of the proposed EMS dispatch model were confirmed on various scenarios under the presence of different levels of power mismatch, high intermittence of PV power output and EV penetration.

Objective The aim of the study was to evaluate outcomes after pediatric out-of-hospital cardiopulmonary interventions (CPIs) by emergency medical services (EMS). Methods Children (age, ≤18 years) who received CPI by EMS from 2001 to 2008 were identified from the Utah Department of Health. Cardiopulmonary intervention was defined as oxygenation, ventilation or CPR, and transport to a hospital by EMS. Univariate and multivariable regression analyses evaluated associations between potential predictors and outcomes (death and new neurologic dysfunction). Results A total of 464 patients (58% male) received EMS attention. For the 71% patients (327) who were alive on EMS arrival, 63% (205) received CPI without CPR. Of note, 6% (12) of these patients died after arrival to the hospital and new neurologic dysfunction was diagnosed in 6% (13). Among the 12 patients who died, 50% (6) were younger than 1 year.On multivariable regression analysis, factors associated with increased risk of death before and in-hospital are the following: age younger than 1 year (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.17-0.39), shorter EMS transport time (OR, 0.94; 95% CI, 0.89-0.99), and longer EMS dispatch time (OR, 1.23; 95% CI, 1.08-1.40). Factors associated with increased risk of new neurologic dysfunction are the following: lack of pulse (OR, 0.14; 95% CI, 0.04-0.53), requiring CPR (OR, 6.15; 95% CI, 1.48-25.6), and CPR duration (OR, 1.20; 95% CI, 1.05-1.37). Conclusions Age younger than 1 year, shorter transport time, and longer dispatch time were associated with increased risk of death. Being pulseless upon discovery and receiving CPR were associated with new neurologic dysfunction. Maximizing EMS transport interventions for patients younger than 1 year requiring CPI may improve patient outcomes.

Introduction Studies examining the factors linked to survival after out of hospital cardiac arrest (OHCA) have either aimed to describe the characteristics and outcomes of OHCA in different parts of the world, or focused on certain factors and whether they were associated with survival. Unfortunately, this approach does not measure how strong each factor is in predicting survival after OHCA. Aim To investigate the relative importance of 16 well-recognized factors in OHCA at the time point of ambulance arrival, and before any interventions or medications were given, by using a machine learning approach that implies building models directly from the data, and arranging those factors in order of importance in predicting survival. Methods Using a data-driven approach with a machine learning algorithm, we studied the relative importance of 16 factors assessed during the pre-hospital phase of OHCA. We examined 45,000 cases of OHCA between 2008 and 2016. Results Overall, the top five factors to predict survival in order of importance were: initial rhythm, age, early Cardiopulmonary Resuscitation (CPR, time to CPR and CPR before arrival of EMS), time from EMS dispatch until EMS arrival, and place of cardiac arrest. The largest difference in importance was noted between initial rhythm and the remaining predictors. A number of factors, including time of arrest and sex were of little importance. Conclusion Using machine learning, we confirm that the most important predictor of survival in OHCA is initial rhythm, followed by age, time to start of CPR, EMS response time and place of OHCA. Several factors traditionally viewed as important, e.g. sex, were of little importance.

This work presents a dashboard tool that helps emergency responders analyze and manage spatial-temporal incidents like crime and traffic accidents. It uses state-of-the-art statistical models to learn incident probabilities based on factors such as prior incidents, time and weather. The dashboard can then present historic and predicted incident distributions. It also allows responders to analyze how moving or adding depots (stations for emergency responders) affects average response times, and can make dispatching recommendations based on heuristics. Broadly, it is a one-stop tool that helps responders visualize historical data as well as plan for and respond to incidents.

IntroductionChest pain is one of the most common reasons for ambulance callouts and presentation to Emergency Departments (EDs). Differentiating patients with serious conditions (e.g. acute coronary syndrome [ACS]) from the majority, who have self-limiting, non-cardiac conditions is extremely challenging. This causes over-triage and over-use of healthcare resources. We aimed to systematically review existing evidence on the accuracy of emergency telephone triage to detect ACS or life-threatening conditions associated with chest pain.MethodsWe conducted a systematic review in accordance with PRISMA guidelines. Two independent investigators searched the Embase, Medline, and Cinahl databases for relevant papers. We included retrospective and prospective cohort studies written in English and investigating EMS telephone triage for chest pain patients linked with final diagnosis of ACS. Studies were summarised in a narrative format as the data were not suitable for meta-analysis.ResultIn total, 553 studies were identified from the literature search and cross-referencing. After excluding 550 studies, three were eligible for inclusion. Among those 3 studies, there are different prediction models developed by authors with variation in variables to detect ACS. The result showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions although they are used to triage sign and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions and therefore it showed better sensitivity and NPV.ConclusionEMS dispatch systems accuracy for ACS and life-threatening conditions associated with chest pain is good. Since the dispatch tools were built to triage ambulance response priority based on sign and symptoms, this led to over triage among non-life-threatening chest pain patients. Over triage were slightly reduced by deriving prediction models and showed better sensitivity.

Introduction Stroke treatment must be given within the first few hours of symptom onset, so rapid Emergency Medical Services (EMS) response is essential for positive patient outcomes. Examining EMS response characteristics across temporal and geographical perspectives is critical for improving Alabama's stroke death rate from its current 49th place in the U.S. Methods We examined EMS delay characteristics for patients with suspected strokes from 2018-2019 across Alabama, with particular attention paid to rural and urban differences. We used EMS call data from the Alabama Department of Public Health and defined possible stroke cases as calls where a stroke scale completed by EMS was positive or indeterminate. We coded the time between EMS dispatch and destination arrival as EMS delay. This study incorporates global and local spatio-temporal weighted ordered logistic regression models to evaluate significant non-stationary correlations of factors with EMS delay by accounting for unobserved heterogeneity. Results We examined 17,088 possible stroke cases and found that 74% of these calls had total response times within 60 min. The longest EMS delay occurred in rural counties. EMS response characteristics, such as pre-arrival instructions and advanced vehicle navigation, were associated with shorter delays, while long travel distance and on-scene/transport times were associated with longer EMS delays. The impact of response characteristics on stroke-event-based EMS delay varied significantly across rural and urban counties and time (i.e., between 2018 and 2019). Conclusion The revealed spatio-temporal correlations are useful for EMS personnel in applying effective localized rural and urban EMS response improvement strategies.

The public commonly calls 911 for unintentional ingestions, rather than calling the local poison center. By utilizing a series of scripted questions, 911 dispatchers in Los Angeles determine if an ingestion meets "omega-1" classification. Under such circumstances, the regional poison center is contacted prior to dispatch of paramedics. If the poison center advises that the patient can remain at home, EMS is not dispatched and the patient is followed at home by the poison center. The primary objective is to determine the number of averted transports through involvement of a poison center. A secondary objective is to determine the potential costs and charges saved with the use of such a strategy.A retrospective review of all overdose calls with an "omega-1" classification to a single EMS system between 1/2008-6/2012. Each call culminating in an EMS dispatch was subsequently reviewed by two additional reviewers. The cost savings was determined by utilizing data from the Medical Expenditure Panel Survey (MEPS) from 2000 to 2010. Monetary values were adjusted to 2012 dollars.Three hundred eighteen cases received "omega-1" dispatch classification. EMS was dispatched 19 times (5.98 %), and 11 patients (3.46 %) were ultimately transported. The most common reasons for transport were ambiguity over the ingested agent or amount, and caller insistence. Using these estimates, routine consultation of a regional poison center as part of EMS dispatch averted $486,595 in charges, and $183,279 in payments.Routine consultation of a poison center by emergency medical dispatchers can reduce unnecessary dispatches, ambulance transports, and ED visits with significant associated cost savings.

OBJECTIVES: To determine the etiology of emergency medical services (EMS) activations in 2011 to public buildings, places of recreation or sport, and health care facilities involving children aged 5 to 18 years in Pennsylvania. METHODS: Electronic records documenting 2011 EMS activations as provided by the Pennsylvania Department of Health's Bureau of EMS were reviewed. Data elements (demographics, dispatch complaint, mechanism of injury, primary assessment) from patients aged 5 to 18 years involved in an EMS response call originating from either a public building, a place of recreation and sport, or health care facility were analyzed. RESULTS: A total of 12,289 records were available for analysis. The most common primary assessments from public buildings were traumatic injury, behavioral/psychiatric disorder, syncope/fainting, seizure, and poisoning. The most common primary assessments from places of recreation or sport were traumatic injury, syncope/fainting, altered level of consciousness, respiratory distress, and abdominal pain. The most common primary assessments from health care facilities were behavioral/psychiatric disorder, traumatic injury, abdominal pain, respiratory distress, and syncope/fainting. When examining the mechanism of injury for trauma-related primary assessments, falls were the most common mechanism at all 3 locations, followed by being struck by an object. Of the 1335 serious-incident calls (11% of the total EMS activations meeting inclusion criteria), 61.2% were from public buildings, 14.1% from places of recreation or sport, and 24.7% from health care facilities. CONCLUSIONS: Our identification of common EMS dispatch complaints, mechanisms of injury, and primary assessments can be used in the education of staff and preparation of facilities for medical emergencies and injuries where children spend time. Language: en

Key Points Question What is the association between insurance expansion and emergency medical services (EMS) dispatches for an ambulatory care–sensitive condition like asthma? Findings In this cohort study including 217 303 EMS dispatches for asthma emergencies in New York City, implementation of the Patient Protection and Affordable Care Act was associated with a decrease in calls for asthma emergencies. In adjusted models, larger decreases in the uninsured rate were associated with larger decreases in the asthma EMS dispatch rate. Meaning The findings of this study suggest that insurance expansion may lead to improved outpatient management of ambulatory care–sensitive conditions like asthma, resulting in decreased utilization of EMS., This quasi-experimental cohort study assesses the association between Affordable Care Act implementation and asthma treatment by examining changes in ambulance dispatch rates for asthma emergencies in New York City between 2008 and 2018., Importance Emergency medical services (EMS) are an essential component of the health care system, but the effect of insurance expansion on EMS call volume remains unclear. Objective This study investigated the association between health insurance expansion and EMS dispatches for asthma, an ambulatory care–sensitive condition. We hypothesized that insurance expansion under the Patient Protection and Affordable Care Act (ACA) would be associated with decreased EMS dispatches for asthma emergencies. Design, Setting, and Participants This cohort study examined 14 865 267 ambulance calls dispatched within New York City from 2008 to 2018, including 217 303 calls for asthma-related emergencies, and used interrupted time series analysis to study the change in the annual incidence of EMS dispatches for asthma emergencies after implementation of the ACA. Multivariable linear regression examined the association between the uninsured rate and the incidence of asthma-related dispatches, controlling for population demographic characteristics and air quality index. Exposures Implementation of ACA on January 1, 2014. Main Outcomes and Measures Incidence of EMS dispatches for asthma emergencies per 100 000 population per year (ie, asthma EMS dispatch rate) as classified by the 911 call–taker. Results In this study of 217 303 EMS dispatches for asthma-related emergencies, there was a decrease in the asthma EMS dispatch rate after implementation of the ACA, from a mean (SD) of 261 (24) dispatches per 100 000 population per year preintervention to 211 (47) postintervention (P = .047). This decrease in asthma EMS dispatch rate after ACA implementation was significant on interrupted time series analysis. Prior to 2014, the annual asthma EMS dispatch rate was increasing by 11.8 calls per 100 000 population per year (95% CI, 6.1 to 17.4). After ACA implementation, the asthma EMS dispatch rate decreased annually by 28.5 calls per 100 000 population per year (95% CI, −37.6 to −19.3), a significant change in slope from the preintervention period (P

Objective: Anaphylaxis is a medical emergency requiring prompt recognition and treatment with intramuscular epinephrine to optimize outcomes. To date, there is a paucity of data regarding t...

IntroductionTime is the most crucial factor limiting efficacy of intravenous thrombolysis (IVT) and intra-arterial thrombectomy (IAT). The delay between alarming the Emergency Medical Services (EMS) dispatch office and IVT/IAT initiation, that is, the‘total system delay’(TSD), depends on logistics and team effort. A promising method to reduce TSD is real-time audio-visual feedback to caregivers involved. With ‘A Reduction in Time with Electronic Monitoring in Stroke’ (ARTEMIS), we aim to investigate the effect of real-time audio-visual feedback on actual TSD to IVT/IAT to caregivers.Methods and analysisARTEMIS is a multiregional, multicentre, randomised open end-point trial including patients ≥18 years considered IVT/IAT-eligible by the EMS dispatch office or on-site EMS personnel. Patients are electronically tracked and randomised for real-time audio-visual feedback on TSD to caregivers via premounted handhelds and tablets throughout the TSD trajectory. Primary outcome is TSD to IVT/IAT. Secondary outcomes comprise proportion of IVT/IAT-treated patients, symptomatic intracerebral haemorrhage, IVT/IAT-treated stroke mimics, clinical outcome after three months and cost-effectiveness. Separate analyses for IAT-patients with or without prior IVT, within or out of office hours and EMS region will be performed. With 75 IAT-patients and 225 IVT-patients in each arm, we will be able to demonstrate a 20 min difference in TSD to IAT and a 10 min difference in TSD to IVT (p=0.05 and power=0.8).Ethics and disseminationStudy findings will be disseminated through peer-reviewed journals and (inter)national conference presentations.Trial registration numberNCT02808806

Introduction: Despite evidence from other healthcare settings that language barriers negatively impact patient outcomes, the literature on language barriers in emergency medical services (EMS) has not been previously summarized. The objective of this study is to systematically review existing studies of the impact of language barriers on prehospital emergency care and identify opportunities for future research. Methods: A systematic review with narrative synthesis of publications with populations specific to the prehospital setting and outcome measures specific to language barriers was conducted. A four-prong search strategy of academic databases (PubMed, Academic Search Complete, and Clinical Key) through March 2015, web-based search for gray literature, search of citation lists, and review of key conference proceedings using pre-defined eligibility criteria was used. Language-related outcomes were categorized and reported as community-specific outcomes, EMS provider-specific outcomes, patient-specific outcomes, or health system-specific outcomes. Results: Twenty-two studies met eligibility criteria for review. Ten publications (45%) focused on community-specific outcomes. Language barriers are perceived as a barrier by minority language speaking communities to activating EMS. Eleven publications (50%) reported outcomes specific to EMS providers, with six of these studies focused on EMS dispatch. EMS dispatchers describe less accurate and delayed dispatch of resources when confronted with language discordant callers, as well as limitations in the ability to provide medical direction to callers. There is a paucity of research on EMS treatment and transport decisions, and no studies provided patient-specific or health system-specific outcomes. Key research gaps include identifying the mechanisms by which language barriers impact care, the effect of language barriers on EMS utilization and clinically significant outcomes, and the cost implications of addressing language barriers. Conclusion: The existing research on prehospital language barriers is largely exploratory, and substantial gaps in understanding the interaction between language barriers and prehospital care have yet to be addressed. Future research should be focused on clarifying the clinical and cost implications of prehospital language barriers.

ObjectivesEmergency medical services (EMS) programs, which provide an alternative to traditional EMS dispatch or transport to the emergency department (ED), are becoming widely implemented. This scoping review identified and catalogued all outcomes used to measure such alternative EMS programs.Data SourceBroad systematized bibliographic and grey literature searches were conducted.Study SelectionInclusion criteria were 911 callers/EMS patients, reported on alternatives to traditional EMS dispatch OR traditional EMS transport to the ED, and reported an outcome measure.Data ExtractionThe reports were categorized as either alternative to dispatch or to EMS transport, and outcome measures were categorized and described.Data SynthesisThe bibliographic search retrieved 13,215 records, of which 34 articles met the inclusion criteria, with an additional 10 added from reference list hand-searching (n=44 included). In the grey literature search, 31 websites were identified, from which four met criteria and were retrieved (n=4 included). Fifteen reports (16 studies) described alternatives to EMS dispatch, and 33 reports described alternatives to EMS transport. The most common outcomes reported in the alternatives to EMS dispatch reports were service utilization and decision accuracy. Twenty-four different specific outcomes were reported. The most common outcomes reported in the alternatives to EMS transport reports were service utilization and safety, and 50 different specific outcomes were reported.ConclusionsNumerous outcome measures were identified in reports of alternative EMS programs, which were catalogued and described. Researchers and program leaders should achieve consensus on uniform outcome measures, to allow benchmarking and improve comparison across programs.

BACKGROUND: There is little data as to what extent national Emergency Medical Services (EMS; 911) utilize poison control centers (PCCs). A review of data from our PCC was done to better understand this relationship and to identify potential improvements in patient care and health care savings. METHODS: Retrospective chart review of a single PCC to identify calls originating from 911 sources over a 4-year study period (1/1/08-12/31/11). Recorded variables included the origin of call to the PCC, intent of exposure, symptoms, management site, hospital admission, and death. Odds ratios (OR) were developed using multiple logistic regressions to identify risk factors for EMS dispatch, management site, and the need for hospital admission. RESULTS: A total of 7556 charts were identified; 4382 (58%) met inclusion criteria. Most calls (63.3%) involved accidental exposures and 31% were self-harm or misuse. A total of 2517 (57.4%) patients had symptoms and 2044 (50.8%) were transported to an Emergency Department (ED). Over 38% of calls (n = 1696) were handled primarily by the PCC and did not result in EMS dispatch; only 6.5% of cases (n = 287) with initial PCC involvement resulted in crew dispatch. There were 955 (21.8%) cases that resulted in admission, and five deaths. The OR for being transported to an ED was 45.4 (95% confidence interval [CI]: 30.2-68.4) when the crew was dispatched by the PCC. Hospital admission was predicted by intent for self-harm (OR 5.0; 95% CI: 4.1-6.2) and the presence of symptoms (OR 2.43; 95% CI: 1.9-3.0). The ORs for several other predictive variables are also reported. CONCLUSIONS: When 911 providers contact a PCC about poisoning-related emergencies, a history of intentional exposure and the presence of symptoms each predicted EMS dispatch by the PCC, patient transport to an ED, and hospital admission. Early involvement of a PCC may prevent the need for EMS activation or patient transfer to a health care facility. Language: en

Hurricanes Irene and Sandy heavily impacted New Jersey. Investigating EMS dispatch trends during these storms may allow us to prepare for future disasters.Our objectives to characterize the types of EMS dispatches immediately before, during, and after landfall compared to a control period.This retrospective study was conducted at a large EMS dispatch center that provides first responders, Basic Life Support (BLS), Advanced Life Support (ALS), and critical care transport services to an area with approximately 20 receiving hospitals including a Level I Trauma Center. At peak staffing, there are 8-10 ALS vehicles, 25 BLS vehicles, and 3 critical care transport vehicles deployed. We included of the day of landfall and seven days before and after. We compared dispatch data to a control period in 2010 that mirrored Hurricane Sandy the dates of. Descriptive statistics and two way ANOVA were used to assess dispatch, gender and age differences.We found Hurricane Sandy dispatches peaked 2 days after landfall. Both ALS and BLS had an increase in age in the post-Sandy period compared to the pre-Sandy (ALS 58.5 to 64.2, p = 0.005, ANOVA p = 0.078; BLS 47.4 to 56.3, p0.001, ANOVA p = 0.001). There were 17 "hurricane related" (loss of power related issues, oxygen supply depleted, evacuation) and 15 carbon monoxide dispatches in the post-Sandy period and none in the others, including peri-Irene. The average age of cardiac arrest dispatches was lower in the post-Irene group compared to pre-Irene (74.3 to 47.8, p = 0.023). There were no critical care requests before or after Hurricane Sandy, but there were 14 around Hurricane Irene and 10 surrounding the control period.Dispatch data can inform natural disaster planning. Education efforts can focus on geriatric patients, as well as resource distribution planning for an increase in geriatric populations. However, pattern variability between storms shows further study is needed to clarify exactly which resources should be utilized in order to maintain an ideal response to a natural disaster.

Background:Helicopter emergency medical services (HEMS) and ground EMS (GEMS) are both integral parts of out-of-hospital transport systems for patients with ST-elevation myocardial infarction (STEMI) undergoing emergency transport for primary percutaneous coronary intervention (PPCI). There are firm data linking time savings for PPCI transports with improved outcome. A previous pilot analysis generated preliminary estimates for potential HEMS-associated time savings for PPCI transports.Methods:This non-interventional multicenter study conducted over the period 2012–2014 at six centers in the USA and in the State of Qatar assessed a consecutive series of HEMS transports for PPCI; at one center consecutive GEMS transports of at least 15 miles were also assessed if they came from sites that also used HEMS (dual-mode referring hospitals). The study assessed time from ground or air EMS dispatch to transport a patient to a cardiac center, through to the time of patient arrival at the receiving cardiac unit, to determine proportions of patients arriving within accepted 90- and 120-minute time windows for PPCI. Actual times were compared to “route-mapping” GEMS times generated using geographical information software. HEMS' potential time savings were calculated using program-specific aircraft characteristics, and the potential time savings for HEMS was translated into estimated mortality benefit.Results:The study included 257 HEMS and 27 GEMS cases. HEMS cases had a high rate of overall transport time (from dispatch to receiving cardiac unit arrival) that fell within the predefined windows of 90 minutes (67.7% of HEMS cases) and 120 minutes (91.1% of HEMS cases). As compared to the calculated GEMS times, HEMS was estimated to accrue a median time saving of 32 minutes (interquartile range, 17–46). The number needed to transport for HEMS to get one additional case to PPCI within 90 minutes was 3. In the varied contexts of this multicenter study, the number of lives saved by HEMS, solely through time savings, was calculated as 1.34 per 100 HEMS PPCI transports.Conclusions:In this multicenter study, HEMS PPCI transport was found to be appropriate as defined by meeting predefined time windows. The overall estimate for lives saved through time savings alone was consistent with previous pilot data and was also generally consistent with favorable cost-effectiveness. Further research is necessary to confirm these findings, but judicious HEMS deployment for PPCI transports is justified by these data.

Aim The Advanced Medical Priority Dispatch (AMPDS) system is used to triage emergency medical calls in Victoria, Australia. However, the level of response assigned to each AMPDS Event Type (ET), which may include triage away from an emergency medical service (EMS) attendance, is determined by Ambulance Victoria. This study aimed to increase the proportion of low-acuity calls diverted to secondary triage and onto an alternative service provider (ASP), ultimately reducing EMS demand. Methods A review of the level of EMS response assigned to AMPDS ET was conducted using research, audit and clinical expertise. Existing ‘time-critical’ and ‘acute but not time-critical’ ETs were assessed for suitability against the assigned level of EMS response and existing dispatch rules. An analysis of events occurring pre-reform (8 Feb–8 May 2016) and post-reform (9 May–8 Aug 2016) was conducted. Results A total of 105 ‘time-critical’ ETs were assessed as suitable for downgrade to an ‘acute’ response, while 221 ‘acute’ and ‘time-critical’ ETs were deemed suitable for diversion to secondary triage. The changes were implemented using staged approach, commencing in October 2015. The proportion of cases receiving a ‘time-critical’ EMS response decreased from 55.1% pre-reform to 48.9% post-reform (p Conclusion This study provides a sound methodological approach for revising EMS dispatch protocols. Ongoing monitoring of the dispatch changes aims to identify areas that may benefit from further optimisation. Conflict of interest None declared. Funding None declared.

Aim National Early Warning Score (NEWS)1 has been shown to be the best early warning score to predict in-hospital mortality.2 A single study also supports it’s use in a prehospital setting.3 The aim of the current retrospective cohort study was to investigate the association of prehospital NEWS and mortality using large population based databases. Methods We analysed prehospital electronic patient record data to calculate NEWS values and compared these to national mortality data. We included all patient records for patients 18 years or older with sufficient prehospital data to calculate NEWS from 17 August 2008 to 18 December 2015 encountered by the emergency medical services (EMS) in the Hospital District of Helsinki and Uusimaa, Finland. The primary outcome measure was death within one day of EMS dispatch. Results 35 845 cases were included. Mean age of patients was 65.8 years (SD 19.9 years). 47.5% of patients were male. Median NEWS was 3 (IQR 1–5). The primary outcome of death within one day of EMS dispatch occurred in 441 (1.2%) cases. The AUROC for primary outcome of death within one day was 0.502. Conclusion In our retrospective cohort study, prehospital NEWS did not predict mortality within one day of EMS dispatch. References Williams B, Alberti G, Ball C, Bell D, Binks R, Durham L. National Early Warning Score (NEWS): Standardising the assessment of acute-illness severity in the NHS. London: The Royal College of Physicians; 2012 Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation2013;84:465–70. Silcock DJ, Corfield AR, Gowens PA, Rooney KD. Validation of the National Early Warning Score in the prehospital setting. Resuscitation2015;89:31–5. Conflict of interest None declared. Funding None declared.

Background: The mobile health and social care unit – Sociolancen (MHSCU) is a specialized unit within the Emergency Medical Services (EMS) of the Capital Region of Denmark. The unit provides acute social care for homeless and social deprived groups and is staffed with a social worker and a paramedic and available through the EMS dispatch during daytime. The MHSCU is dispatched to citizens where the need for acute social care is suspected, falling outside the normal scope of practice for emergency ambulances. The aim of this study was to evaluate the dispatch outcomes of the MHSCU and the constellation of paramedical and social effort. Methods: Data on the total number of MHSCU dispatches and outcomes in 2016 and 2017 was retrieved from the dispatch system operated by EMS Copenhagen. Outcome data was grouped for descriptive statistics. Results: During the data collection period the MHSCU was dispatched 2976 times. The outcome resulted in 384 (12.9%) citizens being brought to a somatic emergency department (ED) and 255 (8.6%) citizens being brought to a psychiatric ED. A total of 355 (11.9%) citizens were left to selfcare and 196 (6.6%) citizens were brought to a shelter. Number of citizens handed over from emergency ambulances was 41 (1.4%), number of citizens handed over to emergency ambulances was 4 (0.1%), number of citizens handed over to police was 13 (0.4%). In 1386 (46.6%) cases MHSCU were doing outreach work, citizen had left scene or MHSCU was cancelled. Number of dispatches labeled ‘unknown’ was 342 (11.5%). Conclusions: The outcome of MHSCU dispatches indicate the need for both paramedical and social staffing when attending the homeless and social deprived citizens, as there is an approximately even distribution between health related and social related referral. Half of dispatches covers outreach work not within the normal scope of practice for emergency ambulances, enabling MHSCU to provide community service and security. Further, based on the low referral to emergency ambulances and police, the dispatch of MHSCU seems well-prioritized. Acknowledgments: The authors wish to thank Paramedic Martin Betzer for assistance.

The decision about which servers to dispatch to which customers is an important aspect of service systems. This decision is complicated when servers must be equitably—as well as efficiently—dispatched to customers. In this paper, we formulate a model for determining how to optimally dispatch distinguishable servers to prioritized customers given a set of equity constraints. These issues are examined through the lens of emergency medical service (EMS) dispatch, for which a Markov decision process model is developed that captures how to dispatch ambulances (servers) to prioritized patients (customers). It is assumed that customers arrive sequentially, with the priority and location of each customer becoming known upon arrival. Four types of equity constraints are considered—two of which reflect customer equity and two of which reflect server equity—all of which draw upon the decision analytic and social science literature to compare the effects of different notions of equity on the resulting dispatching policies. The Markov decision processes are formulated as equity-constrained linear programming models. A computational example is applied to an EMS system to compare the different equity models.

Background: Immediately after a stroke, the time it takes to reach a designated stroke center can determine the patient’s chances of recovery or permanent disability. In pre-hospital care, the first level of care occurs when 911 is called, second when the paramedics arrive and triage, and third, transport to the nearest primary stroke center (PSC). When emergency medical dispatchers (EMD) initially recognize stroke they provide critical stroke triage codes guiding the paramedic’s decision in appropriate hospital choice, saving time and improving patient recovery. This study assessed EMD and paramedic stroke recognition and performance in an urban area. Hypothesis: EMD recognition of stroke would provide paramedics adequate codes for correct recognition and influence transports to area primary stroke centers (PSCs). Methods: All emergency medical service (EMS) transports in an urban county area (392,664 population) during 2014 were retrospectively analyzed. The transports encompassed True/Negatives, False/Positives, False/Negatives and True/Positives for data on the number and percentages of EMS correctly identified stroke ground transport 911 calls. Dispatch impressions of calls were compared to paramedic decisions and confirmed by hospital ICD-9-CM billing codes 430-438. Transports to area PSC and non-PSC hospitals were determined. Results: Over 12 months, in N=40,171 total transports, EMDs impression of strokes were n=942 with 51.3% confirmed as strokes by paramedics. The other 47.6% of calls reported as strokes by EMDs were coded by paramedics as syncope/fainting, altered level of consciousness, abdominal pain, diabetic, behavioral, cardiac rhythm disturbance and seizures. Paramedic reported strokes were coded by dispatchers as 52.0% strokes/CVA or as headaches, sick person, unconscious/fainting, fall victim, chest pain, convulsions/seizures and breathing problems. Significantly more stroke-related deliveries were made to PSCs (55%, p Conclusion: EMS dispatch and paramedic services could benefit from stroke recognition education.

There are no contemporary national-level data on Emergency Medical Services (EMS) response times for suspected stroke in the United States (US). Because effective stroke treatment is time-dependent, we characterized response times for suspected stroke, and examined whether they met guideline recommendations.Using the National EMS Information System dataset, we included 911 calls for patients ≥ 18 years with an EMS provider impression of stroke. We examined variation in the total EMS response time by dispatch notification of stroke, age, sex, race, region, time of day, day of the week, as well as the proportion of EMS responses that met guideline recommended response times. Total EMS response time included call center dispatch time (receipt of call by dispatch to EMS being notified), EMS dispatch time (dispatch informing EMS to EMS starts moving), time to scene (EMS starts moving to EMS arrival on scene), time on scene (EMS arrival on scene to EMS leaving scene), and transport time (EMS leaving scene to reaching treatment facility).We identified 184,179 events with primary impressions of stroke (mean age 70.4 ± 16.4 years, 55% male). Median total EMS response time was 36 (IQR 28.7-48.0) minutes. Longer response times were observed for patients aged 65-74 years, of white race, females, and from non-urban areas. Dispatch identification of stroke versus "other" was associated with marginally faster response times (36.0 versus 36.7 minutes, p0.01). When compared to recommended guidelines, 78% of EMS responses met dispatch delay of1 minute, 72% met time to scene of8 minutes, and 46% met on-scene time of15 minutes.In the United States, time from receipt of 9-1-1 calls to treatment center arrival takes a median of 36 minutes for stroke patients, an improvement upon previously published times. The fact that 22%-46% of EMS responses did not meet stroke guidelines highlights an opportunity for improvement. Future studies should examine EMS diagnostic accuracy nationally or regionally using outcomes based approaches, as accurate recognition of prehospital strokes is vital in order to improve response times, adhere to guidelines, and ultimately provide timely and effective stroke treatment.

Objectives: Delays in the clinical handover of patient care from emergency medical services (EMS) to the ED because of ED crowding are a substantial problem for many EMS systems. This study was conducted to quantify handover delays experienced by the Ambulance Service of New South Wales (ASNSW), and to investigate patient and system factors associated with handover delay. Methods: A retrospective study of EMS dispatch and ambulance patient care records was conducted for all patients transported by ASNSW in January/April/July/October 2009. Patient characteristics and time intervals were summarised using descriptive statistics, with handover delay categorised as

Background The Medical Priority Dispatch System (MPDS) is an emergency medical dispatch (EMD) system that is widely used to prioritize 9-1-1 calls and optimize resource allocation. Calls are assigned an MPDS determinant, which includes a number (1–32) representing chief complaint and priority (Alpha through Echo) representing acuity. Objective This study evaluates the number of emergency dispatches per cardiac arrest (NOD-CA) in cardiac arrest and non-cardiac arrest MPDS determinants. Methods All patients assigned a determinant by MPDS from January 1, 2008 to June 30, 2009 in a large metropolitan area were included. Prehospital electronic patient care records were linked with dispatch data. For each MPDS determinant, the number of calls for which the paramedic impression was listed as "Cardiac Arrest – Non-Traumatic" was tabulated. The NOD-CA was calculated for each cardiac arrest and non-cardiac arrest MPDS determinant. Non-MPDS calls with cardiac arrests were analyzed separately. Results A total of 101,642 patients were included. Among them, 555 had "Cardiac Arrest – Non-Traumatic" listed as the paramedic impression. The Cardiac/Respiratory Arrest/Death protocol had the highest number of cardiac arrests (285), followed by Breathing Problems (99) and Unconscious/Fainting (76). Overall, 183 dispatched occurred for each cardiac arrest, 131 of which resulted in a lights and sirens response. The NOD-CA was 7 in the Cardiac Arrest/Death protocol, 122 in Breathing Problems, and 104 in Unconscious/Fainting. 31 Cardiac arrests occurred in non-MPDS dispatch categories ( N =62,989), most of which were calls for medical assistance from police or fire units. Conclusions MPDS was designed to detect cardiac arrest with high sensitivity, leading to a significant degree of mistriage. The number of dispatches for each cardiac arrest may be a useful way to quantify the degree of mistriage and optimize EMS dispatch. This large descriptive study revealed a low NOD-CA in most cardiac arrest MPDS determinants. We demonstrated significant variability in the NOD-CA among non-cardiac arrest MPDS determinants, and few cardiac arrests in non-MPDS dispatch categories.

BACKGROUND Although the prognosis of many diseases relies on timely diagnosis and treatment, the admission process of patients taken into hospitals by emergency medical services (EMS) is often affected by delays or rejection of patients. A smooth interaction between these two phases is critical for the prognosis in time-critical situations. The implementation of an in-hospital coordinating emergency physician (ZINK) responsible for the admission of EMS patients, a concept which was developed and introduced in our hospital, is suggested. CONCEPT The ZINK represented by the most senior anaesthesiologist on duty is responsible for the registration of emergency patients from all departments under one telephone number, decides on admittance, alerts necessary resources and documents inquiries. RESULTS After an initial three calls the ZINK is currently contacted on average 8 times per day and experiences the satisfaction of EMS personnel and EMS dispatch centers. The number of rejected emergency patients has decreased by over 80%. CONCLUSION Implementation of a ZINK can optimize the process of hospital admission in emergency patients. This can decrease the legal risk of hospitals and improve the external representation. Hospitals should consider designating a ZINK.

RELIABILITY AND VALIDITY OF EMS DISPATCH CODE-BASED CATEGORIZATION OF EMERGENCY PATIENTS FOR SYNDROMIC SURVEILLANCE March 28, 2008 A retrospective study involving the secondary analysis of public health surveillance records was undertaken to characterize the reliability and validity of an EMS dispatch data-based scheme for assigning emergency patients to surveillance syndromes in relation to two other schemes, one based on hospital ED clinicians' manual categorization according to patients' chief complaint and clinical presentation, and one based on ICD-9 coded hospital ED diagnoses. Comparisons of a sample of individual emergency patients' syndrome assignments according to the EMS versus each of the two hospital categorization schemes were made by matching EMS run records to their corresponding emergency department patient encounter records. This new, linked dataset was analyzed to assess the level of agreement beyond chance between the three possible pairs of syndrome categorization schemes in assigning patients to a respiratory or non-respiratory syndrome and to a gastrointestinal or nongastrointestinal syndrome. Cohen's kappa statistics were used to measure chance-adjusted agreement between categorization schemes (raters). Z-tests and a chi-square-like test based on the variance of the kappa statistic were used

Introduction:On 14 August 2003, New York City and a large portion of the northeastern United States experienced the largest blackout in the history of the country. An analysis of such a widespread disaster on emergency medical service (EMS) operations may assist in planning for and managing such disasters in the future.Methods:A retrospective review of all EMS activity within New York City's 9-1-1 emergency telephone system during the 29 hours during which all or parts of the city were without power (16:11 hours (h) on 14 August 2003 until 21:03 h on 15 August 2003) was performed. Control periods were established utilizing identical time periods during the five weeks preceding the blackout.Results:Significant increases were identified in the overall EMS demand (7,844 incidents vs. 3,860 incidents; pConclusions:The citywide blackout resulted in dramatic changes in the demands upon the EMS system of New York City, the types of patients for whom EMS providers were assigned to provide care, and the dispositions for those assignments. During this time of increased, system-wide demand, the use of cross-trained firefighter and first-responder engine companies resulted in improved response times to cardiac arrest patients. Finally, the ability of the EMS dispatch center to process the increased requests for EMS assistance proved to be the rate-limiting step in responding to these emergencies.These findings will prove useful in planning for future blackouts or any disaster that may broadly impact the infrastructure of a city.

To validate the predictive ability of previously derived emergency medical services (EMS) dispatch codes to identify patients with low-acuity illnesses.This prospective descriptive study was conducted in Rochester, New York. An expert panel reviewed and modified a previously derived set of low-priority EMS dispatch codes. Patients assigned these 21 codes between July 2002 and June 2003 were included for further analysis. Dispatch data and level of EMS care were recorded for each dispatch code. The proportion of low-acuity patients (i.e., those who received only basic life support (BLS) care or those who were not transported using lights and sirens) was determined using previously established definitions. Codes were defined as associated with low-acuity patients if the lower bound of the 95% confidence interval (CI) exceeded 90%. Medical records for patients identified as high-acuity were reviewed to evaluate whether the advanced life support (ALS) level care that was provided had a clinical impact.Emergency medical services cared for 43,602 patients during the study, and 7,540 were dispatched as low-priority. We found that 7,197 (95%; 95% CI: 95-96%) of these patients met low-acuity criteria and that 11 of the evaluated codes were validated, with low-acuity care provided at least 90% of the time. Of the 343 patients identified as high-acuity, 62 (18%; 95% CI: 14-23%) were determined to have received interventions that had a clinical impact.This study prospectively validates 11 EMS dispatch codes as being associated with low-acuity patients. These codes could be used to triage EMS patients based on dispatch information.

"The Neely Conference: Developing Research Criteria to Define Medical Necessity in EMS" convened emergency medical services (EMS) physicians, researchers, administrators, providers, and federal agency representatives to begin the development of a set of uniform triage criteria and outcome measures that could be used to study and evaluate medical necessity among EMS patients. These standardized criteria might be used in research studies examining EMS dispatch and response (e.g., dispatch triage protocols, alternative response configurations), and EMS treatment and transport (e.g., field triage protocols, alternative care destinations). The conference process included review and analysis of the literature, expert judgment, and consensus building. There was general agreement on the following: 1. Any dispatch triage or field triage system that is developed must be designed to offer patients alternatives to EMS, not to refuse care to patients. 2. It is theoretically possible to develop a set of clinical criteria for need. Some groups of patients will clearly need a traditional EMS response and other groups will not, but this has yet to be defined. 3. In addition to clinical criteria, certain social and other nonclinical criteria such as pain or potential abuse may be used to justify a response. 4. Communication barriers, patient age, special needs, and other conditions complicate patient assessment but should not exclude patients from consideration for alternate triage or transport. 5. These research questions are important, and standard sets of outcome measures are needed so that different studies and innovative programs can be compared.