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On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions

Published online by Cambridge University Press:  08 May 2017

Julia Tärnqvist ,
Erik Dahlén ,
Gabriella Norberg ,
Carl Magnusson ,
Johan Herlitz ,
Anneli Strömsöe ,
Christer Axelsson  and
Magnus Andersson Hagiwara
Julia Tärnqvist
Affiliation:
The Ambulance Service in Skaraborg, Lidköping, Sweden
Erik Dahlén
Affiliation:
The Ambulance Service in Skaraborg, Lidköping, Sweden
Gabriella Norberg
Affiliation:
The Prehospital Research Centre Western Sweden, University of Borås, Borås, Sweden
Carl Magnusson
Affiliation:
Ambulance and Prehospital Emergency, Sahlgrenska Univ Hospital, Gothenburg, Sweden
Johan Herlitz*
Affiliation:
The Prehospital Research Centre Western Sweden, University of Borås, Borås, Sweden Inst of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
Anneli Strömsöe
Affiliation:
School of Health and Social Sciences, University of Dalarna, SE-791 88 Falun, Sweden
Christer Axelsson
Affiliation:
The Prehospital Research Centre Western Sweden, University of Borås, Borås, Sweden Ambulance and Prehospital Emergency, Sahlgrenska Univ Hospital, Gothenburg, Sweden Inst of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
Magnus Andersson Hagiwara
Affiliation:
The Prehospital Research Centre Western Sweden, University of Borås, Borås, Sweden
*
Correspondence: Johan Herlitz, MD, PhD School of Health Sciences, Research Centre PreHospen University of Borås, Prehospital Research Centre of Western Sweden Sahlgrenska University Hospital SE-413 45 Göteborg, Sweden E-mail: [email protected]
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Abstract

Introduction

The use of Emergency Medical Services (EMS) is increasing. A number of patients call repeatedly for EMS. Early studies of frequent callers show that they form a heterogenous group.

Problem

There is a lack of research on frequent EMS callers. There is furthermore a lack of knowledge about characteristics and the prehospital assessment of the patients who call for EMS on several occasions. Finally, there is a general lack of knowledge with regard to the association between the prehospital assessment by health care providers and the final diagnosis.

Method

Patients in Skaraborg in Western Sweden, who used the EMS at least four times in 2014, were included, excluding transport between hospitals. Information on the prehospital assessment on-scene and the final diagnosis was collected from the EMS and hospital case records.

Results

In all, 339 individual patients who used the EMS on 1,855 occasions were included, accounting for five percent of all missions. Fifty percent were women. The age range was 10-98 years, but more than 50.0% were in the age range of 70-89 years.

The most common emergency signs and symptoms (ESS) codes on the scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease (eight percent).

Thirteen percent of all cases had a final diagnosis defined as a potentially life-threatening condition. Among these, 22.0% of prehospital assessments were retrospectively judged as potentially inappropriate.

Forty-nine percent had a defined final diagnosis not fulfilling the criteria for a potentially life-threatening condition. Among these cases, 30.0% of prehospital assessments were retrospectively judged as potentially inappropriate.

Conclusion:

Among patients who used EMS on multiple occasions, the most common symptoms on-scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease. In 13.0%, the final diagnosis of a potentially life-threatening condition was indicated. In a minority of these cases, the assessment on-scene was judged as potentially inappropriate.

TärnqvistJ, DahlénE, NorbergG, MagnussonC, HerlitzJ, StrömsöeA, AxelssonC, Andersson HagiwaraM. On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions. Prehosp Disaster Med. 2017;32(5):528–535.

Keywords

assessmentdiagnosisEmergency Medical Servicesmultiple use
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 32 , Issue 5 , October 2017 , pp. 528 - 535
Copyright
© World Association for Disaster and Emergency Medicine 2017 

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Footnotes

Conflicts of interest: none

References

1. Scott, J, Strickland, AP, Warner, K, Dawson, P. Frequent callers to and users of emergency medical systems: a systematic review. Emerg Med J. 2014;31(8):684-691.CrossRefGoogle ScholarPubMed
2. Billings, J, Raven, MC. Dispelling an urban legend: frequent emergency department users have substantial burden of disease. Health Aff. 2013;32(12):2099-2108.CrossRefGoogle ScholarPubMed
3. Hansagi, H, Olsson, M, Sjöberg, S, Tomson, Y, Göransson, S. Frequent use of the hospital emergency department is indicative of high use of other health care services. Ann Emerg Med. 2001;37(6):561-567.Google Scholar
4. Martin, GB, Stokes-Buzzelli, SA, Peltzer-Jones, JM, Schultz, LR. Ten years of frequent users in an inner-city emergency department. West J Emerg Med. 2013;14(3):243-246.Google Scholar
5. Suserud, B-O, Svensson, L. Prehospital Akutsjukvård. Stockholm, Sweden: Liber; 2009.Google Scholar
6. Department of Health. Tackling demand together: a toolkit for improving urgent and emergency care pathways by understanding increases in 999 demand. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_106925. Accessed June 3, 2015.Google Scholar
7. Hjalte, L, Suserud, B-O, Herlitz, J, Karlberg, I. Why are people without medical needs transported by ambulance? A study of indications for prehospital care. Eur J Emerg Med. 2007;14(3):151-156.Google Scholar
8. Palazzo, FF, Warner, OJ, Harron, M, Sadana, A. Misuse of the London ambulance service: How much and why? J Accid Emerg Med. 1998;15(6):368-370.Google Scholar
9. Norberg, G, Wireklint Sundström, B, Christensson, L, Nyström, M, Herlitz, J. Swedish Emergency Medical Services’ identification of potential candidates for primary health care: retrospective patient record study. Scand J Prim Health Care. 2015;33(4):311-317.CrossRefGoogle ScholarPubMed
10. Bigham, BL, Bull, E, Morrison, M, et al. Patient safety in Emergency Medical Services: executive summary and recommendations from the Niagara Summit. CJEM. 2011;13(1):13-18.CrossRefGoogle ScholarPubMed
11. Atack, L, Maher, J. Emergency medical and health providers’ perceptions of key issues in prehospital patient safety. Prehosp Emerg Care. 2010;14(1):95-102.Google Scholar
12. Fairbanks, RJ, Crittenden, CN, O’Gara, KG, et al. Emergency Medical Services provider perceptions of the nature of adverse events and near-misses in out-of-hospital care: an ethnographic view. Acad Emerg Med. 2008;15(7):633-640.Google Scholar
13. Wang, HE, Fairbanks, RJ, Shah, MN, Abo, BN, Yealy, DM. Tort claims and adverse events in emergency medical services. Ann Emerg Med. 2008;52(3):256-262.Google Scholar
14. Suserud, B-O. A new profession in the prehospital care field—the ambulance nurse. Nurs Crit Care. 2005;10:269-271.Google Scholar
15. Widgren, BR, Jourak, M. Medical Emergency Triage and Treatment System (METTS): a new protocol in primary triage and secondary priority decision in emergency medicine. J Emerg Med. 2011;40(6):623-628.Google Scholar
16. Andersson Hagiwara, M, Nilsson, L, Strömsöe, A, Axelsson, C, Kängström, A, Herlitz, J. Patient safety and patient assessment in prehospital care: a study protocol. Scand J Trauma Resusc Emerg Med. 2016;24(14):1-7.Google Scholar
17. Gustafsson, B, Hermerén, G, Petersson, B. Good Research Practice. Stockholm, Sweden: The Swedish Research Council; 2011.Google Scholar
18. Edwards, MJ, Bassett, G, Sinden, L, Fothergill, RT. Frequent callers to the ambulance service: patient profiling and impact of case management on patient utilization of the ambulance service. Emerg Med J. 2015;32(5):392-396.Google Scholar
19. Knowlton, A, Weir, BW, Hughes, BS, et al. Patient demographic and health factors associated with frequent use of Emergency Medical Services in a Midsized City. Acad Emerg Med. 2013;20(11):1101-1111.Google Scholar
20. Hunt, KA, Weber, EJ, Showstack, JA, Colby, DC, Callaham, ML. Characteristics of frequent users of emergency departments. Ann Emerg Med. 2006;48(1):1-8.Google Scholar
21. Tangherlini, N, Pletcher, MJ, Covec, MA, Brown, JF. Frequent use of Emergency Medical Services by the elderly: a case-control study using paramedic records. Prehosp Disaster Med. 2010;25(3):258-264.CrossRefGoogle ScholarPubMed
22. Weiss, SJ, Ernst, AA, Miller, P, Russell, S. Repeat EMS transports among elderly emergency department patients. Prehosp Emerg Care. 2002;6(1):6-10.Google Scholar
23. Andersson Hagiwara, M, Suserud, B-O, Andersson-Gare, B, Sjoqvist, B, Henricson, M, Jonsson, A. The effect of a Computerized Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study. BMC Med Inform Decis Mak. 2014;14(70):1-9.CrossRefGoogle ScholarPubMed
24. Prekker, ME, Feemster, LC, Hough, CL, et al. The epidemiology and outcome of prehospital respiratory distress. Acad Emerg Med. 2014;21(5):543-550.CrossRefGoogle ScholarPubMed
25. Bigham, BL, Buick, JE, Brooks, SC, Morrison, M, Shojania, KG, Morrison, LJ. Patient safety in Emergency Medical Services: a systematic review of the literature. Prehosp Emerg Care. 2012;16(1):20-35.Google Scholar
26. Calder, L, Forster, A, Nelson, M, et al. Adverse events among patients registered in high-acuity areas of the emergency department: a prospective cohort study. CJEM. 2010;12(5):421-430.CrossRefGoogle ScholarPubMed
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