NHS emergency response to 999 calls: alternatives for cases that are neither life threatening nor serious

Abstract

on cumulative dose by introducing matching (at least partially) on dose.Breslow and Day have said: "Occasions arise in which the association of one factor with disease appears at least partially to be explained by a second factor (associated both with disease and with the first factor), but where the two factors are essentially measuring the same thing, or where the second factor is a consequence of the first." 1 Although over-matching is mentioned in textbooks, substantive examples are not common. We have presented an example in which results from other studies were different. This difference indicated that over-matching was likely to be a problem.We thank BNFL, which allowed its data to be used in the study, and the Office for National Statistics for information on mortality. We also thank David McGeoghegan of Westlakes Scientific Consulting for his important contribution to the design, the data collection, and the examination of the matching factors; and Steve Whaley, also of Westlakes Scientific Consulting, whose work on the nested case-control analysis identified date of entry as the likely factor causing the over-matching.Funding: The Engineering and Physical Sciences Research Council (EPSRC), Westlakes Scientific Consulting (CASE studentship).Competing interests: JLH was an investigator on the EPSRC CASE award, which funded JLM; the CASE partner was Westlakes Scientific Consulting. KB was also an investigator on the EPSRC CASE award and is employed by Westlakes Scientific Consulting, which receives research funding from British Nuclear Fuels to support KB, DMcG, and SW in their work on the case-control study. The number of emergency (999) calls received by ambulance services in the United Kingdom has risen consistently over recent years. Ambulance services must respond to calls immediately by sending vehicles staffed by paramedics, with flashing lights and sirens. All patients have to be taken to an accident and emergency department. This response is not always appropriate, and it can result in inefficient use of resources and unnecessary risks to the general public, patients, and paramedics.The NHS Plan and the recent consultation document Reforming Emergency Care have emphasised the importance of trying new approaches to deliver appropriate care. 1 2 They highlight the need to consider new ways to integrate the ambulance response to 999 calls into the overall system that deals with emergencies.

Safety of telephone consultation for "non-serious" emergency ambulance service patients

“…1 Between 11% and 52% of emergency ambulance call outs are to patients with non-serious problems. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Excessive demand may lead to delays in the arrival of ambulances to those with life threatening needs, potentially contributing to avoidable morbidity and mortality. 16 There is limited evidence about the impact and acceptability of alternatives to immediate emergency ambulance despatch.…”

The appropriateness of emergency medical service responses in the eThekwini district of KwaZulu-Natal, South Africa

“…Adopting evidence-based alternatives to the traditional dispatch of emergency ambulances and the transportation of patients to primary admitting centres may be a way to achieve this. [12][13][14] Two important strategies that may be considered are computeraided dispatch, such as the Medical Priority Dispatch System (MDPS), and alternative routing of patients.…”

“…At the point of dispatch, these may include referral to non-emergency access numbers, such as the NHS 111 number in the UK, or alternative appropriate services or facilities. [12] Additionally, if patients can be identified as suffering from minor illness or injury once an EMS unit reaches the scene, it may be possible to offer alternatives to emergency ambulance transportation. [13] These alterna tives, based on patient presentation, may include a straightforward refusal to transport, treatment at the scene and/or referral to a further care facility by other transportation means, or on-scene treatment and discharge.…”

Actividad y seguridad de la enfermera de urgencias a domicilio para patologías leves

“…7 Además, un análisis de los motivos de atención urgente ha puesto de manifiesto que entre el 40 y 50 % de ellos corresponden a demandas inadecuadas o patologías leves no urgentes, siendo los factores socioeconómicos los detonantes de dichas demandas, como son: la edad avanzada, los cambios en las estructuras familiares, la lejanía del domicilio al punto fijo de urgencias y no disponer de vehículo, entre otros; y existe controversia de algunos factores como el sexo. [7][8][9][10] No obstante, se podría matizar que en una reciente revisión de la literatura se observó una amplia variabilidad de criterios para detectar la inadecuación de las demandas, dando lugar a un amplio rango de resultados; si bien se encontró una mediana del 32 % en relación a asistencias inadecuadas. 11 En España y en el año 2010, los servicios de urgencias extrahospitalarias atendieron 34.9 millones de demandas de atención en todo el país (datos extrapolados a partir de 14 comunidades autónomas), de los que el 3.6 %, es decir, más de 1.25 millones de asistencias correspondieron a demandas de asistencia a domicilio.…”