Knowledge and Beliefs of EMS Providers toward Lights and Siren Transportation

Tennyson, Joseph; Maranda, Louise; Darnobid, Adam

doi:10.5811/westjem.2015.2.24212

Cited by 7 publications

(8 citation statements)

References 26 publications

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“…e prehospital lights and siren transport (LST) of patients from the field to the hospital has been a matter of debate for several years. LST is perceived as a method for reducing travel time between the field and the hospital [1,2]. On the other hand, LST is potentially associated with an increased risk of collision and injury to Emergency Medical Services (EMS) providers, patients, and bystanders [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…LST is perceived as a method for reducing travel time between the field and the hospital [1,2]. On the other hand, LST is potentially associated with an increased risk of collision and injury to Emergency Medical Services (EMS) providers, patients, and bystanders [1][2][3][4][5][6][7]. Furthermore, the time saved, a couple of minutes, is considered moderate, with no clinical benefit demonstrated to date [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Lights and Siren Transport and the Need for Hospital Intervention in Nontrauma Patients: A Prospective Study

Bertholet

Pasquier

Christes

et al. 2020

Emergency Medicine International

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Background. The use of lights and siren transport (LST) has been a matter of debate because of the short time savings and well-established increased risks for Emergency Medical Services (EMS) and bystanders. Time-critical hospital intervention (TCHI) denotes urgently needed procedures that cannot be performed properly in an out-of-hospital setting. Since 2013, rapid transportation from the field, fast-track, is currently used for patients with acute ST-elevation myocardial infarction, suspicion of acute stroke and out-of-hospital cardiac arrest. The aim of this study was to determine whether the use of LST was associated with the realization of TCHI for nontrauma cases within 15 minutes of hospital arrival, to quantify overtriage (LST without TCHI) and to identify the predictors of TCHI. Methods. This is a monocentric prospective observational study of nontrauma patients transported by ambulance. Based on Ross et al.’s work in 2016 on trauma patients, TCHI procedures were developed by the study team. Descriptive statistics were used to determine whether the use of LST was associated with the realization of TCHI. Multivariable analyses determined the predictors of TCHI and compared clinical outcomes. Results. On the 324 patients included, 67 (20.7%) benefitted from LST, with 40 (59.7%) receiving TCHI (p<0.001). The overtriage rate was 40.3%. The most common medical TCHI was the fast-track (65.2% of all TCHI). LST was predictive of the need for TCHI (p<0.001), as was the clinical condition of the patient and also when EMS providers expected TCHI. Conclusions. A majority of the LST benefitted from TCHI with an overtriage rate of 40%. To reduce the rate of overtriage (LST without TCHI), LST should mainly be used for fast-track and when TCHI is expected by the EMS providers.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lights and Siren Transport and the Need for Hospital Intervention in Nontrauma Patients: A Prospective Study

Bertholet

Pasquier

Christes

et al. 2020

Emergency Medicine International

View full text Add to dashboard Cite

show abstract

“…The prehospital lights and siren transport (LST) of patients from the field to the hospital has been a matter of debate for several years. LST is perceived as a method for reducing travel time between the field and the hospital [1,2]. On the other hand, LST is potentially associated with an increased risk of collision and injury to Emergency Medical Services (EMS) providers, patients and bystanders [1][2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…A relatively simple way to assess LST adequacy has been to consider it appropriate when dealing with a potentially life-threatening situation [11][12][13][14]. Some studies have applied a more comprehensive approach, using the application of time-critical hospital intervention (TCHI) as an endpoint to indicate the appropriateness of LST [2,9,10,15]. TCHI is defined as those procedures or treatments that are urgently needed, requiring skills or devices that are either not available or cannot be properly performed in the prehospital setting [2,8,10].…”

Section: Introductionmentioning

confidence: 99%

“…Some studies have applied a more comprehensive approach, using the application of time-critical hospital intervention (TCHI) as an endpoint to indicate the appropriateness of LST [2,9,10,15]. TCHI is defined as those procedures or treatments that are urgently needed, requiring skills or devices that are either not available or cannot be properly performed in the prehospital setting [2,8,10]. Recent studies have demonstrated that up to a quarter of life-threatening situations, such as airway obstruction, severe dyspnoea, hemodynamic instability and abnormal Glasgow Coma Scale, require TCHI [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Lights and Siren Transport and the Need for Hospital Intervention in Non-Trauma Patients: A Prospective Study

Bertholet

Pasquier

Christes

et al. 2019

Preprint

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Background: The use of lights and siren transport (LST) has been a matter of debate because of the short time savings and well-established increased risks for Emergency Medical Services (EMS) and bystanders. Time-critical hospital intervention (TCHI) denotes urgently needed procedures that cannot be performed properly in an out-of-hospital setting. Since 2013, rapid transportation from the field – fast-track – is currently used for patients with acute ST-elevation myocardial infarction, suspicion of acute stroke and out-of-hospital cardiac arrest. We aimed to determine whether the use of LST was associated with the realization of TCHI for non-trauma cases within 15 minutes of hospital arrival, to identify the predictors of TCHI and to compare clinical outcomes in patients transported with or without LST. Methods: This is a monocentric prospective observational study of non-trauma patients transported by ambulance. Based on Ross et al.’s work in 2016 on trauma patients, TCHI procedures were developed by the study team. We used descriptive statistics to determine whether the use of LST was associated with the realization of TCHI. Univariate and multivariate analyses determined the predictors of TCHI and compared clinical outcomes. Results: On the 324 patients included, 67 (20.7%) benefitted from LST, with 40 (59.7%) receiving TCHI ( p < 0.001). The most common medical TCHI was the fast-track (65.2% of all TCHI). LST was predictive of the need for TCHI ( p < 0.001), as was the clinical condition of the patient and also when EMS providers expected TCHI. When transported with LST, patients were hospitalized significantly more often in acute care units and less often in general wards or discharged from the Emergency Department ( p < 0.001). Conclusions: The use of LST for non-trauma patients was positively associated with the realization of TCHI. EMS providers demonstrated a high level of precision in discerning which patients deserved LST. A majority of the LST benefitted from TCHI. Nevertheless, when fast-track was excluded the rate dropped by more than 50%. To reduce the rate of over-triage (LST without TCHI), LST should be used only for fast-track and also when TCHI is expected by the EMS providers.

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Effect of urgency level on prehospital emergency transport times: a natural experiment

Valentin,

Hansen,

Behrndtz

et al. 2023

Intern Emerg Med

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Accurate estimation of ambulance transport time from the scene of incident to arrival at the emergency department (ED) is important for effective resource management and emergency care system planning. Further, differences in transport times between different urgency levels highlight the benefits of ambulance transports with highest urgency level in a setting where ambulances are allowed to not follow standard traffic rules. The objective of the study is to compare ambulance urgency level on the differences in estimates of ambulance transport times generated by Google Maps and the observed transport times in a prehospital setting where emergency vehicles have their own traffic laws. The study was designed as a natural experiment and register study. Ambulance transports dispatched with different levels of urgency (Level A and B) were included in the Central Denmark Region (a mixed urban and rural area) from March 10 to June 11, 2021. Ambulance transports for highest urgency level were compared to lowest urgency level with Google Maps estimated transport times as reference. We analyzed 1981 highest urgency level and 8.958 lowest urgency level ambulance transports. Google Maps significantly overestimated the duration of transports operating at highest level of urgency (Level A) by 1.9 min/10 km (95% CI 1.8; 2.0) in average and 4.8 min/10 km (95% CI 3.9; 5.6) for the first driven 10 km. Contrary, Google Maps significantly underestimated the duration of transports operating at lowest level of urgency (Level B) by −1.8 min/10 km (95% CI −2.1; −1.5) in average and −4.4 min/10 km (95% CI −5.4; −3.5) for the first driven 10 km. Google Maps systematically overestimates transport times of ambulance transports driven with Level A, the highest level of urgency in a setting where ambulances are allowed to not follow standard traffic rules. The results highlight the benefit of using urgency Level A and provide valuable information for emergency care management.

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Knowledge and Beliefs of EMS Providers toward Lights and Siren Transportation

Cited by 7 publications

References 26 publications

Lights and Siren Transport and the Need for Hospital Intervention in Nontrauma Patients: A Prospective Study

Lights and Siren Transport and the Need for Hospital Intervention in Nontrauma Patients: A Prospective Study

Lights and Siren Transport and the Need for Hospital Intervention in Non-Trauma Patients: A Prospective Study

Effect of urgency level on prehospital emergency transport times: a natural experiment

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