Operational issues in EMS

Factors Influencing the Emergency Medical Service Response Time for Cardiovascular Disease in Guangzhou, China

While emergency medical service (EMS) response time (ERT) is a major factor associated with the survival of patients with cardiovascular disease (CVD), relatively few studies have explored the factors associated with ERT. This study aimed to assess the current status of ERT and to identify the factors affecting ERT in patients with CVD in China. Between January 1, 2011 and December 31, 2015, EMS responses to CVD incidents in Guangzhou, China, were examined. The primary outcome was ERT, defined as the time from receipt of an emergency call to the arrival of paramedics on the scene. Factors associated with ERT were evaluated by multivariable logistic regression. A total of 44 383 CVD incidents were analysed. The median ERT was 12.58 min (interquartile range=9.98-15.67). Among the risk factors, distance (OR=13.73, 95% CI=11.76-16.04), level of hospital (OR=1.57, 95% CI=1.40-1.75), and site of the incident (OR=1.53, 95% CI=1.38-1.69) were the top three significant factors affecting the ERT. Our results suggest that greater attention should be given to factors affecting the ERT. It is essential to make continuous efforts to promote the development of effective interventions to reduce the response time.

Realities of Rural Emergency Medical Services Disaster Preparedness

Introduction:

Disaster preparedness is an area of major concern for the medical community that has been reinforced by recent world events. The emergency healthcare system must respond to all types of disasters, whether the incidents occur in urban or rural settings. Although the barriers and challenges are different in the rural setting, common areas of preparedness must be explored.

Problem:

This study sought to answer several questions, including: (1) What are rural emergency medical services (EMS) organizations training for, compared to what they actually have seen during the last two years?; (2) What scale and types of events do they believe they are prepared to cope with?; and (3) What do they feel are priority areas for training and preparedness?

Methods:

Data were gathered through a multi-region survey of 1,801 EMS organizations in the US to describe EMS response experiences during specific incidents as well as the frequency with which these events occur. Respondents were asked a number of questions about local priorities.

Results:

A total of 768 completed surveys were returned (43%). Over the past few years, training for commonly occurring types of crises and emergencies has declined in favor of terrorism preparedness. Many rural EMS organizations reported that events with 10 or fewer victims would overload them. Low priority was placed on interacting with other non-EMS disaster response agencies, and high priority was placed on basic staff training and retention.

Conclusion:

Maintaining viable, rural, emergency response capabilities and developing a community-wide response to natural or man-made events is crucial to mitigate long-term effects of disasters on a local healthcare system. The assessment of preparedness activities accomplished in this study will help to identify common themes to better prioritize preparedness activities and maximize the response capabilities of an EMS organization.

Analysis and applicability of the Dutch EMS system into countries developing EMS systems

Development of an Emergency Medical Services (EMS) system is a challenging task for administrators, government agencies, and politicians. Factors such as the political climate, governmental support, and monetary resources heavily influence and shape the development of an EMS system. There are various systems in place to meet the functional needs and abilities of different regions while maintaining the basic principle of providing fast attention to those in need, and transportation to a definitive care facility. In this report, we describe the current Dutch EMS system in Amsterdam and the methods of daily pre-hospital health care delivery used, while exploring its potential applicability in developing nations. The Dutch EMS system is a nurse-driven triage system, both at the dispatch level and at the treatment level. Of the approximate yearly 165,000 calls received at the dispatch center, 40% of the requests were triaged based on national protocols such that no emergency ambulance dispatching was necessary. Furthermore, 30% of patients were treated at the scene, and did not subsequently require emergency transport to a definitive care facility.

International EMS Systems: The United States: past, present, and future

Emergency medical services (EMS) is an organised system designed to transport sick or injured patients to the hospital. Though EMS system configurations can be quite varied in design depending on locale, we provide an overview of EMS as it has evolved and is currently modelled in the US. We outline the history of EMS in the US, including the major events and legislation that shaped the current models that are in existence. We provide an overview of provider training, system design, system funding, and dispatch issues. The concepts of medical direction for physician surrogates, as well as EMS as it relates to specialty care are also elucidated.