SEARCH · PubMed Health

Results for “Emergency Medical Service Communication Systems”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources

PubMed1995

The role of protocols and professional judgement in emergency medical dispatching.

The task of evaluating incoming calls to Emergency Medical Services (EMS) systems in order to determine the most appropriate response is performed in many different ways in current EMS systems. At one end of the spectrum, the process is entirely dependent on the judgement of professionals, while at the other end protocols specify the exact questions to be asked and corresponding decisions. This case study describes the experience of the Montreal EMS system, Urgences santé, where professional telephone evaluation performed by nurses since 1981 was replaced by a protocolized system in 1992. During the professional era, there were many attempts to formalize the nurses' decision-making process. These first revealed that professional judgement tended to override decision-support tools that did not allow a flexible processing of the information spontaneously provided by callers. Second, the choice of a single protocol for each call was unnatural for professionals who could spontaneously integrate multiple aspects of a problem in parallel. Third, when protocols were used by professionals, it was a posteriori in order to document their decisions rather than actually support them. Fourth, the use of Artificial Intelligence (AI) methods in order to formalize professional judgement revealed its great complexity, which was confirmed by cognitive analyses of the nurses' decision-making processes. In particular, decisions of not sending EMS resources seemed to be the most difficult. These unsuccessful attempts at formalizing professional judgement led to an evaluation of its performance in terms of results, i.e. to which extent actual decisions minimized errors (both false positives and false negatives) and decision times. A random sample of 1006 calls was collected and the ideal decision was determined by concensus of experts for each call based on the patient's clinical condition. This theoretical decision was considered as a goal standard to which actual decisions were compared. Data analysis revealed that sensitivity of telephone triage (i.e. decision to send EMS resources or not) was almost perfect and specificity was 0.55. The necessary compromise between sensitivity and specificity varied with the types of decisions. Decision times were related to the urgency of the situations, more urgent calls being processed more rapidly. These results were interpreted as representing sophisticated optimization processes in professional judgement. The professional system was replaced by a non-professional protocolized system in 1992. This new system has not yet been formally evaluated in terms of results, but many sources of evidence suggest that it was accompanied by a deterioration of performance. Many contextual factors influence the organization of telephone assessment in EMS systems. This case study suggests that professional judgement may be most useful in contexts where the demand for EMS services often exceeds the availability of resources. On the other hand, protocolized systems may be more appropriate in the absence of such constraints, and where the litigation context prohibits the occurrence of any false negative.

Artificial Intelligence↗

PubMed1980

Involving and educating base station physicians in paramedic programs.

There is often misunderstanding and conflict between the emergency physician and paramedic team, particularly as a new system is being implemented. This paper outlines a four-pronged approach to reduce this conflict: 1) community physician involvement in protocol development by means of a Paramedic Policy and Procedures Committee; 2) clinical training of paramedics in community hospitals; 3) involvement of community physicians in primary training and by riding rescue squads; and 4) formulation of a base station physician course to familiarize physicians with radio technique, system operation, and paramedic field work. An outline of the base station physician course is given and discussed. The reactions and outcome of the course and the positive changes it made in both physician and paramedic attitudes are discussed.

Allied Health Personnel↗

PubMed2001

GPS computer navigators to shorten EMS response and transport times.

GPS (global positioning satellite system to determine one's position on earth) units have become inexpensive and compact. The purpose of this study is to assess the effectiveness of a GPS enhanced computer street map navigator to improve the ability of EMS drivers in an urban setting to locate their destination and shorten response times. For part I, residential addresses in the city were randomly selected from a telephone directory. Two driver/navigator teams were assigned to drive to the address adhering to speed limits. One team used a standard street map, whereas the other team used a GPS computer navigator. The travel time and distance of the runs were compared. For part II, the computer GPS navigator was placed on an ambulance to supplement their normal methods of navigation to find the address requesting EMS. After the run was completed, EMS providers were interviewed to determine their opinion of whether the GPS navigator was helpful. For part I the results showed that in the 29 initial test runs, comparing the GPS team versus the standard map team, the mean distances traveled were 8.7 versus 9.0 kilometers (not significant) and the mean travel times were 13.5 versus 14.6 minutes (P=.02), respectively. The GPS team arrived faster in 72% runs. For part II the results showed that most EMS providers surveyed noted that the GPS computer navigator enhanced their ability to find the destination and all EMS providers acknowledged that it would enhance their ability to find a destination in an area in which they were unfamiliar. These results suggest that a portable GPS computer navigator system is helpful and can enhance the ability of prehospital care providers to locate their destination. Because these units are accurate and inexpensive, GPS computer navigators may be a valuable tool in reducing pre-hospital transport times.

Ambulances↗

PubMed1991

[Outpatient emergency services].

Emergency is felt very differently according to the level of education, and the sensitivity of the patient and his family circle. Pain is often the alarm but a physician only is able to appreciate the seriousness and the development of a seriously threatening emergency, which slowly evolves in their beginning but becomes degraded afterwards. The only victims who are operated on the first hour, the golden hour, take chance to survive. But there are only 2 or 3 golden minutes to rescue a cardiac arrest. Quicker an effective treatment is done, better the results are. If time is lost, a tissular hypoxia settle and lead to multiple organ failure especially in the brain. Then the dead come in more or less longer time whatever it is done: it's the irreversible shock which drive to the brain death. In the beginning the only patient and his family circle are able to do something. From that you can understand the importance of public education and alert organization for getting suited and early aid. The attending physician have to educate his patients as they are able to recognize the signs of a real seriousness. Telephone play an essential role especially because the dial 15 for health free call is now put in service in France. The phone questioning allows medical regulation of "SAMU-15" (EMS-dial 15 Centre) to dismiss most of the ill-founded calls and to carry the patient in an hospital able to immediately treat him efficiently. The emergencies organization is inspired by two principles: 1. without any loss of time all patient shall fully treated, possibly on the spot. 2. effective intensive care shall be done to avoid tissular hypoxia. Hence the rescue medicalization and the emergency medical system. These principles are the basis of organization of french SAMU whom control role is also to inform the receiving hospital for preparing the reception. The 6.1.1986 french law had defined the emergency medical system, legalizing the SAMU, and fixing their role in connection with policy and firemen. The equipment of ambulances is well standardized and they should radio connected with SAMU. Helicopters may give inestimable service to carry patients in well equipped center as U.S. trauma centres. Small hospitals should only treat small emergency according their means in personnel and equipment.

Emergencies↗

PubMed2005

London bombings July 2005: the immediate pre-hospital medical response.

On July 7th 2005 a series of terrorist bombs exploded in London. The transport system was targeted and at least 54 passengers were killed and around 700 injured. This paper describes the immediate pre-hospital medical response to the four scenes. From the perspective of the London Helicopter Emergency Medical Service the deployment, difficulties on scene and the initial lessons learned are discussed.

Blast Injuries↗

PubMed2002

Case study: ED acts quickly after anthrax.

After last year's anthrax attacks, EDs at Capital Health System in Trenton, NJ, had to address decontamination of large numbers of patients. Patients who didn't require decontamination were sent to the hospital's employee health facility so they could bypass the ED. Clinicians, nursing staff, educators, and paramedics were trained in the decontamination process. Direct communication with first responders was established with a portable scanner.

Anthrax↗

PubMed1994

The role of the dispatch centre in preclinical emergency medicine.

Failure to recognise the importance of the dispatch centre in emergency medical services (EMS) limits standards and procedures in prehospital emergency medicine. The dispatch centre should be identified as the point of leadership and management of the entire system. Measures for quality control and quality assurance should be an integral part of EMS administration. Minimum requirements for equipment and personnel depend on EMS structure and on geographic and epidemiological factors. Clearly defined algorithms for decision-making and computer-assisted dispatching can increase efficiency and reduce costs.

Decision Making↗

PubMed2001

Action sequence for layperson cardiopulmonary resuscitation.

Although some minor modifications were forged, the general consensus was to maintain most of the current guidelines for phone first/phone fast, no-assisted-ventilation CPR, the A-B-C (vs C-A-B) sequence of CPR, and the recovery position. The decisions to leave these guidelines as they are were based on a lack of evidence to justify the proposed changes, coupled with a reluctance to make revisions that would require major changes in worldwide educational practices without such evidence.Nonetheless, some major changes were made. The time-honored procedure ol pulse check by lay rescuers was eliminated altogether and replaced with an assessment for other signs of circulation. Likewise, it was recommended that even the professional rescuer now check for these other signs of circulation. Although professional rescuers may simultaneously check for a pulse, they should do so only for a short period of time (within 10 seconds). There was also enthusiasm for deleting the ventilation aspect of EMS dispatcher-assisted CPR instructions that are provided to rescuers at the scene who are inexperienced in CPR. lt was made clear, though, that the data are applicable only to adult patients who are receiving CPR and that the data are appropriate most for EMS systems with rapid response times.

Adult↗

PubMed2006

Emergency medical service systems in Japan: past, present, and future.

Emergency medical services are provided by the fire defence headquarters of the local government in Japan. There is a one-tiered EMS system. Ambulances are staffed by three crew members trained in rescue, stabilisation, transport, and advanced care of traumatic and medical emergencies. There are three levels of care provided by ambulance personnel including a basic-level ambulance crew (First Aid Class One, FAC-1), a second level (Standard First Aid Class, SFAC), and the highest level (Emergency Life Saving Technician, ELST). ELSTs are trained in all aspects of BLS and some ALS procedures relevant to pre-hospital emergency care. Further development of an effective medical control system is imperative as the activities of ambulance crews become more sophisticated. A marked recent increase in the volume of emergency calls is another issue of concern. Currently, private services for transportation of non-acute or minor injury/illness have been introduced in some areas, and dispatch protocols to triage 119 calls are being developed.

Advanced Cardiac Life Support↗

PubMed1994

Increasing the efficiency of emergency medical services by using criteria based dispatch.

STUDY OBJECTIVES: To determine whether criteria based dispatch (CBD) improved the efficiency of the emergency medical services system. DESIGN: A before and after design was used to measure effects of CBD. Data were reviewed from medical reports from January 1986 through June 1992. SETTING: King County, Washington, excluding the city of Seattle. PARTICIPANTS: Residents who called 911 to report a medical emergency. INTERVENTIONS: Emergency medical dispatching (EMD), basic life support (BLS), and advanced life support (ALS). RESULTS: Findings show a decrease in ALS responses for two tracer conditions that medical control physicians determined not require ALS intervention. The percentage of febrile seizures in which paramedics responded decreased from 41% to 21% (P < .001). The percentage of cerebrovascular accidents in which paramedics responded decreased from 41% to 28% (P < .001). CBD led to a decrease, from 4.7% to 3.8% (P < .001), in frequency of requests by BLS units for dispatch of ALS units. There was no increase in the time required to dispatch each call. CONCLUSION: CBD increased the efficiency of the EMS system by significantly reducing ALS responses to incidents not requiring ALS intervention and reducing requests by BLS units for dispatch of ALS units while maintaining a consistent time from receipt of call to dispatch.

Cerebrovascular Disorders↗

PubMed2005

Prehospital care of the acute stroke patient.

Emergency medical services (EMS) is the first medical contact for most acute stroke patients, thereby playing a pivotal role in the identification and treatment of acute cerebrovascular brain injury. The benefit of thrombolysis and interventional therapies for acute ischemic stroke is highly time dependent, making rapid and effective EMS response of critical importance. In addition, the general public has suboptimal knowledge about stroke warning signs and the importance of activating the EMS system. In the past, the ability of EMS dispatchers to recognize stroke calls has been documented to be poor. Reliable stroke identification in the field enables appropriate treatment to be initiated in the field and potentially inappropriate treatment avoided; the receiving hospital to be prenotified of a stroke patient's imminent arrival, rapid transport to be initiated; and stroke patients to be diverted to stroke-capable receiving hospitals. In this article we discuss research studies and educational programs aimed at improving stroke recognition by EMS dispatchers, prehospital personnel, and emergency department (ED) physicians and how this has impacted stroke treatment. In addition public educational programs and importance of community awareness of stroke symptoms will be discussed. For example, general public's utilization of 911 system for stroke victims has been limited in the past. However, it has been repeatedly shown that utilization of the 911 system is associated with accelerated arrival times to the ED, crucial to timely treatment of stroke patients. Finally, improved stroke recognition in the field has led investigators to study in the field treatment of stroke patients with neuroprotective agents. The potential impact of this on future of stroke treatment will be discussed.

Emergency Medical Service Communication Systems↗

PubMed1990

The impact of the M1 air crash on the radiological services at the Queen's Medical Centre, Nottingham.

Following the M1 air crash on 8 January 1989, 39 casualties were taken to the Queen's Medical Centre, Nottingham. A team of 31 radiographers and four radiologists used all five X-ray rooms adjacent to the Accident and Emergency Department. Patients with head and spinal injuries were further assessed in the CT suite by four radiographers and a neuroradiologist. The volume of work in the first few hours and in the subsequent days is described. All radiological examinations have been reviewed and the injuries, including those missed at initial assessment, are discussed. The role of the radiologists was to issue immediate reports, manage examinations so as to minimize any delay and assess the need for further specialized investigation. Important problems were identified, specifically: the call-out system; patient deterioration and lack of resuscitation equipment; patient flow; documentation; radiology equipment; and missed injuries. These problems are discussed and recommendations are made for X-ray Departments in dealing with disasters.

Accidents, Aviation↗

PubMed2003

Trauma care systems in Italy.

In this article we analyse the Italian Trauma System, stressing what has been modified over the last decade, in order to provide a more adequate and safe pre-hospital care, as well as a more efficient in-hospital treatment. We describe how the 118 operative exchange is organised, the most important educational courses for the health personnel and the new emergency/urgency structures called DEA.

Ambulances↗

PubMed2005

RealityFlythrough: enhancing situational awareness for medical response to disasters using ubiquitous video.

The first moments at a disaster scene are chaotic. The command center initially operates with little knowledge of hazards, geography and casualties, building up knowledge of the event slowly as information trickles in by voice radio channels. RealityFlythrough is a tele-presence system that stitches together live video feeds in real-time, using the principle of visual closure, to give command center personnel the illusion of being able to explore the scene interactively by moving smoothly between the video feeds. Using RealityFlythrough, medical, fire, law enforcement, hazardous materials, and engineering experts may be able to achieve situational awareness earlier, and better manage scarce resources. The RealityFlythrough system is composed of camera units with off-the-shelf GPS and orientation systems and a server/viewing station that offers access to images collected by the camera units in real time by position/orientation. In initial field testing using an experimental mesh 802.11 wireless network, two camera unit operators were able to create an interactive image of a simulated disaster scene in about five minutes.

Disaster Planning↗

PubMed2003

Clinical evaluation of the Emergency Medical Services (EMS) ambulance dispatch-based syndromic surveillance system, New York City.

Since 1998, the New York City Department of Health has used New York City Emergency Medical Services (EMS) ambulance dispatch data to monitor for a communitywide rise in influenzalike illness (ILI) as an early detection system for bioterrorism. A clinical validation study was conducted during peak influenza season at six New York City emergency departments (EDs) to compare patients with ILI brought in by ambulance with other patients to examine potential biases associated with ambulance dispatch-based surveillance. We also examined the utility of 4 EMS call types (selected from 52) for case detection of ILI. Clinical ILI was defined as fever (temperature higher than 100 degrees F) on history or exam, along with either cough or sore throat. Of the 2,294 ED visits reviewed, 522 patients (23%) met the case definition for ILI, 64 (12%) of whom arrived by ambulance. Patients with ILI brought in by ambulance were older, complained of more severe symptoms, and were more likely to undergo diagnostic testing, be diagnosed with pneumonia, and be admitted to the hospital than patients who arrived by other means. The median duration of symptoms prior to presenting to the ED, however, was the same for both groups (48 hours). The selected call types had a sensitivity of 58% for clinical ILI, and a predictive value positive of 22%. Individuals with symptoms consistent with the prodrome of inhalational anthrax were likely to utilize the EMS system and usually did so early in the course of illness. While EMS-based surveillance is more sensitive for severe illness and for illness affecting older individuals, there is not necessarily a loss of timeliness associated with EMS-based (versus ED-based) surveillance.

Adolescent↗

PubMed2002

200 city survey. JEMS 2001 annual report on EMS operational & clinical trends in large, urban areas.

This year's survey offered examples of evolving partnerships between the public and EMS providers with a growing number of systems implementing PAD programs. The apparent influence of a communication center's managing agency on prioritization strategies is concerning. However, further study is needed. EMS managers must pay careful attention to comm center practices and technology to ensure their ability to support response prioritization and the efficient management of EMS resources. The small reduction in the use of hot response (lights and siren) to every request for service is disappointing in light of medical literature and position statements that condemn this practice. Resource response can be safely prioritized using today's EMD protocol systems. Prioritization and changing response [figure: see text] time requirements to address impending revenue and service demand changes will require additional standardization of methodologies and reporting of response times to relate this measure to other system performance indicators (e.g., patient morbidity/mortality, cost, customer satisfaction, etc.). The future presents a difficult road for system administrators. However, the adoption of a growing number of information-management tools and changes in procedures and dispatch processes offer potential solutions. The increased use of hand-held computers or personal digital assistant (PDAs) to gather and provide information and the almost universal use of CAD will aid providers in performing the research necessary to change response time performance requirements, improving EMS system efficiency. Use of this technology will also likely improve patient care and reimbursement through more timely and accurate reporting and analysis. The medical director's role will be critical to ensuring potential changes don't compromise patient care. Obtaining a better understanding of how much time can safely elapse between the time of the 9-1-1 call and when patient-care activities commence will be an important component of future strategies. More sophisticated EMD, CAD and AVL technologies will also play an indispensable role in reforming system design and daily operations. In light of the events of Sept. 11 and events yet to occur, EMS managers and providers face significant operational challenges. Overcoming these challenges will require leadership, a willingness to question and change tradition and the ability to cope with the discomfort of changing demands and uncertainty. Maintaining the hard-fought successes of EMS will increasingly require more imagination and the willingness of current and future practitioners to study, develop and implement innovative approaches to addressing future requirements.

Advanced Cardiac Life Support↗

PubMed1990

Cellular communication.

Generally, cellular-telephone communications seem to be a valuable means for the public to communicate that an accident has occurred on highways in metropolitan areas. Response time is reduced and congestion quickly relieved. This system could be improved by making a provision in emergency call boxes for the separation of vehicle problems from true emergency calls to ensure the proper response priority. Cellular-telephone communications are a valuable adjunct to EMS radio communications for biotelemetry, when channels are overcrowded or communications are needed in a "dead" area. A system of dedicated hospital-emergency-department lines and telephone numbers is needed. Cellular telephones shouldn't be used as a primary means of providing medical control. Advance planning should be undertaken to ensure immediate access to hospital emergency departments if cellular is used for secondary purposes. The amount of communication traffic at and surrounding a multi-casualty incident or disaster may overwhelm a local cell. Priority numbers providing immediate access and bumping of non-emergency calls for emergency responders are needed. All means of communication should be coordinated by an EMS communications MCI or disaster plan.

California↗

PubMed1979

Self-administered analgesia with nitrous oxide. Adjunctive aid for emergency medical care systems.

Analgesia with a mixture containing 50% nitrous oxide and 50% oxygen (Nitronox) was evaluated in 47 patients with abdominal pain, chest pain, musculoskeletal trauma, and burns. Of these, 93.6% experienced either partial or complete relief of pain. There were no complications attributed to its application; the short duration of action makes its use suitable during emergency transportation.

Adolescent↗