Drivers of Increasing Emergency Ambulance Demand

Andrew, Emily; Nehme, Ziad; Cameron, Peter; Smith, Karen

doi:10.1080/10903127.2019.1635670

Cited by 94 publications

(97 citation statements)

References 25 publications

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“…Surprisingly, according to the univariate analyses, mission priority D did not predict any increase in non-conveyance than C. On the other hand, the dispatch process in Finland has been questioned especially related to the accuracy of non-lifethreatening situations [7], and unnecessary EMS missions arouse debate globally [34]. It seems that the number of missions, which do not require any medical intervention from an EMS unit, is increasing [1]. Although, it's universally accepted that the dispatch process is designed to recognize life-threatening incidents, it seems that majority of emergency calls are related to non-life threatening incidents which challenges the use of EMS resources.…”

Section: Discussionmentioning

confidence: 94%

“…Abnormal vital signs are common predictors of all subsequent events [12], and a study found that two out of three conveyed patients had one or more abnormal vital functions [11]. A review indicates that patients with a score of NEWS 0 are very unlikely to deteriorate, and patients with high scores (NEWS ≥7) were more likely to deteriorate, but evidence of intermediate scores (1)(2)(3)(4)(5)(6) is unclear [16]. We found that if the patient's NEWS2 score increases by one point or two points, the likelihood of conveyance increased.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Emergency Medical Services (EMS) and Emergency Departments (ED) have reported increasing attendance rates [1][2][3]. An ageing population, lack of social support and difficulties to access primary care were found to be examples of associated factors [3].…”

Section: Introductionmentioning

confidence: 99%

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Changing role of EMS –analyses of non-conveyed and conveyed patients in Finland

Paulin

Kurola

Salanterä

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Emergency Medical Services (EMS) and Emergency Departments (ED) have seen increasing attendance rates in the last decades. Currently, EMS are increasingly assessing and treating patients without the need to convey patients to health care facility. The aim of this study was to describe and compare the patient casemix between conveyed and non-conveyed patients and to analyze factors related to non-conveyance decision making. Methods: This was a prospective study design of EMS patients in Finland, and data was collected between 1st June and 30th November 2018. Adjusted ICPC2-classification was used as the reason for care. NEWS2-points were collected and analyzed both statistically and with a semi-supervised information extraction method. EMS patients' geographic location and distance to health care facilities were analyzed by urban-rural classification. Results: Of the EMS patients (40,263), 59.8% were over 65 years of age and 46.0% of the patients had zero NEWS2 points. The most common ICPC2 code was weakness/tiredness, general (A04), as seen in 13.5% of all patients. When comparing patients between the non-conveyance and conveyance group, a total of 35,454 EMS patients met the inclusion criteria and 14,874 patients (42.0%) were not conveyed to health care facilities. According the multivariable logistic regression model, the non-conveyance decision was more likely made by ALS units, when the EMS arrival time was in the evening or night and when the distance to the health care facility was 21-40 km. Furthermore, younger patients, female gender, whether the patient had used alcohol and a rural area were also related to the non-conveyance decision. If the patient's NEWS2 score increased by one or two points, the likelihood of conveyance increased. When there was less than 1 h to complete a shift, this did not associate with either nonconveyance or conveyance decisions. Conclusions: The role of EMS might be changing. This warrants to redesign the chain-of-survival in EMS to include not only high-risk patient groups but also non-critical and general acute patients with non-specific reasons for care. Assessment and on-scene treatment without conveyance can be called the "stretched arm of the emergency department", but should be planned carefully to ensure patient safety.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Changing role of EMS –analyses of non-conveyed and conveyed patients in Finland

Paulin

Kurola

Salanterä

et al. 2020

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…Both nationally and internationally, the demand for emergency medical services (EMS) has been growing approximately 3-5% annually [1,2], and 40-79% of assessed patients do not need EMS interventions [3][4][5]. The proportion of patients who are assessed but do not require EMS interventions has also reportedly increased [1]. Because of the increasing demand and the fact that growing numbers of EMS users do not need EMS interventions, an increasing number of patients are left at the scene of the incident without ambulance conveyance to the emergency department (ED) [3,4].…”

Section: Introductionmentioning

confidence: 99%

Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden

et al. 2020

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Background There has been an increasing demand for emergency medical services (EMS), and a growing number of patients are not conveyed; i.e., they are referred to levels of care other than ambulance conveyance to the emergency department. Patient safety issues have been raised regarding the ability of EMS to decide not to convey patients. To improve non-conveyance guidelines, information is needed about patients who are not conveyed by EMS. Therefore, the purpose of this study was to describe and compare the proportion and characteristics of non-conveyed EMS patients, together with assignment data. Methods A descriptive and comparative consecutive cohort design was undertaken. The decision of whether to convey patients was made by EMS according to a region-specific non-conveyance guideline. Non-conveyed patients’ medical record data were prospectively gathered from February 2016 to January 2017. Analyses was conducted using the chi-squared test, two-sample t test, proportion test and Mann-Whitneys U-test. Results Out of the 23,250 patients served during the study period, 2691 (12%) were not conveyed. For non-conveyed adults, the most commonly used Emergency Signs and Symptoms (ESS) codes were unspecific symptoms/malaise, abdomen/flank/groin pain, and breathing difficulties. For non-conveyed children, the most common ESS codes were breathing difficulties and fever of unclear origin. Most of the non-conveyed patients had normal vital signs. Half of all patients with a designated non-conveyance level of care were referred to self-care. There were statistically significant differences between men and women. Conclusions Fewer patients were non-conveyed in the studied region compared to national and international non-conveyance rates. The differences seen between men and women were not of clinical significance. Follow-up studies are needed to understand what effect patient outcome so that guidelines might improve.

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Epidemiology of prehospital emergency calls according to patient transport decision in a middle eastern emergency care environment: Retrospective cohort‐based

Farhat,

Alinier,

El Aifa

et al. 2024

Health Science Reports

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Background and AimThough emergency medical services (EMS) respond to all types of emergency calls, they do not always result in the patient being transported to the hospital. This study aimed to explore the determinants influencing emergency call‐response‐based conveyance decisions in a Middle Eastern ambulance service.MethodsThis retrospective quantitative analysis of 93,712 emergency calls to the Hamad Medical Corporation Ambulance Service (HMCAS) between January 1 and May 31, 2023, obtained from the HMCAS electronic system, was analyzed to determine pertinent variables. Sociodemographic, emergency dispatch‐related, clinical, and miscellaneous predictors were analyzed. Descriptive, bivariate, ridge logistic regression, and combination analyses were evaluated.Results23.95% (N = 21,194) and 76.05% (N = 67,285) resulted in patient nontransport and transportation, respectively. Sociodemographic analysis revealed that males predominantly activated EMS resources, and 60% of males (n = 12,687) were not transported, whilst 65% of females (n = 44,053) were transported. South Asians represented a significant proportion of the transported patients (36%, n = 24,007). “Home” emerged as the primary emergency location (56%, n = 37,725). Bivariate analysis revealed significant associations across several variables, though multicollinearity was identified as a challenge. Ridge regression analysis underscored the role of certain predictors, such as missing provisional diagnoses, in transportation decisions. The upset plot shows that hypertension and diabetes mellitus were the most common combinations in both groups.ConclusionsThis study highlights the nuanced complexities governing conveyance decisions. By unveiling patterns such as male predominance, which reflects Qatar's expatriate population, and specific temporal EMS activity peaks, this study accentuates the importance of holistic patient assessment that transcends medical histories.

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Drivers of Increasing Emergency Ambulance Demand

Cited by 94 publications

References 25 publications

Changing role of EMS –analyses of non-conveyed and conveyed patients in Finland

Changing role of EMS –analyses of non-conveyed and conveyed patients in Finland

Characteristics of non-conveyed patients in emergency medical services (EMS): a one-year prospective descriptive and comparative study in a region of Sweden

Epidemiology of prehospital emergency calls according to patient transport decision in a middle eastern emergency care environment: Retrospective cohort‐based

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