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At least 19 recordsLinked to original sources

PubMed2003

Computer assisted assessment and advice for "non-serious" 999 ambulance service callers: the potential impact on ambulance despatch.

OBJECTIVE: To investigate the potential impact for ambulance services of telephone assessment and triage for callers who present with non-serious problems (Category C calls) as classified by ambulance service call takers. DESIGN: Pragmatic controlled trial. Calls identified using priority dispatch protocols as non-serious were allocated to intervention and control groups according to time of call. Ambulance dispatch occurred according to existing procedures. During intervention sessions, nurses or paramedics within the control room used a computerised decision support system to provide telephone assessment, triage and, if appropriate, offer advice to permit estimation of the potential impact on ambulance dispatch. SETTING: Ambulance services in London and the West Midlands. SUBJECTS: Patients for whom emergency calls were made to the ambulance services between April 1998 and May 1999 during four hour sessions sampled across all days of the week between 0700 and 2300. MAIN OUTCOME MEASURES: Triage decision, ambulance cancellation, attendance at an emergency department. RESULTS: In total, there were 635 intervention calls and 611 controls. Of those in the intervention group, 330 (52.0%) were triaged as not requiring an emergency ambulance, and 119 (36.6%) of these did not attend an emergency department. This compares with 55 (18.1%) of those triaged by a nurse or paramedic as requiring an ambulance (odds ratio 2.62; 95% CI 1.78 to 3.85). Patients triaged as not requiring an emergency ambulance were less likely to be admitted to an inpatient bed (odds ratio 0.55; 95% CI 0.33 to 0.93), but even so 30 (9.2%) were admitted. Nurses were more likely than paramedics to triage calls into the groups classified as not requiring an ambulance. After controlling for age, case mix, time of day, day of week, season, and ambulance service, the results of a logistic regression analysis revealed that this difference was significant with an odds ratio for nurses:paramedics of 1.28 (95% CI 1.12 to 1.47). CONCLUSIONS: The findings indicate that telephone assessment of Category C calls identifies patients who are less likely to require emergency department care and that this could have a significant impact on emergency ambulance dispatch rates. Nurses were more likely than paramedics to assess calls as requiring an alternative response to emergency ambulance despatch, but the extent to which this relates to aspects of training and professional perspective is unclear. However, consideration should be given to the acceptability, reliability, and cost consequences of this intervention before it can be recommended for full evaluation.

Adolescent↗

PubMed1991

Effect of the Cornwall Helicopter Ambulance on ambulance service emergency response time.

OBJECTIVE: To determine whether availability of the Cornwall Helicopter Ambulance enabled the ambulance service to arrive more rapidly at the scene of emergencies. DESIGN: Retrospectively collected ambulance service data analyzed longitudinally. SETTING: The ambulance service in Cornwall. SUBJECTS: Patients carried as emergencies by the ambulance service. VARIABLE STUDIED: Augmentation of a county ambulance service by a Helicopter Ambulance. OUTCOME MEASURE: Ambulance 'response times'. RESULTS: A small improvement in the ambulance service's overall ability to respond to emergency calls was observed. CONCLUSION: Availability of the Helicopter Ambulance marginally improved the ambulance service's response times. It is doubtful if these improved response times were of any clinical significance. More conventional and less expensive means of improving ambulance service performance should be considered by a Health Authority or ambulance service before a helicopter ambulance is deployed.

Aircraft↗

PubMed1992

The effect of the Cornwall and Isles of Scilly helicopter ambulance unit on the ambulance services' ability to deliver acutely traumatized patients to hospital.

OBJECTIVE: to determine whether the use of a helicopter ambulance unit enabled an ambulance service to deliver acutely traumatized patients to hospital more quickly. DESIGN: retrospectively collected ambulance service and hospital records data analysed longitudinally. SETTINGS: The ambulance service and the major casualty department in Cornwall. INTERVENTION: the provision of a helicopter ambulance unit to a county ambulance service. SUBJECTS: patients with compound lower limb fractures carried as emergencies by an ambulance service. Principle outcome measure: ambulance 'mission times'. RESULTS: the ambulance services' ability to deliver emergency patients to hospital more quickly when the helicopter unit was available was not demonstrated. In some instances availability of the helicopter unit probably delayed the timely delivery of emergency patients to the casualty department. CONCLUSION: until a more effective helicopter deployment strategy is in operation it is unlikely that mission time savings will occur.

Aircraft↗

PubMed1983

[Ambulance system. Ambulance Committee identifies with an ambulance law].

Explore the source record for details and available documents.

Ambulances↗

PubMed2002

Medicare program; fee schedule for payment of ambulance services and revisions to the physician certification requirements for coverage of nonemergency ambulance services. Final rule with comment period.

This final rule establishes a fee schedule for the payment of ambulance services under the Medicare program, implementing section 1834(l) of the Social Security Act. As required by that section, the proposed rule on which this final fee schedule for ambulance services is based was the product of a negotiated rulemaking process that was carried out consistent with the Federal Advisory Committee Act and the Negotiated Rulemaking Act of 1990. The fee schedule described in this final rule will replace the current retrospective reasonable cost payment system for providers and the reasonable charge system for suppliers of ambulance services. In addition, this final rule requires that ambulance suppliers accept Medicare assignment; codifies the establishment of new Health Care Common Procedure Coding System (HCPCS) codes to be reported on claims for ambulance services; establishes increased payment under the fee schedule for ambulance services furnished in rural areas based on the location of the beneficiary at the time the beneficiary is placed on board the ambulance; and revises the certification requirements for coverage of nonemergency ambulance services.

Ambulances↗

PubMed1999

Costing of an ambulance system in a developing country, Turkey: costs of Ankara Emergency Aid and Rescue Services' (EARS) ambulance system.

The purposes of the study were to determine the total cost of Ankara Emergency Aid and Rescue Services (EARS), to calculate the cost of a single ambulance response and the cost per patient responded to. A descriptive study was planned to find out the cost of Ankara EARS, conducted between 1 October 1995 and 30 September 1996. The main variables of the study were the capital and recurrent costs of the system. The data relating to the costs were obtained from financial registries of various health institutes and personnel working in the system. The data was collected by two of the researchers. The total and average costs--cost per one ambulance run and cost per one patient--were determined. The total cost of Ankara EARS ambulance system in the period between 1 October 1995 and 30 September 1996 was US$918,877.90. The total capital costs of Ankara EARS was US$85,171.10 (9.3% of the total cost). The total recurrent costs of Ankara EARS was US$833,706.80 (90.7% of the total cost). The cost per one ambulance run was US$163.00. On the other hand the cost per patient or injured person was US$180.50. In Ankara, Turkey, the costs of such ambulance services could not be afforded by the private sector. The ambulance service activities should continue to be a part of primary health care services and the Ministry of Health should continue to serve in this field.

Accidents, Traffic↗

PubMed2001

Ambulance times of Ankara emergency aid and rescue services' ambulance system.

The aim of this study was to determine various times related to the ambulance activities of Ankara Emergency Aid and Rescue Services (EARS) and if necessary contribute to the improvement of them. A descriptive study was planned to determine various times related to the ambulance activities of Ankara EARS. The data was collected by one of the researchers. The study was conducted between 1 October 1995 and 30 September 1996. The variables of the study were: delay time, response time, time at the scene (scene time), round trip time, transport time and total run time of Ankara EARS ambulance activities. Ankara EARS Emergency Call Registry Forms (5638 forms) were evaluated for the above stated variables. The computer program EPI-INFO 5.0 was used in the study. The median response time of Ankara EARS was found to be 9 minutes. In the research year, the median delay time was 2 minutes. Median arrival to patient contact time of Ankara EARS was 2 minutes. Median time at the scene was 7 minutes. Median round trip time of the system was 44 minutes. The median time to arrive at the scene from the ambulance station was 8 minutes. The median transport time was 10 minutes. The median total run time was 30 minutes. As the median response time was found to be 9 minutes it is concluded that there should be more ambulance vehicles to improve this time of Ankara EARS. Due to financial problems, times were recorded manually by the ambulance crew and dispatchers of Ankara EARS. If digital and electronic recording systems are used, these times might be more precise.

Ambulances↗

PubMed1975

Follow-up of emergency ambulance calls in Nottingham: implications for coronary ambulance servie.

Information about patients in ambulance service records has been linked to that in the patients' hospital records in an attempt to make the most efficient use of a special ambulance service for patients suspected of having heart attacks. During one week 248 emergency (999) calls for an ambulance were made by the public in the city of Nottingham. The quality of information given to the ambulance centre was poor, and all four patients eventually found to have had a myocardial infarction were described as having collapsed. A further study of patients who were also described as having collapsed has led to a system which allows an ambulance controller to send a "coronary ambulance" only in answer to those emergency calls where there is a reasonable possibility that the patient has had a heart attack.

Ambulances↗

PubMed1976

The Brighton resuscitation ambulances: a continuing experiment in prehospital care by ambulance staff.

Two ambulances from the existing fleet in Brighton and one in Hove are equipped with portable defibrillator-oscilloscope units. Selected attendants have been trained not only to defibrillate patients but also to perform endotracheal intubation and administer intravenous atropine and lignocaine for carefully defined indications. In the two years up to December 1975 the ambulances responded to 2253 calls which were considered possible emergencies. Retrospective analysis showed that half of these had been for patients with myocardial infarction, coronary insufficiency, or angina. The ambulances took a median time of five minutes to reach a patient. Attempts at resuscitation were made in 207 patients with circulatory arrest, of whom 160 had ventricular fibrillation. Coordinated rhythm was restored at least transiently in 66 patients, and 27 of them survived to leave hospital. Sixteen of the survivors had been in ventricular fibrillation before the arrival of the ambulance. The delay before admission to hospital was reduced: over 50% of patients carried in the ambulances were admitted within two hours of the onset of major symptoms. No extra ambulance staff have been employed for the scheme. The increased load on hospital services has been limited by encouraging a rational admission policy and also by early discharge.

Ambulances↗

PubMed1990

Variations in the provision of extended-trained ambulance personnel within the Welsh ambulance services.

This paper describes the distribution of extended-trained ambulance personnel within the nine Welsh Ambulance Services. While over a quarter of all emergency ambulance crews possess some extended skills, there is a wide variation in their distribution and protocols of treatment. Increasing numbers of ambulance personnel will receive such training in the future, leading to improved standards of pre-hospital care. To justify the use of such skills in terms of clinical outcome and expenditure, the ambulance services must provide accurate data to allow subsequent audit of pre-hospital clinical practice. It is therefore essential that the medical profession becomes aware of these developments and participates in advising, assessing and training extended-trained ambulance personnel.

Ambulances↗

PubMed1992

[Ambulance services in Copenhagen, Odense and Ringkøbing County. Results from the spot test conducted by the Ministry of Health and the County Councils Association in 1990. 2. Treatment by ambulance staff, medical support and pattern of diagnoses].

In this investigation, the results from a spot test investigation comprising 3182 emergency ambulance services (AU) from three geographical regions with different degrees of urbanization are presented: The Danish capital (Municipality of Copenhagen), a large provincial town (Odense) and a rural district with smaller towns (the County of Ringkøbing). The conditions of the patients were assessed by the ambulance staff: 7-12% of the patients transported had visible haemorrhage, 5-8% were unconscious, 4-7% were cyanotic, 2-3% had seizures and 1-2% had pareses. The serious cases tended to be most frequent in the least urbanized regions. Registration of the therapeutic efforts by the ambulance staff prior to and during transport revealed that 15-33% of the patients did not receive any treatment. The commonest forms of treatment consisted of oxygen treatment (13-18%), treatment for shock (8-12%), Nato position (4-16%) and stopping of haemorrhage (7-12%). No differences were observed between the three geographic regions except that fewer patients in the capital received treatment. In cases of emergency ambulance services employing signals, medical support was available in 22% of the cases in Copenhagen, mainly by means of medically staffed ambulances. In the County of Ringkøbing, doctors, usually the doctor-on-call, participated in 27% of these services while medical support was only available in 2% of the cases in Odense. Registration of the diagnoses by the hospitals which received the patients revealed that the commonest group of diagnoses were injuries (36-44%) and cardiovascular disease (14-21%).(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulances↗

PubMed1989

[Requests for ambulances for patients with acute diseases and injuries. Are ambulance services abused?].

The aim of this study was to describe the dispatch of emergency ambulance requests in Trondheim and to evaluate the medical justification of such ambulance missions. Data concerning 555 emergency ambulance missions were recorded from March to August 1986. A review of the cases shows that almost 40 per cent were unjustified. However, whether the ambulance missions were justified or not was significantly connected to the age of the patient and with the person requesting the ambulance. Missions requested by health care professionals and missions to elderly patients were the most justified ones. Furthermore, the mission was more justified in the case of internal medical problems than for surgical cases and trauma. We also discuss different ways of improving the use made of emergency medical services outside hospital.

Ambulances↗

PubMed1984

Ambulance utilization in Sweden: analysis of emergency ambulance missions in urban and rural areas.

Data concerning ambulance utilization in a rural and an urban region were registered in a computer. In both regions approximately 30% of missions were emergencies. In the urban area, 20% of the emergency missions were due to trauma, compared with 10% in the rural area (P less than .01). The major symptoms were unconsciousness (34%) and shortness of breath (24%) in the rural region, while in the urban region pain (32%) was the dominating symptom. The response time in emergency missions, used as a measure of the service level of the emergency medical system, was shorter in the urban area than in the rural area (P less than .01): less than 15 minutes in 93% of emergencies in the urban area (mean time, 8.1 minutes) and in 78% of emergencies in the rural area (mean time, 10.2 minutes). Ambulance utilization was higher (P less than .01) in the urban region (0.37 missions/ambulance/hour) than in the rural region (0.22 missions/ambulance/hour). The study indicates that there are great differences between urban and rural areas with respect to the incidence and character of ambulance missions. This difference must be considered when analyzing the cost effectiveness of emergency medical services.

Ambulances↗

PubMed1995

Ambulance despatchers' estimation of intensity of pain and presence of associated symptoms in relation to outcome in patients who call for an ambulance because of acute chest pain.

BACKGROUND: A large number of patients who call for an ambulance because of acute chest pain have an acute ischaemic event, but some do not. AIM. To relate the ambulance despatcher's estimated severity of pain and presence of associated symptoms, in patients who call for an ambulance because of acute chest pain, to whether they develop acute myocardial infarction (AMI) and to the risk of early death. PATIENTS: All those with acute chest pain who contacted the despatch centre in Göteborg over a 2-month period. RESULTS: In all, 503 patients fulfilled the inclusion criteria. Patients judged as having severe chest pain (68%) developed AMI during the first 3 days in hospital on 26% of occasions as compared with 13% among patients judged as having only vague chest pain (P = 0.0004). The difference was less marked among the elderly and women. The presence of any of the following associated symptoms, dyspnoea, nausea, vertigo, cold sweat or syncope, tended to be associated with a higher infarction rate (24%) than if none of these symptoms was present (17%, P = 0.06). Mortality during the pre-hospital and the hospital phase was not associated with the estimated severity of pain or the presence of associated symptoms. CONCLUSIONS: The despatcher's estimation of the severity of pain and the presence of associated symptoms appears to be associated with the development of AMI but not with early mortality.

Adolescent↗

PubMed1990

The use and abuse of the emergency ambulance service: some of the factors affecting the decision whether to call an emergency ambulance.

Over a 1-month period all patients arriving in the accident and emergency department by ambulance following a '999' call were questioned using a standard proforma. They were assessed as to whether their medical condition warranted ambulance transfer. A number of social and practical points were analyzed to see whether they would identify any group of patients who used the emergency service without medical need. Overall 289 patients were questioned. Of these 178 (62%) were considered to have medically warranted an ambulance call whereas 111 (38%) did not. A number of features which were more likely to result in an unjustified call were identified. These would suggest that basic knowledge of first aid by the public is poor and should be improved.

Age Factors↗

PubMed1997

Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 5. Lower extremity blood flow and hyperemic responses to occlusion are augmented by ambulation training.

OBJECTIVE: To test whether 12 weeks of exercise conditioning using functional neuromuscular stimulation (FNS) ambulation alters the resting lower extremity blood flow and hyperemic responses to vascular occlusion in subjects with paraplegia, and to determine whether an association exists between limb flow and lower extremity fat-free mass. DESIGN: Pretest, posttest. SETTING: Academic medical center. PARTICIPANTS: Subjects with chronic neurologically complete paraplegia. INTERVENTION: Thirty-two sessions of microprocessor-controlled ambulation using electrically stimulated contractions of lower extremity muscles and a rolling walker. OUTCOME MEASURES: Subjects underwent quantitative Doppler ultrasound examination of the common femoral artery (CFA) before and after training. End-diastolic arterial images and arterial flow-velocity profiles obtained at rest and after 5 minutes of suprasystolic thigh occlusion were computer-digitized for analysis of heart rate (HR), CFA peak systolic velocity (PSV), CFA cross-sectional area (CSA), flow velocity integral (FVI), pulse volume (PV), and CFA (arterial) inflow volume (AIV). RESULTS: Significant effects of training on CSA (p < .0001), FVI (p < .05), computed PV (p < .001), and computed AIV (p < .01) were observed. Resting HR was lower following training (p < .05). The change for resting PSV approached but did not reach significance (p = .083). Analysis of postocclusion PV and AIV showed significant effects for conditioning status (p values < .01), postcompression time (p values < .0001), and their interaction (p values < .01). At 1 minute after occlusion, the posttraining AIV response was 78.2% greater in absolute magnitude and 17.4% more robust when expressed as a percentage change from its resting value than before training. Significant correlations were found between thigh fat free mass and both AIV and PV (p values < .05). CONCLUSION: Exercise training using FNS ambulation increases the resting lower extremity AIV in individuals with paraplegia and augments the hyperemic response to vascular occlusion. Improved posttraining blood flow is attributable both to vascular structural changes and upregulation of vascular flow control mechanisms. Limb mass is associated with the volume of arterial blood flow.

Adult↗

PubMed1997

Effectiveness of ambulance paramedics versus ambulance technicians in managing out of hospital cardiac arrest.

OBJECTIVE: To determine the effectiveness of extended trained ambulance personnel (paramedics) for the management of out of hospital cardiac arrest. METHODS: A retrospective cohort study of patients who suffered a cardiac arrest between 1 January 1992 and 31 July 1994, and who were transported to their local accident and emergency (A&E) department. Data were collected on basic demography, operational time intervals, and ambulance crew status. Further clinical data were collected, and outcome measures included status on arrival at A&E, status on leaving A&E (hospital admission), and status on leaving hospital. The data were analysed using univariate and multivariate techniques. RESULTS: Univariate analysis showed the likelihood of arriving in A&E with a return of spontaneous circulation was more than doubled among patients attended by a paramedic crew compared with those attended by technicians (relative risk = 2.48, 95% confidence interval 1.34 to 4.60). The likelihood of successful hospital admission was also significantly increased (RR = 1.92, 95% CI 1.13 to 3.27); however, beyond this point, further survival benefits appeared to be much smaller. Similar findings were revealed using multivariate analysis. Second level modelling revealed further possible differences between paramedic and technician crews according to type of incident. Patients successfully admitted to hospital who died before discharge remained severely disabled between admission and death. CONCLUSIONS: There are marked short term survival advantages after cardiac arrest associated with paramedic care, but these probably diminish rapidly over time.

Aged↗

PubMed1977

Studies of ambulance patients with ischemic heart disease. 11. Selection of patients for ambulance telemetry.

One hundred eighty-two of 1,928 patients (9.4 per cent) transported by ambulance during a six-month period in Baltimore had ECGs transmitted. Review of the remaining 1,746 records by two cardiologists indicated that an additional 113 patients should have had their ECGs transmitted because of life-threatening conditions. Of patients with acute ischemic heart disease, 47 had ECG monitoring and 24 did not. There were 22 per cent more Killip 111/1V patients with a 19 per cent higher mortality at three months among the "non-transmitted" patients as compared to the "transmitted" patients, controlling for all other relevant variables. Critical presentations inappropriately affect ambulance staffs' selection of patients for monitoring.

Aged↗