An Effective Prehospital Emergency System

McManus, William F.; Tresch, Donald D.; Darin, Joseph C.

doi:10.1097/00005373-197704000-00008

Cited by 40 publications

(42 citation statements)

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“…Since then, EMS has evolved from a rudimentary hospital transport service with minimally trained personnel to a sophisticated public health system delivering advanced medical care to patients with medical emergencies in the out-of-hospital environment. [1][2][3][4][5][6] Today, more than 25 million EMS responses are made in the United States each year, including a significant number (5-15%) that may involve the advanced monitoring and invasive interventional skills of paramedics. [6][7][8][9] In retrospect, however, between 30% and 50% of all EMS responses still are made to nonemergency situations, and an equal number of cases require only basic life support (BLS) skills such as splinting and spinal immobilization.…”

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confidence: 99%

“…[1][2][3][4][5][6] Today, more than 25 million EMS responses are made in the United States each year, including a significant number (5-15%) that may involve the advanced monitoring and invasive interventional skills of paramedics. [6][7][8][9] In retrospect, however, between 30% and 50% of all EMS responses still are made to nonemergency situations, and an equal number of cases require only basic life support (BLS) skills such as splinting and spinal immobilization. 7,10 Recognizing that only a small percentage of calls ever utilize advanced life support (ALS) skills, modern priority dispatch systems have been developed that either triage the need for a rapid, ''lights and siren'' response (which may pose some additional traffic risk) or, in other cases, simply limit paramedic deployment to those emergencies that probably will require advanced skills.…”

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confidence: 99%

“…7,[10][11][12][13][14][15][16][17][18][19][20][21] By sending nonparamedic ambulances staffed by BLS-providing emergency medical technicians (EMTs) to the lower-priority calls, EMS systems can function with fewer paramedics. 1,6,7,22 With fewer paramedics, each paramedic gains more experience with those true emergency situations for which he or she needs to be focused, thereby improving his or her clinical performance in these situations. 6,7,13,[16][17][18] In addition, by making the pool of paramedic ambulances (or other ALS response units) more available, one can actually improve response intervals to the more critical cases.…”

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confidence: 99%

“…1,6,7,22 With fewer paramedics, each paramedic gains more experience with those true emergency situations for which he or she needs to be focused, thereby improving his or her clinical performance in these situations. 6,7,13,[16][17][18] In addition, by making the pool of paramedic ambulances (or other ALS response units) more available, one can actually improve response intervals to the more critical cases. 7,22 In many systems, rapidly-responding fire suppression apparatus or police vehicles, staffed with crews who can provide BLS, are used to supplement the initial ambulance response.…”

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confidence: 99%

“…7,22 In many systems, rapidly-responding fire suppression apparatus or police vehicles, staffed with crews who can provide BLS, are used to supplement the initial ambulance response. 1,6,21 Although they do not transport patients, these ''neighborhood'' crews can routinely arrive much faster than ambulances (for myriad reasons) and thus provide more rapid basic medical care, ranging from oxygen administration and spinal immobilization to basic cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. 21 While the traditional use of these ''first responders'' (FRs) has been to provide a more reliable and rapid response to critical cases requiring time-dependent interventions (e.g., cardiac arrest, chokings), it may also be considered reasonable to dispatch well-trained FRs to provide faster triage and evaluation of those cases that may not require either urgent ambulance responses or even hospital transport altogether.…”

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confidence: 99%

See 4 more Smart Citations

Can First Responders Be Sent to Selected 9-1-1 Emergency Medical Services Calls without an Ambulance?

Key

Pepe²,

Persse

et al. 2003

Acad Emergency Med

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Objectives: To evaluate the feasibility and safety of initially dispatching only first responders (FRs) to selected low-risk 9-1-1 requests for emergency medical services. First responders are rapidly-responding fire crews on apparatus without transport capabilities, with firefighters trained to at least a FR level and in most cases to the basic emergency medical technician (EMT) level. Low-risk 9-1-1 requests include automatic medical alerts (ALERTs), motor vehicle incidents (MVIs) for which the caller was unable to answer any medical dispatch questions designed to prioritize the call, and 9-1-1 call disconnects (D/Cs). Methods: A beforeand-after study of patient dispositions was conducted using historical controls for comparison. During the historical control phase of six months, one year prior to the study phase, basic life support ambulances (staffed with two basic EMTs) were dispatched to selected low-risk 9-1-1 incidents. During the six-month study phase, a fire FR crew equipped with automated external defibrillators (AEDs) was sent initially without an ambulance to these incidents. Results: For ALERTs (n ¼ 290 in historical group vs. 330 in study group), there was no statistical difference in the transport rate (7% vs 10%), but there was a statistically significant increase in the follow-up use of advanced life support (ALS) (1% vs 4%, p ¼ 0.009). No patient in the ALERTs historical group required airway management, while one patient in the study group received endotracheal intubation. No patient required defibrillation in either group. Analysis of the MVIs showed a significant decrease (p \ 0.0001) in the patient transport rate from 39% of controls to 33% of study patients, but no change in the follow-up use of ALS interventions (2% for each group). For both the ALERTs and MVIs, the FR's mean response time was faster than ambulances (p \ 0.0001). Among the 9-1-1 D/Cs with FRs only (n ¼ 1,028), 15% were transported and 43 (4%) received subsequent ALS care. Four of these patients (0.4%) received intubation and two (0.2%) required defibrillation. However, no patient was judged to have had adverse outcomes as a result of the dispatch protocol change. Conclusions: Fire apparatus crews trained in the use of AEDs can safely be used to initially respond alone (without ambulances) to selected, low-risk 9-1-1 calls. This tactic improves response intervals while reducing ambulance responses to these incidents.

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