Comparing emergency medical service systems--a project of the European Emergency Data (EED) Project

AIM

The aim of this prospective study was the comparison of four emergency medical service (EMS) systems-emergency physician (EP) and paramedic (PM) based-and the impact of advanced live support (ALS) on patients status in preclinical care.

METHODS

The EMS systems of Bonn (GER, EP), Cantabria (ESP, EP), Coventry (UK, PM) and Richmond (US, PM) were analysed in relation to quality of structure, process and performance when first diagnosis on scene was cardiac arrest (OHCA), chest pain or dyspnoea. Data were collected prospectively between 01.01.2001 and 31.12.2004 for at least 12 month.

RESULTS

Over all 6277 patients were included in this study. The rate of drug therapy was highest in the EP-based systems Bonn and Cantabria. Pain relief was more effective in Bonn in patients with severe chest pain. In the group of patients with chest pain and tachycardia ≥ 120 beats/min, the heart rate was reduced most effective by the EP-systems. In patients with dyspnoea and S(p)O(2) <90% the improvement of oxygen saturation was most effective in Bonn and Richmond. After OHCA significant more patients reached the hospital alive in EMS systems with EPs than in the paramedic staffed (Bonn = 35.6%, Cantabria = 30.1%; Coventry = 11.9%, Richmond = 9.2%). The introduction of a Load Distributing Band chest compression device in Richmond improved admittance rate after OHCA (21.7%) but did not reach the survival rate of the Bonn EMS system.

CONCLUSIONS

Higher qualification and greater training and experience of ALS unit personnel increased survival after OHCA and improved patient's status with cardiac chest pain and respiratory failure.

Recommended guidelines for reporting on emergency medical dispatch when conducting research in emergency medicine: the Utstein style

OBJECTIVES

To establish a uniform framework describing the system and organisation of emergency medical response centres and the process of emergency medical dispatching (EMD) when reporting results from studies in emergency medicine and prehospital care.

DESIGN AND RESULTS

In September 2005 a task force of 22 experts from 12 countries met in Stavanger; Norway at the Utstein Abbey to review data and establish a common terminology for medical dispatch centres including core and optional data to be used for health monitoring, benchmarking and future research.

Evolution of triage systems

The French word "trier", the origin of the word "triage", was originally applied to a process of sorting, probably around 1792, by Baron Dominique Jean Larrey, Surgeon in Chief to Napoleon's Imperial Guard. Larrey was credited with designing a flying ambulance: the Ambulance Volante. Baron Francois Percy also contributed to the organisation of a care system for the ongoing management of casualties. Out of the French Service de Santé, not only emerged the concept of triage, but the organisational structure necessary to handle the growing number of casualties in modern warfare.

"Reforming Emergency Care": the ambulance impact. A personal view

"Reforming Emergency Care" has huge implications for ambulance services to develop their future role and the opportunity to improve patient care. This article aims to stimulate debate on the effect on ambulance services in the United Kingdom.

European Emergency Data Project (EED Project): EMS data-based health surveillance system

Emergency Medical Services (EMS) constitute a unique component of health care at the interface between primary and hospital care. EMS data within the pre-hospital setting represents an unparalleled source of epidemiological and health care information that have so far been neglected for public health monitoring. The European Emergency Data Project (EED Project) thus intends to identify common indicators for European EMS systems and to evaluate their suitability for integration into a comprehensive public health monitoring strategy. The article provides a brief overview on objectives and methodology in the form of a progress report.

Reforming emergency care: implications for the trauma patient

Published in October 2001, Reforming Emergency Care (REC) recognized the need to reorganize unscheduled care. It identified the need for radical restructuring and reform of emergency care by the use of an integrated system with common triage, prioritization and streaming. REC forms part of the modernization process for the National Health Service (NHS) in the UK. It will result in major change in primary care, accident and emergency care, and ambulance services. Local care systems combining emergency, elective, primary care and GP out of hours are a possible solution. The opportunity to improve trauma care by developing a network of 24-hour emergency hospitals for the critically ill and injured will improve the delivery of definitive care in minimum time, by passing the ‘baton of care’ the minimum number of times. Reforming emergency care represents a unique window of opportunity to improve the care of the critically ill and injured.

Clinical governance in pre-hospital care

This article seeks to discover and recognize the importance of clinical governance within a new and emerging quality National Health Service (NHS) system. It evaluates the present state of prehospital care and recommends how change, via clinical governance, can ensure a paradigm shift from its currently fragmented state to a seamless ongoing patient care episode. Furthermore, it identifies the drivers of a quality revolution, examines the monitoring and supervision of quality care, and evaluates the role of evidence-based practice. A frank and open view of immediate care doctors is presented, with recommendations to improve the quality of skill delivery and reduce the disparity that exists. Finally, it reviews the current problems with pre-hospital care and projects a future course for quality and patient care excellence.