Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-23T10:54:33.707Z Has data issue: false hasContentIssue false
  • English
  • Français

System Implications of the Ambulance Arrival-to-Patient Contact Interval on Response Interval Compliance

Published online by Cambridge University Press:  28 June 2012

Jack P. Campbell ,
Matthew C. Gratton ,
Joseph A. Salomone III ,
Daniel J. Lindholm  and
William A. Watson
Jack P. Campbell*
Affiliation:
Department of Emergency Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Mo. Emergency Medical Services, Health Department, Kansas City, Mo.
Matthew C. Gratton
Affiliation:
Department of Emergency Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Mo.
Joseph A. Salomone III
Affiliation:
Department of Emergency Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Mo.
Daniel J. Lindholm
Affiliation:
Emergency Medical Services, Health Department, Kansas City, Mo.
William A. Watson
Affiliation:
Department of Emergency Medicine, School of Medicine, University of Missouri-Kansas City, Kansas City, Mo. Department of Pharmacy Practice, School of Pharmacy, University of Missouri-Kansas City, Kansas City, Mo.
*
Department of Emergency Medicine, Truman Medical Center, 2301 Holmes Street, Kansas City, MO 64108, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Background: In some emergency medical services (EMS) system designs, response time intervals are mandated with monetary penalties for noncompliance. These times are set with the goal of providing rapid, definitive patient care. The time interval of vehicle at scene-to-patient access (VSPA) has been measured, but its effect on response time interval compliance has not been determined.

Purpose:

To determine the effect of the VSPA interval on the mandated code 1 (<9 min) and code 2 (<13 min) response time interval compliance in an urban, public-utility model system.

Methods:

A prospective, observational study used independent third-party riders to collect the VSPA interval for emergency life-threatening (code 1) and emergency nonlife-threatening (code 2) calls. The VSPA interval was added to the 9-1-1 call-to-dispatch and vehicle dispatch-to-scene intervals to determine the total time interval from call received until paramedic access to the patient (9-1-1 call-to-patient access). Compliance with the man dated response time intervals was determined using the traditional time intervals (9-1-1 call-to-scene) plus the VSPA time intervals (9-1-1 call-to-patient access). Chi-square was used to determine statistical significance.

Results:

Of the 216 observed calls, 198 were matched to the traditional time intervals. Sixty three were code 1, and 135 were code 2. Of the code 1 calls, 90.5% were compliant using 9-1-1 call-to-scene intervals dropping to 63.5% using 9-1-1 call-to-patient access intervals (p<0.0005). Of the code 2 calls, 94.1% were compliant using 9-1-1 call-to-scene intervals. Compliance decreased to 83.7% using 9-1-1 call-to-patient access intervals (p = 0.012).

Conclusion:

The addition of the VSPA interval to the traditional time intervals impacts system response time compliance. Using 9-1-1 call-to-scene compliance as a basis for measuring system performance underestimates the time for the delivery of definitive care. This must be considered when response time interval compliances are defined.

Keywords

definitive careemergency medical servicesHawthorne effect9-1-1 call-to-dispatch intervalresponse time interval compliancesystem performance parameterthird-party observersUtstein modelvehicle at scene-to-patient access intervalvehicle dispatch-to-scene interval
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 9 , Issue 4 , December 1994 , pp. 230 - 232
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Braun, O: EMS system performance: The use of cardiac arrest time liness. Ann Emerg Med 1993;22:52–61.CrossRefGoogle Scholar
2. Spaite, DW, Valenzuela, TD, Meislin, HW, et al. : Prospective validation of a new model for evaluating emergency medical services systems by in-field observation of specific time intervals in prehospital care. Ann Emerg Med 1993;22:638–645.CrossRefGoogle ScholarPubMed
3. Eisenberg, MS, Bergner, L, Hallstrom, A: Cardiac resuscitation in the community: Importance of rapid provision and implications for program planning. JAMA 1979;241:1905–1907.CrossRefGoogle ScholarPubMed
4. Roth, R, Stewart, RD, Rogers, K, Cannon, GM: Out-of-hospital cardiac arrest: Factors associated with survival. Ann Emerg Med 1984;13:237–243.CrossRefGoogle ScholarPubMed
5. Cummins, RO, Eisenberg, MS, Hallstrom, AP, Litwin, PE: Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. Am J Emerg Med 1985;3:114–118.CrossRefGoogle ScholarPubMed
6. Larsen, MP, Eisenberg, MS, Cummins, RO, Hallstrom, AP: Predicting survival from out-of-hospital cardiac arrest: A graphic model. Ann Emerg Med 1993;22:1652–1658.CrossRefGoogle ScholarPubMed
7. Valenzuela, TD, Spaite, DW, Meislin, HW, et al. : Emergency vehicle intervals versus collapse-to-CPR and collapse-to-defibrillation intervals: Monitoring emergency medical services system performance in sudden cardiac arrest. Ann Emerg Med 1993:22:1678–1683.CrossRefGoogle ScholarPubMed
8. Roush, WR, McDowell, RM: Emergency medical services systems. In: Roush, WR (ed), Principles of EMS Systems. Dallas: American College of Emergency Physicians, pp 9–17.Google Scholar
9. Stout, JL: System status management: The strategy of ambulance placement. JEMS 1983;5:22–32.Google Scholar
10. Eisenberg, MS, Horwood, BT, Cummins, RO, et al. : Cardiac arrest and resuscitation: A tale of 29 cities. Ann Emerg Med 1990;19:179–186.CrossRefGoogle ScholarPubMed
11. Campbell, JP, Gratton, MC, Salomone, JA III, Watson, WA: Ambulance arrival to patient contact: The hidden component of prehospital response time intervals. Ann Emerg Med 1993;22:1254–1257.CrossRefGoogle ScholarPubMed
12. Clawson, J: The Medical Dispatch Card Priority System. Salt Lake City, Utah: Medical Priority Consultants, Inc., 1988.Google Scholar
13. Campbell, JP, Gratton, MC, Salomone, JA III, Watson, WA: Time-to-patient interval: The hidden component of response time. Ann Emerg Med 1992:21:643. (Abstract.)Google Scholar
14. Cummins, RO, Chamberlain, DA, Abramson, NS, et al. : Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: The Utstein style. Ann Emerg Med 1991:20:861–874.Google ScholarPubMed
15. Becker, LB, Pepe, PE: Ensuring the effectiveness of community-wide emergency cardiac care. Ann Emerg Med 1993:22:354–365.CrossRefGoogle ScholarPubMed
16. Campbell, JP, Gratton, MC, Girkin, J, Watson, WA: Vehicle at scene to patient access interval measured with computer-aided dispatch. Presented at the 1994 ACEP Research Forum, San Diego, California 20 March 1994. (Abstract.)Google Scholar