Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-22T06:32:34.282Z Has data issue: false hasContentIssue false
  • English
  • Français

Unexpected ALS Procedures on Non-Emergency Ambulance Calls: The Value of a Single-Tier System

Published online by Cambridge University Press:  28 June 2012

Bryan Wilson ,
Matthew C. Gratton ,
Jerry Overton  and
William A Watson
Bryan Wilson*
Affiliation:
Department of Emergency Medicine, University of Missouri—Kansas City, Truman Medical Center—West, Kansas City, Mo.
Matthew C. Gratton
Affiliation:
Assistant Professor, Department of Emergency Medicine, University of Missouri—Kansas City, Truman Medical Center—West, Kansas City, Missouri; Medical Director, Metropolitan Ambulance Services Trust, Kansas City, Mo.
Jerry Overton
Affiliation:
Executive Director, Metropolitan Services Trust, Kansas City, Mo.
William A Watson
Affiliation:
Clinical Associate Professor, School of Pharmacy and Department of Emergency Medicine, The University of Missouri—Kansas City, Truman Medical Center, Kansas City
*
Department of Emergency Medicine, The University of Missouri—Kansas City, Truman Medical Center, 2301 Holmes, Kansas City, MO 64108USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

In a single-tier, advanced-life-support (ALS) emergency medical service (EMS) system, ALS-trained staff in ALS-equipped vehicles respond to all ambulance calls. In some two-tier systems, basic life support (BLS) vehicles respond to calls which are determined initially to be non-emergency based on dispatcher triage. I emergency requiring ALS is discovered (or recognized) by BLS personnel, then a subsequent ALS response can be requested.

Purpose:

The purpose of this study was to determine the frequency of ALS care provided on ambulance calls initially dispatched as non-emergency.

Setting:

A single-tier, all-ALS provider, EMS system, serving an urban population of 475,000 with an annual response volume of 45,000 calls.

Methods:

A retrospective review of all prehospital transports initially dispatched as non-emergency from 1 January 1989 to 1 January 1990 that resulted in an ALS intervention being performed was conducted. An ALS intervention was defined as, “administration of a medication, endotracheal intubation, attempted IV insertion, and/or ECG monitoring.”

Results:

A total of 6,362 non-emergency calls were identified; of these 309 (5%) were upgraded to emergency while the responding unit was in route. Of 6,053 non-emergency calls remaining, 710 (11.7%) involved the provision of one or more ALS interventions. Of these, 296 (42%) received an IV, 24 (3%) a medication, and three (0.4%) were intubated. Calls that were upgraded by dispatchers required one or more interventions in 144/309 calls (46.6%). This was statistically significantly different than for the non-upgraded calls.

Conclusion:

Despite the use of strict dispatching protocols, 11.7% of patients prioritized as non-emergent unexpectedly received ALS care after evaluation by ALS personnel. These results add support for the use of a single-tier, ALS ambulance system.

Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 4 , December 1992 , pp. 380 - 382
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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, McCallion, R, Fazackerley, J: Characteristics of midsized urban EMS systems. Ann Emerg Med 1991;19:1469–1470.Google Scholar
2. Stout, J: Ambulance system designs. JEMS 1986;11:85–98.Google Scholar
3. Ornato, J, Racht, E, Fitch, J, Berry, J: The need for ALS in urban and suburban EMS system (Editorial). Ann Emerg Med 1990;19:1469–1470.CrossRefGoogle Scholar
4. Curka, PA, Pepe, PE, Ginger, VF, Sherrard, RC: Computer-aided EMS priority dispatch: Ability of a computerized triage system to safely spare paramedics from responses not requiring advance life support. Ann Emerg Med 1991;20:446.Google Scholar
5. Clawson, J: The Medical Priority Dispatch System, 1986 edition. Medical Priority Consultants, Inc.: Salt Lake City, Utah, 1986.Google Scholar
6. Kallsen, G, Nabors, M: The use of priority medical dispatch to distinguish between high and low risk patients. Ann Emerg Med 1990;19:458–459. Abstract.Google Scholar
7. Slovis, C, Carruth, TB, Seitz, W, et al. : A priority dispatch system for emergency medical services. Ann Emerg Med 1985;14:1055–1060.CrossRefGoogle ScholarPubMed
8. Eisenberg, MS, Horwood, BT, Cummins, RO, et al. : Cardiac arrest and resuscitation: A tale of 29 cities. Ann Emerg Med 1990;19:179–186.Google Scholar