Secondary triage in prehospital emergency ambulance services: a systematic review

Eastwood, Kathryn; Morgans, Amee; Smith, Karen; Stoelwinder, Johannes Uiltje

doi:10.1136/emermed-2013-203120

Cited by 39 publications

(42 citation statements)

References 24 publications

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“…16 There is a movement towards expandedscope EMS, where increased emergency or primary care is delivered onsite, thereby avoiding transport to the ED. [17][18][19] Other innovative ideas of managing low-priority EMS calls include secondary telephone triage 20 , paramedic referral services 21 , and community paramedic models 17 . Either individually or in combinations, the implementation of such innovative programs can allow for EMS services to adapt to the changing health care needs of the population.…”

Section: Discussionmentioning

confidence: 99%

The Epidemiology of Prehospital Emergency Responses for Older Adults in a Provincial EMS System

Goldstein

Jensen

Carter

et al. 2015

CJEM

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Objectives: Societal aging is expected to impact the use of emergency medical services (EMS). Older adults are known as high users of EMS. Our primary objective was to quantify the rate of EMS use by older adults in a Canadian provincial EMS system. Our secondary objective was to compare those transported to those not transported. Methods: We analysed data from a provincial EMS database for emergency responses between January 1, 2010 and December 31, 2010 and included all older adults (≥65 years) requesting EMS for an emergency call. We described EMS use in relation to age, sex, and resources. Results: There were 30,653 emergency responses for older adults in 2010, representing close to 50% of the emergency call volume and an overall response rate of 202.8 responses per 1,000 population 65 years and older. The mean age was 79.9 ± 8.5 years for those 57.3% who were female. The median paramedic-determined Canadian Triage and Acuity Scale (CTAS) score was 3 and the mean on-scene time was 24.2 minutes. Non-transported calls (12.3%) for the elderly involved predominantly (54.9%) female patients of similar mean age (78.3 years) but lower acuity (CTAS 5) and longer average on-scene times (32.6 minutes). Conclusions: We confirmed the increasingly high rate of EMS use with age to be consistent with other industrialized populations. The low-priority and non-transport calls by older adults consumed considerable resources in this provincial system and might be the areas most malleable to meet the challenges facing EMS systems. Les données sur les appels qui se sont soldés par le non-transport des personnes âgées à l'hôpital (12,3%) ont révélé que le phénomène concernait davantage les femmes (54,9%), qu'elles avaient un âge moyen comparable (78,3 ans), que le degré de gravité des troubles était faible (ECTG: 5) et que le temps passé sur place en moyenne était généralement plus long (32,6 minutes). Conclusions: Les résultats de l'étude confirmant une utilisation de plus en plus grande des SMU en fonction de l'âge concordent avec ceux d'études menées dans d'autres pays industrialisés. Le faible degré de priorité des appels et le non-transport à l'hôpital des personnes âgées entraînent une forte consommation des ressources disponibles dans le système provincial de SMU en question, et ce sont peut-être là les points qui se prêteraient le plus à des changements afin de permettre aux SMU de faire face aux difficultés qu'ils rencontrent.

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Section: Discussionmentioning

confidence: 99%

The Epidemiology of Prehospital Emergency Responses for Older Adults in a Provincial EMS System

Goldstein

Jensen

Carter

et al. 2015

CJEM

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“…[12, 13] Quality level 1 consisted of prospective studies that studied a clearly defined outcome measure with a random or consecutive sample large enough to have narrow confidence intervals as well as heterogeneous enough to have good generalizability. Quality level 2 was similar to level 1, but was more limited with respect to sample sizes or generalizability.…”

Section: Methodsmentioning

confidence: 99%

Lack of evidence for intravenous vasodilators in ED patients with acute heart failure: a systematic review

Alexander

Alkhawam

Curry

et al. 2015

The American Journal of Emergency Medicine

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There are nearly 700,000 annual US emergency department (ED) visits for acute heart failure (AHF). While blood pressure is elevated on most of these visits, acute therapy remains focused on preload and not afterload reduction. Data from recent prospective studies suggest AHF patients with concomitant acute hypertension benefit from intravenous (IV) vasodilators. To better understand the use of vasodilators for such patients, we conducted a systematic review of 1) currently available intravenous vasodilators for ED patients with AHF, or 2) intravenous vasodilators which are not yet available, but have completed Phase III clinical trials in AHF, and may be available for ED use in the future. We employed multi-term search queries to retrieve research involving nitroglycerin, nitroprusside, enalaprilat, hydralazine, relaxin and nesiritide. A total of 2001 unique citations were identified from three databases: PubMed, EMBASE, and CINAHL. Of these, 1966 were excluded based on established review criteria, leaving 35 published papers for inclusion. Our primary finding was that IV nitrovasodilators, when used in the treatment of AHF in ED and ED-like settings, do improve short-term symptoms and appear safe to administer. There is no data suggesting they impact mortality. Other commonly used vasodilators such as hydralazine and enalaprilat have very little published data about their safety and efficacy. Of note, few studies enrolled patients early in their course of treatment. Thus, to assess the specific impact of vasodilator therapy on both short- and long-term outcomes, future research efforts should focus on patient recruitment in the ED setting.

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“…32 Our scoping review captured the same articles included in this review by Eastwood et al, with the exception of a descriptive publication that did not report on outcomes. 33 Our review located 15 publications (16 studies), of which the majority reported on EMS dispatch programs that diverted callers to either nurse-advice lines or alternate EMS services (other than standard emergency ambulance dispatch).…”

Section: Alternative To Dispatchmentioning

confidence: 99%

“…These alternative EMS programs have often developed out of local needs in attempts to better serve their patient population with the resources that are available. 32 While appropriate, this leads to difficulty in understanding what the findings mean in aggregate, and certainly prohibits quantitative pooling in a systematic review. This heterogeneity can also significantly limit the generalizability of the findings to contemporary EMS systems; however, the outcomes used can still be considered for use in modern research and quality projects.…”

Section: Limitationsmentioning

confidence: 99%

Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes

Jensen

Carter

Rose

et al. 2015

CJEM

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Objectives: Emergency medical services (EMS) programs, which provide an alternative to traditional EMS dispatch or transport to the emergency department (ED), are becoming widely implemented. This scoping review identified and catalogued all outcomes used to measure such alternative EMS programs. Data Source: Broad systematized bibliographic and grey literature searches were conducted. Study Selection: Inclusion criteria were 911 callers/EMS patients, reported on alternatives to traditional EMS dispatch OR traditional EMS transport to the ED, and reported an outcome measure. Data Extraction: The reports were categorized as either alternative to dispatch or to EMS transport, and outcome measures were categorized and described. Data Synthesis: The bibliographic search retrieved 13,215 records, of which 34 articles met the inclusion criteria, with an additional 10 added from reference list hand-searching (n = 44 included). In the grey literature search, 31 websites were identified, from which four met criteria and were retrieved (n = 4 included). Fifteen reports (16 studies) described alternatives to EMS dispatch, and 33 reports described alternatives to EMS transport. The most common outcomes reported in the alternatives to EMS dispatch reports were service utilization and decision accuracy. Twenty-four different specific outcomes were reported. The most common outcomes reported in the alternatives to EMS transport reports were service utilization and safety, and 50 different specific outcomes were reported. Conclusions: Numerous outcome measures were identified in reports of alternative EMS programs, which were catalogued and described. Researchers and program leaders should achieve consensus on uniform outcome measures, to allow benchmarking and improve comparison across programs. RÉSUMÉObjectif: Les programmes de services médicaux d'urgence (SMU), qui offrent une solution de rechange à la répartition traditionnelle des SMU ou au transport classique des malades aux services des urgences (SU), gagnent de plus en plus de terrain. Dans l'examen d'établissement de la portée décrit ici, les auteurs ont relevé et classé tous les résultats utilisés pour mesurer l'efficacité de ces programmes novateurs de SMU. Sources des données: Les auteurs ont entrepris une vaste recherche systématisée de références bibliographiques, et effectué des recherches méthodiques dans la documentation parallèle. Sélection des études: Les critères de sélection comprenaient les appels faits aux services d'urgence 911 ou les malades examinés par les SMU, inscrits dans les rapports de solutions de rechange à la répartition traditionnelle des SMU OU au transport classique des malades au SU par les SMU, ainsi que l'existence d'un critère d'évaluation. Extraction des données: Les rapports ont été classés soit dans la catégorie des solutions de rechange à la répartition des services, soit dans la catégorie des solutions de rechange aux transports effectués par les SMU; quant aux critères d'évaluation, ils ont été classés et décrits. Synthèse...

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Secondary triage in prehospital emergency ambulance services: a systematic review

Abstract: These results suggest that, while secondary triage of these patients is safe, further research is required to determine its most appropriate structure and its effect on ambulance demand.

Cited by 39 publications

References 24 publications

The Epidemiology of Prehospital Emergency Responses for Older Adults in a Provincial EMS System

The Epidemiology of Prehospital Emergency Responses for Older Adults in a Provincial EMS System

Lack of evidence for intravenous vasodilators in ED patients with acute heart failure: a systematic review

Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes

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