Aligning ambulance dispatch priority to patient acuity: A methodology

Andrew, Emily; Jones, Colin; Stephenson, Michael; Walker, Tony; Bernard, Stephen; Cameron, Peter; Smith, Karen

doi:10.1111/1742-6723.13181

Cited by 25 publications

(20 citation statements)

References 23 publications

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“…More than 5 million people reside in the capital city of Melbourne. Emergency phone calls are made to Triple Zero (000) and are triaged by non-medically trained call-takers using the Medical Priority Dispatch System 14. The EMS is two-tiered, with ALS and intensive care paramedics responding to medical emergencies.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of paediatric patients who are not transported to hospital by Emergency Medical Services: a data linkage study

2022

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BackgroundData on the safety of non-transport decisions for paediatric patients attended by Emergency Medical Services (EMS) are lacking. We describe the characteristics and outcomes of paediatric non-transported patients in Victoria, Australia.MethodsA retrospective data linkage study of consecutive paediatric (aged <18 years) non-transported patients between January 2015 and June 2019. Patients were linked to ED, hospital admission and death records. Multivariable logistic regression analyses were used to determine factors associated with EMS recontact, ED presentation, hospital admission and an adverse event (death/cardiac arrest, intensive care unit admission or highest ED triage category) within 48 hours of the initial emergency call.ResultsIn total, 62 975 non-transported patients were included. The mean age was 7.1 (SD 6.0) years and 48.9% were male. Overall, 2.2% recontacted the EMS within 48 hours, 13.7% self-presented to a public ED, 2.4% were admitted to hospital and 0.1% had an adverse event, including two deaths. Among patients with paramedic-initiated non-transport (excluding transport refusals and transport via other means), 5.6% presented to a public ED, 1.1% were admitted to hospital and 0.05% had an adverse event. In the overall population, an abnormal vital sign on initial assessment increased the odds of hospital admission and an adverse event. Among paramedic-initiated non-transports, cases occurring in the early hours of the morning (04:00–08:00 hours) were associated with increased odds of subsequent hospital admission, while the odds of ED presentation and hospital admission also increased with increasing prior exposure to non-transported cases.ConclusionAdverse events were rare among paramedic-initiated non-transport cases. Vital sign derangements and attendance by paramedics with higher prior exposure to non-transports were associated with poorer outcomes and may be used to improve safety.

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Section: Methodsmentioning

confidence: 99%

Outcomes of paediatric patients who are not transported to hospital by Emergency Medical Services: a data linkage study

2022

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“…The list of indicators (see Table A1) comprises medications administered, clinical interventions and observation parameters, as recorded by paramedics in the ePCR and were agreed by the reference group to be indicative of a high-acuity incident, and for which an L&S response is appropriate. The development of the high acuity indicators at SJ-WA is based on a similar approach to that used by Ambulance Victoria (Andrew et al , 2019).…”

Section: Methodsmentioning

confidence: 99%

Can ambulance dispatch categories discriminate traffic incidents that do/do not require a lights and sirens response?

Ceklic

Tohira

Finn

et al. 2021

IJES

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PurposeTraffic incidents vary considerably in their severity, and the dispatch categories assigned during emergency ambulance calls aim to identify those incidents in greatest need of a lights and sirens (L&S) response. The purpose of this study was to determine whether dispatch categories could discriminate between those traffic incidents that do/do not require an L&S response.Design/methodology/approachA retrospective cohort study of ambulance records was conducted. The predictor variable was the Traffic/Transportation dispatch categories assigned by call-takers. The outcome variable was whether each incident required an L&S response. Possible thresholds for identifying dispatch categories that require an L&S response were developed. Sensitivity and specificity were calculated for each threshold.FindingsThere were 17,099 patients in 13,325 traffic incidents dispatched as Traffic/Transportation over the study period. “Possible death at scene” ‘had the highest odds (OR 22.07, 95% CI 1.06–461.46) and “no injuries” the lowest odds (OR 0.28 95% CI 0.14–0.58) of requiring an L&S response compared to the referent group. The area under the ROC curve was 0.65, 95% CI [0.64, 0.67]. It was found that Traffic/Transportation dispatch categories allocated during emergency ambulance calls had limited ability to discriminate those incidents that do/do not require an L&S response to the scene of a crash.Originality/valueThis research makes a unique contribution, as it considers traffic incidents not as a single entity but rather as a number of dispatch categories which has practical implications for those emergency medical services dispatching ambulances to the scene.

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“…Investment in EMS infrastructures can optimize EMS dispatch, response and transport times, reduce rural–urban disparities, and enhance transfer systems. 101 102 103 104 105 106 107 108 109 110 Disparities in field triage may widen with the advent of advanced interventions, such as neuro-ICUs, available only in select medical centers. 111 112 113 For example, Ward and colleagues estimated that less than one-third of the U.S. population has timely transport access to a neurocritical care facility, and 21 states lacked access entirely.…”

Section: Hyperacute Phasementioning

confidence: 99%

Neuroethics across the Disorders of Consciousness Care Continuum

Young

Peterson

2022

Semin Neurol

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This review provides an ethical analysis of disorders of consciousness (DoC) along the care continuum, from preinjury to injury, acute care to subacute care and early rehabilitation, and finally transitioning to chronic rehabilitation and societal reintegration. We provide an actionable, chronological assessment of ethical issues related to DoC care. This expands upon established ethics literature, which focuses almost exclusively on the clinical encounter for DoC. Our goal is to broaden the aperture of ethical analysis to address how social and environmental conditions predispose some persons to brain injury, and how such conditions might also pose barriers to meaningful societal reintegration after recovery.

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Aligning ambulance dispatch priority to patient acuity: A methodology

Cited by 25 publications

References 23 publications

Outcomes of paediatric patients who are not transported to hospital by Emergency Medical Services: a data linkage study

Outcomes of paediatric patients who are not transported to hospital by Emergency Medical Services: a data linkage study

Can ambulance dispatch categories discriminate traffic incidents that do/do not require a lights and sirens response?

Neuroethics across the Disorders of Consciousness Care Continuum

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