Identification of new demands regarding prehospital care based on 35,188 missions in 2018

Abstract

Background Population ageing and increased prevalence of chronic diseases result in the emergence of new demands in prehospital care. The prehospital system is facing an increase of cases without acute threat to life (so-called “non-urgent”), which generates tension due to a higher number of admissions to emergency departments and a greater use of prehospital resources. Our aim is to understand this transition in prehospital activities and to delineate the primary missions performed by paramedics in 2018 with a focus on the population concerned, the severity of cases encountered and the typology of health issues. Method The study is retrospective, and descriptive, using a statistical description of 35,188 primary missions realized in 2018 in the State of Vaud (Switzerland). The characteristics taken into consideration are the age and gender of patients, as well as the health issue, the severity of cases based on National Advisory Committee for Aeronautics score (NACA score), and the time and place of intervention. Results The results describe the primary missions in the State of Vaud in 2018 and show that 87% of missions concern “non-urgent” situations (without acute threat to life). Over half of patients are 65 or older, the highest proportion of health issues, 49%, are medical and only 23% of missions are for traumas. Mission related to mental health issues reach 7% and those for intoxication 6%. Most missions take place between 7:00 am and 6:00 pm (67%), and around 12% of missions lead to the non-transport of the patient. Conclusion The prehospital sector is confronted with a major transition in terms of patient care. An increase of non-urgent cases is observed, associated with the care of persons aged 65 or more. Our results question the adequacy between the needs in terms of prehospital care and the paramedic profession as it is currently defined, as well as the place of this profession within the health network. Reflecting upon the role of paramedics with respect to the socio-demographic evolution of populations appears necessary, to analyse the adequacy of the paramedics’ skills to respond to the current needs.

Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines

“…A NACA score of 4 means that without hospital treatment, the disease or lesions could evolve toward vital risk, for example, a myocardial infarction. NACA scores between 4 and 6 can be considered "urgent" cases, and cases with NACA scores between 0 and 3 can be considered "nonurgent" [12]. The health issue is described according to 33 predefined categories identified by the paramedics: for example, trauma, cardiac arrest or intoxication (Table 1).…”

“…The latter typically involve elderly persons with complex pathologies (multiple diseases or chronic diseases) or non-specific problems such as decreased general health conditions (7.7%) or mental health concerns (6.9%). Vuilleumier et al [12] also show that over half of the patients requesting emergency services were 65 or older. Nearly 12% of EMS responses resulted in the non-transport of the patient, and only 23% concerned trauma.…”

“…In a recent study, Vuilleumier et al [12] evaluated emergency medical services in the state of Vaud in Switzerland. This study showed that life-threatening emergencies concern only 13% of missions; the remaining, i.e., 87%, concern non-urgent missions.…”

Analyse von Einflussfaktoren auf die Transporthäufigkeit von Frequent Usern mit Angststörung

“…Es muss davon ausgegangen werden, dass sich das Aufgabenspektrum im Rettungsdienst dahin gehend verändern wird, dass die Zuständigkeit für unkritische Patientinnen und Patienten mehr an Bedeutung gewinnen wird [26]. In dem Zusammenhang werden lebensbedrohliche Einsätze auch zukünftig nur einen geringen Anteil an den Gesamteinsätzen ausmachen [31]. Dies steht im Widerspruch In einem Kollektiv von Patientinnen und Patienten, die durch den Rettungsdienst nicht transportiert wurden, wurde festgestellt, dass dies insbesondere bei über den Notruf gemeldeten unspezifischen Symptomen, aber auch bei Bauch-/ Flanken-und Leistenschmerzund Atembeschwerden der Fall war [13].…”

Paramedics in Switzerland: A Mature Profession

“…This allows them to acquire the methodological basis for publishing. Indeed, in recent years, paramedics have published in scientific journals on various topics such as the evolution of non-emergency care requests, on technical aspects during resuscitation or the treatment of pain [ 13 , 14 , 15 ]. Finally, the schools have developed this aspect of methodology considerably during the initial training.…”