Does the use of dedicated dispatch criteria by Emergency Medical Services optimise appropriate allocation of advanced care resources in cases of high severity trauma? A systematic review

McQueen, Carl; Smyth, Michael B.; Fisher, Joanne; Perkins, Gavin D.

doi:10.1016/j.injury.2015.03.033

Cited by 16 publications

(14 citation statements)

References 42 publications

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“…A common HEMS dispatch model is to have a dedicated person situated within an ambulance service emergency operation centre (EOC) to screen incoming emergency calls and assess them for suitability of requiring a HEMS response [ 11 ]. This model is currently used across many UK and international HEMS services [ 8 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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A novel method of non-clinical dispatch is associated with a higher rate of critical Helicopter Emergency Medical Service intervention

Munro

Joy

Coverly³

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundHelicopter Emergency Medical Services (HEMS) are a scarce resource that can provide advanced emergency medical care to unwell or injured patients. Accurate tasking of HEMS is required to incidents where advanced pre-hospital clinical care is needed. We sought to evaluate any association between non-clinically trained dispatchers, following a bespoke algorithm, compared with HEMS paramedic dispatchers with respect to incidents requiring a critical HEMS intervention.MethodsRetrospective analysis of prospectively collected data from two 12-month periods was performed (Period one: 1st April 2014 – 1st April 2015; Period two: 1st April 2016 – 1st April 2017). Period 1 was a Paramedic-led dispatch process. Period 2 was a non-clinical HEMS dispatcher assisted by a bespoke algorithm. Kent, Surrey & Sussex HEMS (KSS HEMS) is tasked to approximately 2500 cases annually and operates 24/7 across south-east England. The primary outcome measure was incidence of a HEMS intervention.ResultsA total of 4703 incidents were included; 2510 in period one and 2184 in period two. Variation in tasking was reduced by introducing non-clinical dispatchers. There was no difference in median time from 999 call to HEMS activation between period one and two (period one; median 7 min (IQR 4–17) vs period two; median 7 min (IQR 4–18). Non-clinical dispatch improved accuracy of HEMS tasking to a mission where a critical care intervention was required (OR 1.25, 95% CI 1.04–1.51, p = 0.02).ConclusionThe introduction of non-clinical, HEMS-specific dispatch, aided by a bespoke algorithm improved accuracy of HEMS tasking. Further research is warranted to explore where this model could be effective in other HEMS services.

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Section: Introductionmentioning

confidence: 99%

“…Two recent systematic reviews concluded that due to a paucity of high quality research in this field, it is not possible to identify a model that best optimises resource utilisation, with currently no validated criteria to guide the development of definitive guidelines [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

A novel method of non-clinical dispatch is associated with a higher rate of critical Helicopter Emergency Medical Service intervention

Munro

Joy

Coverly³

et al. 2018

Scand J Trauma Resusc Emerg Med

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“…Primary dispatch models activate HEMS resources prior to EMS arrival on the scene and are based on dedicated dispatch criteria at the dispatch centre. These models are designed to save time, but there is no evidence of shorter time for the HEMS to reach the incident scene or the effect on mortality, severity of injury in patients actually transported, or proportion of patents admitted to intensive care units compared to secondary HEMS dispatch following requests from EMS personnel at the scene 4, 23. A study from the Air Ambulance of London found that the paramedics of that service had the same precision of identifying serious injury by interrogating the EMCC caller as ambulance personnel at the site of injury, and that both were significantly better than using mechanism of injury 24.…”

Section: Discussionmentioning

confidence: 99%

“…So far, no studies have assessed the use of advanced pre‐hospital services in trauma victims in Norway. International studies have failed to define exact criteria for when to dispatch HEMS 2, 4…”

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confidence: 99%

Are severely injured trauma victims in Norway offered advanced pre‐hospital care? National, retrospective, observational cohort

Wisborg

Ellensen

Svege

et al. 2017

Acta Anaesthesiol Scand

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BackgroundStudies of severely injured patients suggest that advanced pre‐hospital care and/or rapid transportation provides a survival benefit. This benefit depends on the disposition of resources to patients with the greatest need. Norway has 19 Emergency Helicopters (HEMS) staffed by anaesthesiologists on duty 24/7/365. National regulations describe indications for their use, and the use of the national emergency medical dispatch guideline is recommended. We assessed whether severely injured patients had been treated or transported by advanced resources on a national scale.MethodsA national survey was conducted collecting data for 2013 from local trauma registries at all hospitals caring for severely injured patients. Patients were analysed according to hospital level; trauma centres or acute care hospitals with trauma functions. Patients with an Injury Severity Score (ISS) > 15 were considered severely injured.ResultsThree trauma centres (75%) and 17 acute care hospitals (53%) had data for trauma patients from 2013, a total of 3535 trauma registry entries (primary admissions only), including 604 victims with an ISS > 15. Of these 604 victims, advanced resources were treating and/or transporting 51%. Sixty percent of the severely injured admitted directly to trauma centres received advanced services, while only 37% of the severely injured admitted primarily to acute care hospitals received these services.ConclusionA highly developed and widely distributed HEMS system reached only half of severely injured trauma victims in Norway in 2013.

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“…In HEMS dispatch, cooperation between the emergency medical communication centre (EMCC) and HEMS and the judgements of experienced personnel are important for appropriate use of the service . Inter‐operator variability likely affects the missions to which HEMS is dispatched . Several aspects must be considered, such as the patient's condition, accessibility from a road, distance to the hospital, and the proximity of other resources.…”

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confidence: 99%

Outcomes after cancelled helicopter emergency medical service missions due to concurrencies: a retrospective cohort study

Østerås

Heltne

Tønsager

et al. 2017

Acta Anaesthesiol Scand

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CitationØster as Ø, Heltne J-K, Tønsager K, Brattebø G. Outcomes after cancelled helicopter emergency medical service missions due to concurrencies: a retrospective cohort study. Acta Anaesthesiologica Scandinavica 2018 doi: 10.1111/aas.13028Background: Appropriate dispatch criteria and helicopter emergency medical service (HEMS) crew decisions are crucial for avoiding over-triage and reducing the number of concurrencies. The aim of the present study was to compare patient outcomes after completed HEMS missions and missions cancelled by the HEMS due to concurrencies. Methods: Missions cancelled due to concurrencies (AMB group) and completed HEMS missions (HEMS group) in Western Norway from 2004 to 2013 were assessed. Outcomes were survival to hospital discharge, physiology score in the emergency department, emergency interventions in the hospital, type of department for patient admittance, and length of hospital stay. Results: Survival to discharge was similar in the two groups. Onethird of the primary missions in the HEMS group and 13% in the AMB group were patients with pre-hospital conditions posing an acute threat to life. In a sub group analysis of these patients, HEMS patients were younger, more often admitted to an intensive care unit, and had an increased survival to discharge. In addition, the HEMS group had a greater proportion of patients with deranged physiology in the emergency department according to an early warning score. Conclusion: Patients in the HEMS group seemed to be critically ill more often and received more emergency interventions, but the two groups had similar in-hospital mortality. Patients with prehospital signs of acute threat to life were younger and presented increased survival in the HEMS group.

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Does the use of dedicated dispatch criteria by Emergency Medical Services optimise appropriate allocation of advanced care resources in cases of high severity trauma? A systematic review

Cited by 16 publications

References 42 publications

A novel method of non-clinical dispatch is associated with a higher rate of critical Helicopter Emergency Medical Service intervention

A novel method of non-clinical dispatch is associated with a higher rate of critical Helicopter Emergency Medical Service intervention

Are severely injured trauma victims in Norway offered advanced pre‐hospital care? National, retrospective, observational cohort

Outcomes after cancelled helicopter emergency medical service missions due to concurrencies: a retrospective cohort study

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